Home-Based Palliative Care
Building Operational Excellence
High Impact Practices in Home-Based Palliative Care
Evidence-informed practices in home and community care that result in better care, better outcomes and better value
The CHCA is documenting and disseminating five leading practices that facilitate the building of operational excellence in home-based palliative care in Canada. The interventions were identified at the 2018 Home Care Summit and reviewed for applicability by a panel of home care leaders.
These High Impact Practice initiatives were chosen with the purpose of impacting home-based palliative care and the healthcare by:
Promoting home care that provides evidence-informed service delivery directed toward the achievement of health outcomes in the setting that best support the individual and family.
Enhancing the effectiveness of home care.
Raising the awareness of ways that home care contributes to an effective health care system.
Mitigating rising healthcare costs and accentuate existing resources and expertise.
Enabling sharing and transferring of knowledge, expertise and experience through networking and peer-to-peer learning.
Whole Community Palliative Rounds
An innovative approach to inter-professional care planning and delivery in Interior Health
Whole Community Palliative Rounds is a strategy to enable rapid clinical problem-solving for symptom burden in high-risk individuals, purposeful and timely communication, shared decision-making and collaborative care planning among members of an inter-professional care team. This High Impact Practice showcases how Interior Health in British Columbia has successfully implemented this strategy
High Impact Practice (ENG)
Pratiques Optimales (FR)
Rural Palliative Care In-Home Funding Program–Calgary Zone
A flexible approach to enhancing care for rural patients nearing end of life
While rural Canada makes up 95% of the country’s landmass, it accounts for less than 20% of the population. Home care programs across the country are challenged with providing responsive, high-quality services to individuals residing in rural communities. This High Impact Practice showcases an augmented service model in rural Alberta that is supporting clients nearing end of life to stay at home when desired, while ensuring they receive the required additional care.
High Impact Practice
Pratiques Optimales (FR)
The INSPIRED COPD outreach programTM
An INSPIRED palliative approach to care
Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in Canada and the leading cause of adult emergency department visits and hospitalizations for chronic illness. While COPD cannot be cured, individuals with advanced COPD benefit from an integrated palliative approach to care. This High Impact Practice showcases how the INSPIRED Program was enhanced to provide social supports and advance care planning throughout an individual’s illness trajectory.
High Impact Practice (ENG)
Pratiques Optimales (FR)
Virtual Palliative Care Intervention
Championing virtual care to empower patients and build system capacity
Software applications (apps) are providing health care professionals with opportunities to integrate technology into clinical practice. This Virtual Palliative Care Intervention showcases a pilot study of a model that combines an app for early identification of symptoms with videoconferencing to help support palliative care patients in the community.
Operational Innovations in Home-Based Palliative Care
As part of a pan-Canadian initiative, the CHCA selected organizations who have leading practices in the project four key areas.
The following successful innovations were presented at the 2018 CHCA Home Care Summits.
Advance Care Plans Assessment and Care Planning
Telepalliative Care – Co-designed with the Ontario Telemedicine Network this virtual approach to palliative care supports timely symptom assessment for adults across the region who prefer to receive care in their home.
Integrated Palliative Care Approach in Home Care – The integrated clinical care delivery approach is a shared model integrating the Extra-Mural Program (EMP) and the Residential Hospice (RH) – privately owned and operated by the community hospice association, primary care and other community resources.
Virtual Palliative Care: Right Patient, Right Time, Right Place, Right Care – The RELIEF (Remote self-reporting of symptoms by patients) application allows for patients with palliative care needs to self-report their symptoms daily, in their homes, using electronic standardized assessment tools. Their status is monitored in real time and thus allows for more timely and appropriate responses by health care providers.
Effective Communication Strategies and Tactics
Whole Community Palliative Rounding: An Innovative, Collaborative Approach for Rural BC – Population-based “Whole-Community Palliative Rounds” is used in rural communities to facilitate a process for inter-professional sharing of collective clinical expertise and knowledge to address the immediate palliative care needs of persons and families.
Reducing the Silo Mentality – This innovation builds collaboration between established health care programs who traditionally work in silos, to provide seamless palliative care to a population of frail seniors that have not previously been able to access palliative care services.
Integrated Palliative Care Approach in Home Care – An interdisciplinary, interdepartmental team model comprised of the client and their family/caregiver(s), palliative trained nurses and personal support workers (PSWs) that is strategically designed to encourage and promote communication.
The Integration of Palliative Home Care Services and Acute Care Teams in the Provision of Medical Assistance in Dying in the Community – In 2016, the Champlain LHIN Palliative Home Care Program joined forces with The Ottawa Hospital (TOH) in order to provide MAiD to palliative patients in the community. Palliative home care services now support acute care physicians in offering MAiD in the community, resulting in care that is more patient-centered and with improved communication.
The INSPIRED COPD Outreach Program™: Role of the Advance Care Planning Facilitator – As part of the INSPIRED COPD Outreach Program a trained advance care planning facilitator provides in home psychosocial/spiritual support, assisting patients/families in completing personal directives if desired.
Supplies, Equipment and Medication Management
End-of-Life Symptom Management Kit for use at Home in Rural Northwestern Ontario – Designed using best practice and evidence-based research, this is a standardized palliative symptom management kit which includes necessary medications and medical supplies required to treat the most common end-of-life symptoms.
Cost Benefit of Elastomeric Infusors in a Residential Palliative Care Setting – This initiative examined the cost associated with using elastomeric infusors (not CADD pumps) and compared it to the cost of regularly administered medications by conventional methods. Aspects considered include nursing time, supply usage, and medication wastages.
Using Electronic Clinical Management Systems to Drive Best Practices in Palliative Care – Electronic order sets that guide correct formulation and dispensing guidelines and supports physicians with decision making when transitioning from oral to infusion-based medications.Electronic order sets that guide correct formulation and dispensing guidelines and supports physicians with decision making when transitioning from oral to infusion-based medications.
Inclusion of advance care plans into the delivery of care in the home
Access to Advice and Advance Care Planning – An Edmonton Perspective – Advance Care Planning/Goals of Care, the collaboration with Community Emergency Medical Services with an Assess Treat & Refer program, and new ways of accessing technology and caregiver feedback will be presented.
Responding to Policy Issues: How a Provincial Advance Care Planning/Goals of Care Designation Community of Practice Promotes Excellence – The development of a provincial ACP/GCD Community of Practice, a centralized meeting place for ACP champions to share, learn, and interpret the provincial policy and procedure.
Integrating a Palliative Approach to Care by Having Conversations Early (IPACE)- Facilitating early conversations using Ariadne Lab’s Serious Illness Conversation Guide (SICG) or other conversation tools to respect individual’s these wishes regardless of the setting of care and to foster this change in practice as part of the clinician’s daily work.