Tuesday, September 13, 2011

On your marks, set, go! Advanced Certification for Hospital-Based Palliative Care

by Holly Yang

On September 1st 2011, the Joint Commission started certifying hospital-based Palliative Care Programs!  It is open to all Joint Commission accredited hospitals including long-term acute care care and children's hospitals. The standards for certification were based on the National Consensus Project's Clinical Practice Guidelines for Palliative Care and A National Framework and Preferred Practices for Palliative and Hospice Care Quality from the National Quality Forum. For previous comments on the importance of this see Christian's post from spring when it was announced.

 It is "designed to recognize hospital inpatient programs that demonstrate exceptional patient and family-centered care in order to optimize the quality of life for patients with serious illness. Palliative care involves addressing physical, emotional, social and spiritual needs and facilitating patient autonomy, access to information and choice."

The full text is here, but some of the highlights of the requirements are (I'm paraphrasing, so please see the complete text for all the little words that make a big difference):

  • 24/7 coverage - by phone on nights and weekends, with availability of someone to come in to see the patient if necessary, and "must be able to provide the same level of palliative care services during nights/weekends as during normal weekday hours."
  • See patients - At least 10 in the past and at least one during the on-site review
  • Use evidenced-based approach to guide care (and/or practice guidelines to deliver care using a standardized method)
  • Have the ability to direct clinical management and coordinate care
  • Have an IDT (interdisciplinary team) and follow an organized approach to deliver care
  • QI  - Improve performance by collecting performance measurement data over time (at least 4 months' worth). No specific tools, but should be "evidenced-based, relevant, valid and reliable"
While some of these may be a challenge, it will help to standardize what "palliative care" delivery is in hospitals and help patients get the quality care they need. It will help hospitals know what is important in providing palliative care, since they don't live and breathe this every day. For example, making IDT a part of the requirements is so important, because it helps hospital administration types understand the necessity of the team approach to whole-patient care. While I don't think the hospital will be so excited to get this certification that they will immediately offer to hire a full-time social worker and chaplain/spiritual counselor for your team, I do think it is a step in the right direction and can only help you advocate for the inclusion of more psychosocial and spiritual support.

The 24/7 requirement has generated some discussion on the Center to Advance Palliative Care (CAPC) forum, as this may be one of the most difficult requirements for many programs, but does make sense for our patients' care. If I put myself in the patient's shoes, if I needed help from a palliative care team at 9 pm on a Saturday night, I really hope I could get it. Just like if I needed a cardiologist, one better be available. To expect the people who consult us to partner with us fully, we need to be available to help.  It can't rely on one person on call 24/7/365. We may need to get creative and partner with other providers (like your local hospices). It will be interesting to see what teams do, and it will be a great thing for us to share our experiences with each other, a kind of national brain-storming for good solutions. 

CAPC has done a great job getting you the resources you need including how-to guides and an audio conference. Check them out and best of luck!  

Thanks to all those who worked so hard to get these in place, and thanks to all of you out there taking care of the patients every day. 

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