Tweet

by Holly Yang (@hollyby)

Thoughts as I drove to work at the hospital today:

For people and families who stay 6 feet away and wear a mask, buff, or bandana when they work out near others, enjoy busy outdoor spaces, or walk their dog, I see you. I’m grateful.

For grocery, retail, postal, delivery, restaurant and all other essential workers who take care of us with careful hygiene, clean spaces, and by showing up and being professional despite encountering lots of stressed out people, I see you. I’m grateful.

For good citizens who are kind and respectful to grocery, retail, postal, delivery, restaurant and all other essential workers, and those who stand with them against abuse, I see you. I’m grateful.

For people who check in on their friends and neighbors who are high-risk for COVID, or support those who need help due to illness, financial distress, mental health issues, or all of the above, I see you. I’m grateful.

For parents trying to work, teach their kids, and provide a safe and happy place for them despite the disruption of the pandemic, I see you. I’m grateful.

For those of you who have learned how to bake bread, planted a garden, created art, performed music, and found small ways to restore a sense of expectant hope in spite of the chaos, I see you. I’m grateful.

For those of you who are graduating, who are starting a new job or making a pivot, or embarking on anything new in this difficult time, I see you. I’m grateful.

For those of you who volunteer at food banks, deliver food to the homebound, donate blood, foster kids, support nonprofits, participate in research, help animal rescues, or find other ways to give despite the uncertainty in your own life, I see you. I'm grateful.

For first responders and people who work in hospitals, nursing homes and care facilities, hospices, and people’s homes… for caregivers of all kinds who risk illness to continue their critical role, I see you. I’m grateful.

For those speaking up and advocating for communities of color and residents of nursing homes who have experienced the disproportionate burden of illness and death during this pandemic, I see you. I’m grateful.

For the broken-hearted who are separated from loved ones, those who worry for the sick, and people who grieve those who have died of COVID or other causes, I see you. I hurt with you, and hope you find comfort.

For those who feel hopeless, guilty, fearful, angry, or who can’t sleep because of the stress of illness, loneliness, job loss, financial difficulty, or the deep uncertainty we live in, I see you. I hope you find peace and support.

For everyone who just wishes things were “normal” or at least less uncertain, and who feel restless and frustrated, I see you. I hope you discover ways to find joy while keeping our communities safe.

For all of you doing the best you can each day to get by with compassion for yourself and others, who make mistakes and try again with large or small selfless acts for the good of our community, our nation, our world, I see you...and I am so incredibly grateful.

Originally published on Twitter and reprinted here with permission.

Find more posts by Holly Yang on Pallimed here.

Holly Yang, MD is a palliative medicine physician at Scripps Health. Passionate about hospice and palliative care, communication skills, medical education, and increased access to health care

Tweet

Co-published March 13th on GeriPal and Pallimed

Dear Hospice and Palliative Care community,

We are sad we cannot be together this year at the Annual Assembly and deeply concerned about the growing risk of the novel coronavirus. We want to send you a bit of encouragement, and some thoughts on how we can take care of ourselves, our teams, and our community in the setting of this new pandemic.

We have always “punched above our weight” as a field, and the secret to that has been hard work, community, and being smart.

We don’t have to tell you to work hard. You and your teams know how to do this.

1) Start social distancing from others (except patients) now, wherever you are in the country. While we realize this is a stronger recommendation than currently being asked for by many public health entities, we are doing so in the interest of health care workers and patients

--COVID-19 is spreading rapidly, sometimes with minor or no symptoms, with serious impact to healthcare systems worldwide. The exponential growth in cases in China, Italy, and South Korea has overwhelmed the healthcare systems, and has affected our patient population most seriously - the chronically ill and older adults.

--We need to be ready and able to respond when the time comes. We will be exposed to the COVID–19 virus, and we cannot afford to lose our hospice and palliative care clinicians to isolation restrictions or illness, especially given the workforce shortages many of us face already.

--Stay away from public gatherings like movies, sporting events, concerts, the theater, houses of worship and other places where people assemble. Try to participate in these from home via electronic means, if possible. Talk with your spiritual leaders about making services available via streaming tech, for example.

--Attend all meetings electronically unless physical presence is absolutely necessary. Replace non–essential meetings with email or other asynchronous communications,

--Eliminate all non–essential travel, and

--Protect yourself at work using PPE and rigorous technique. *Reminder of how to safely don and doff PPE here

2) Follow all local, state and national guidelines for COVID-19. This is critical as there are regional differences. However these hold true.

--Wash your hands or use at least 60% alcohol hand sanitizer

--Avoid touching your face. (Holly finds this impossible, so she wears her hair up and bobby pinned normally, to avoid itching her face and tucking her hair behind her ear constantly.)

--Stay home if you are sick, until the symptoms are gone for at least 24 hours. (This is hard as we have been trained to just work anyway. Don’t do it. Stay home.)

--If you are exposed and/or have COVID-19 symptoms, you should isolate at home for 14 days. If you think you should be tested, make sure you call ahead and know how your region is handling testing for health care workers. (You should have received copious emails from your institutions on this. If not, contact your institution's occupational health team or COVID response team for local instructions on how to access testing.)

--If you have traveled to or had a layover in any of the 5 countries (China, Iran, Italy, South Korea, or Japan) then you need to stay in isolation at home even if you are asymptomatic. Note these countries may change after this is originally posted on Mar 12, 2020.

--See CDC for the latest guidelines: www.coronavirus.gov

--Wash your hands the right way. (Yeah, we said it already).

3) For hospices and home-based palliative care:

--NHPCO has an excellent resource page for that includes CDC guidance for hospices on COVID-19 infection control and prevention : https://www.nhpco.org/coronavirus

--Proactively provide education to your patients and their caregivers on how to stay safe and get food, medication, pet food, household goods, and other necessities, including companies that deliver to minimize household exposure. You may deliver the patient’s medications, but their caregivers will also need to get their medications.

--Proactively remind patients and caregivers about CDC guidelines (e.g. handwashing, greeting people, etc.), and to clean their cell phones.

--Consider having non-caregiver loved ones Facetime or Skype to “visit” rather than coming in person.

--Use virtual visits whenever possible.

--For patients who need to be seen, send only the necessary team members.

--Call ahead to screen for exposure and symptoms of the patient or caregivers to see if PPE is necessary.

--Ensure your team members have appropriate PPE in their cars, as well as disposal containers. Consider donning and doffing the PPE in attached garages or entryways to help maintain patient privacy.

--Make sure people going into homes know how to don/doff PPE and are FIT tested, if appropriate.

--Wash hands or use hand sanitizer prior to and after seeing patients.

--Wipe down all equipment and cell phones before and after each patient.

--Follow all guidelines for facilities and minimize in-person visits to only needed personnel.

--Don’t let fear prevent appropriate patient care.

4) For ambulatory palliative care:

--Proactively provide education to your patients and their caregivers on how to stay safe and get food, medication, pet food, household goods, and other necessities, including companies that deliver to minimize household exposure.

--Remind patients and caregivers about CDC guidelines (e.g. handwashing, greeting people, etc.) and to clean their cell phones.

--Consider having non-caregiver loved ones Facetime or Skype to “visit” rather than coming in person.

--Screen all patients and caregivers for symptoms or exposure when calling to remind them of their appointment.

--If URI or COVID symptoms, follow your institutional guidelines about home isolation and testing.

--Consider which patients’ needs can be met with virtual or telephone visits.

--Work with your institution to implement HIPAA approved telehealth visit capabilities if you do not have them. Understanding some telehealth visits cannot be reimbursed, talk with your colleagues and health system about what amount of service can be feasibly provided without guarantee of reimbursement.

--Consider which team members really need to be in the room, versus can call to provide information or support.

--For now, do not require that patients be seen at a certain frequency for controlled substance monitoring if it can be safely done for a particular patient, unless required by law or regulation.

--Don’t let fear prevent appropriate patient care.

5) For inpatient palliative care:

--Provide education to your patients’ caregivers on how to stay safe and get food, medication, pet food, household goods, and other necessities, including companies that deliver to minimize household exposure for when the patient is discharged.

--Remind patients and caregivers about CDC guidelines (e.g. handwashing, greeting people, etc.) and to clean their cell phones.

--Consider having loved ones call, Facetime, or Skype to “visit” rather than coming in person, if they even are allowed into the hospital.

--Consider having physicians, NPs, and PAs who are at home in isolation due to a cold, travel, or COVID exposure, be a triage/advice person for your consult service. Palliative care teams are often at capacity without an epidemic, so with COVID we may need to give recommendations to non-palliative clinicians (e.g. teleconsults or curbsides) when we can, and only see the patients who need our in-person services.

--Establish and update what a “patient who needs your service” means as a team at each site, so there is not confusion if the definition changes during a surge. For a palliative care team covering multiple hospitals, consider asking for emergency privileges now at all the hospitals, so all clinicians can flexibly cover hospitals they don’t normally practice in.

--Make sure your institution is planning for symptom management needs, like opioids and benzodiazepines for dyspnea and anxiety.

--Be prepared to offer virtual bereavement support to families who are not allowed to be with critically ill patients.

--Support other teams in the hospital, everyone will be stressed and a kind word or offer to help may go a long way.

--Don’t let fear prevent appropriate patient care.

6) For Program Directors:

--Consider going virtual for education and fellow support.

--Have the trainees see the non-COVID cases, to minimize their exposure and conserve PPE. Attending physicians will need to see the patients, and can teach about COVID outside the room, so the trainees don’t lose out on the learning.

--Consider extra support, like virtual video check-in’s, or more frequent texts/ or calls about the fellows’ well-being, given the stress on the system.

--Make sure your fellows can get food and necessities, and have a place to go, if they are asked to isolate

And as all us hopefully do, prioritize kindness. There are reports of xenophobia behaviors, and shunning of people with COVID, and with heightened emotions we may need to remind people we ALL do better when we care for each other and treat each other equally.

Finally... together we can do this. As hospice and palliative care people, we understand the value of team. And right now we are all on each other's team. While we may be social distancing, we have a vibrant virtual community, as well your home community. AAHPM has Connect, we can find each other at the #hapc hashtag on Twitter, or at the #hpm tweetchat. Take care of you, take care of each other.

Much love folks. Let’s be safe, and let’s be prepared.

Strong back, soft front. Deep breath. Stay grounded.

Holly Yang, Alex Smith, Christian Sinclair, Eric Widera, Paul Tatum, Drew Rosielle

For more posts on COVID-19, click here.
For more posts on Emergency Preparedness, click here.
Check out the Pallimed COVID-19 Resource page here.

Resources: NHPCO - COVID-19 Information
CMS - CMS Actionable Guidance to Providers about COVID-19 Virus

Tweet

The editors of Pallimed are proud to announce a new editorial feature: Pallimed Roundup. In these articles we will publish a collection of quotes culled from palliative care professionals around the world.

Our first question was: What advice would you give to graduating palliative fellows?

“Let the patient's and family's goals be your guide. You will be, and should be involved in discussions of discharge planning, financial and insurance issues, hospice and mortality statistics, but your true north should remain the goals of your patient and family.”

-Ross Albert, MD PhD

“Keep loving your patients till the end; they deserve it and you deserve it.”

- Rafael Bloise, MD

“Keep a clinical palliative care practice. Do not let research, administration or business interests destroy your clinical skills and the ethical foundation of all your career, patients and families.”

- Eduardo Bruera, MD

“In palliative medicine we become experts one patient and family at a time; keep learning, keep your heart open, and remember to breathe.”

- Ira Byock, MD, FAAHPM

“Listen to your patients, they have the answers!”

- Jim Cleary, MD quoting Dame Cicely Saunders

“Get yourself, your ideas, and the view that others have of you out of the way. Discover your true voice and use it.”

 - Michael Fratkin, MD

"Be Kind."

- Sonia Fullerton, MD

"Remember to pause and ask yourself 'what is your intention?' before seeing each and every patient."

 - Robert Gerard, MD

“Remember the doctors of old, the ones without antibiotics, morphine, and all the other modern medicaments and machines—the ones that sat bedside, held hands, and listened—for they were the true doctors, the ones who were present and shared the anguish of suffering, the ones who understood the burden of fear was too heavy to carry alone; model them, and you’ll be fine.”

- Paul Rousseau, MD

“Make time for talking with mentors and professional development activities that peak your curiosity, they are gifts you give yourself.”

- Holly Yang, MD

“Keep in close touch with your colleagues for discussing cases, sharing new ideas and information, not practicing in a vacuum, and even getting some emotional support when things are rough. It is more important than ever since we can be so isolated at times. [Use] the AAHPM Forum, blogs, emails, phone consults, HPM meetings, and set up one-day meetings with other medical directors/HPM doctors in your area."

- Don Zacharias, MD

Interested in participating in the next Pallimed Roundup? Have ideas for a question? Please contact Lizzy Miles.

Tweet

by Holly Yang, MD

I was issued the Thickened Liquid Challenge by Dr. Christian Sinclair. I had resigned myself to the knowledge that I would not escape it the minute I saw it on GeriPal. I somehow had avoided the ice bucket version, so I figured it was my turn. On the upside, it gave me a chance to test a hypothesis that I've been considering for a while.

So, I have been espousing this theory that people are texture people or taste people. Some people can't eat the tops of asparagus because the texture weirds them out. Those people probably can't eat raw oysters, and definitely won't like most things I drank in the thickened liquid challenge. So, I decided to film a mini-documentary of my not-at-all-scientific test of this theory, one minute for each hour.

So, if you watched it, you were able to see the results of my experiment, and you know the final outcome. Here's a quick summary slide.



I also wanted to pass on a few things I learned along the way.

1) There are naturally thicker beverages I enjoy that I drink now. God forbid I have trouble with dysphagia in the future, I will likely stick to those things. Why not recommend some of these things to our patients?

2) Some things that I thought would be awful, were actually okay, not great, but okay. (Well, for me anyway.)

3) Some things that I thought would be okay, were really, really not.

4) Don't give your spouse the "not now" look when he tries to make filming recommendations, or he may keep his mouth shut about taking it easy with the thickener too.

5) Patience is a virtue, and may help you avoid unpleasant things. Give the thickener time or everything becomes pudding thick either in the glass or in your stomach. (See #4)

6) Thickened liquids can make you feel really full. (See #5)

7) Thickened liquids may be able to hydrate you, as perplexing as that seems while you are "drinking" them, but they make your mouth really dry. Good oral care is going to be necessary for your patients.

8) If you drink a frozen frappucino too quickly in order to keep it "honey thick" consistency, it will most definitely give you an ice-cream headache to replace your caffeine-withdrawal headache.

9) Bananas = #thickenedliquidhack

10) Carbonated beverages get crazy bubbly with thickener added. Not Mentos bubbly, but more like root beer float bubbly.

11) We should think twice before asking patients to do things we aren't willing to do ourselves. Certainly not things that we make "yuck faces" at and giggle about. Not cool, Robert Frost!

12) Add ice cubes AFTER thickener when drinking scotch.

Unanswered questions:

1) How do you brush your teeth on a thickened liquid restriction?

2) Does Fitbit have a calorie count for thickener?

3) Exactly when does a liquid become a solid?

Thanks for watching, and thanks for reading.

If you haven't been nominated for the challenge, nominate yourself, and then a few of your best friends, frienemies, or that person at work that bugs you. Or... hope and pray that no one calls you out.

Seriously though, I think we should know what we are asking our patients and families to do, put ourselves at their place at the table instead of labeling them "noncompliant," work on shared decision making with real information (see GeriPal post), and help them incorporate what ever the decision is in the tastiest way possible with our nutrition and speech and language pathology colleagues as partners (See posts here and here).

Cheers!

Holly Yang is a Hospice and Palliative Medicine doc practicing at Scripps Health in San Diego, with a particular love for medical education, especially the communication, international, and moving the field forward bits. She is also fascinated by the intersections of #hpm, humanities, and spirituality. Holly surfs whenever she can, and has a bit of an obsession with Kansas City barbecue.

Tweet

by Holly Yang, MD

I try to greet each new year by jumping into the ocean and catching a wave. If I'm good about it (and not on call) I try to meet the dawn of the new year in a special kind of hello and thank you. So... I guess it's a good time to highlight a bit of surf culture. Why surfing?  Well, because it is an integral part of who I am, but also because it illustrates beautifully how different ideas of culture impact how we see life and death, and celebrate who we are and were.

Culture is a funny word, and is probably overused.  We tend to view it through the eyes of ethnicity, nationality, or faith, but we each exist in many types of communities each with their own cultures. As you think of your own life, you can probably identify which communities are the ones that are most important to you, which "culture" has the most meaning and helps you define who you are at your core.  Isn't this where we find the stuff in the top three layers of Maslow's?  Isn't that what gives us meaning and purpose?  Isn't this some of what is lost when we find some our patients in the deepest throes of existential suffering?

So how does this connect to surfing?  Well, I can connect most anything to surfing...

"A wave does not need to die to become water. She is already water."

- Thich Nhat Hanh

Surfers are a funny bunch.  It includes people of all educational backgrounds and socioeconomic levels, young and old, male and female.  We are linked by our fierce passion for the ocean, and we know we are a part of something mysterious, awesome, and greater than ourselves.  You only have to sit atop your board at sunset with dolphins playing in front of you, or paddle like hell to get over the huge wave about to break on your head to know that truth deep in your core.  If you practice medicine near a body of water with waves (this includes the Great Lakes too!), you will probably have a surfer for a patient.  Ask about hobbies in your social history.  Know that one of their most profound connections is to that deep blue mystery.  Rell Sunn, known as the Queen of Makaha, exemplified this when she continued to surf despite being hospitalized and getting chemotherapy for her breast cancer.

When a respected members of our tribe dies, we mourn their loss and celebrate their life by having a paddle out.  The Irish have wakes, people in New Orleans have jazz funerals and second line parades, surfers have paddle outs.  The tradition is thought to have originated in Hawaii in the early 1900's and moved to the U.S. mainland and around the world since that time.


Paddle outs can be done as a memorial or a celebration of life, with less or more of the spiritual components.  Most paddle outs are more humble affairs, but all include family, friends, and members of the local surfing community.  There are pictures, food, flowers, not so different from other types of remembrance ceremonies. Some are big affairs as you can see in the videos from the paddle outs for pro-surfer Andy Irons in 2010, or Newport Beach lifeguard Ben Carlson who died in 2014 while in the line of duty. Some are done more than once, the most famous is done annually for the opening ceremony of the Eddie Aikau memorial surf competition held by Quiksilver. UCSB surf club hosted a paddle out for their classmates who were killed in 2014 in Isla Vista. Junior Seau, the NFL player, had a paddle out after his death in 2012. It happens more than you are aware of, but if you have a chance to be a part of one, go. It's a beautiful experience.

In a more traditional version of a Hawaiian paddle out, a Hawaiian Kahuna or Ku'puna stands on the beach in the water with the family and calls in the person's spirit with prayer, and an Alaka'i blows a conch shell which has been blessed in the ocean. Ocean water is brought in a bowl and the family, close friends, and the ashes are blessed by the Kahuna or Ku'puna with wet tea leaves. As the tea leaves touch those close to the deceased, it is a way of passing on the person's mana, or spiritual power. The family publicly thanks the gathered community, prayers are said, and the conch shell is blown again calling out to the spirits. The ashes are wrapped in the tea leaves with the sinking stone, and the people who are going to be paddling out stand on the beach facing the surf and hit their surfboards to make noise as the Kahuna or Ku'puna chants a warrior chant. Next, everyone paddles out on their surfboards (often family is in a boat), and form a circle with the family in the center.  People hold hands, say prayers, and tell stories about the person who has died. The ashes are placed into the water, the flowers and leis are thrown into the center of the circle, and people cheer and splash the water to celebrate the person who has died. Finally, people catch a wave in to shore carried along, surfing, with that person's spirit.

The first paddle out I went to, was for a long-time local surfer whose last name I didn't know until he died of a heart attack on the beach. He was a kind man, who gave me a few gruff pointers when I first started surfing, and yelled, "Paddle!" at me when the wave came. You have to understand that most people either avoid you or grumble at you when you are first starting to surf, so his help was very much appreciated. It was moving for me to witness the powerful ceremony, to be a part of celebrating him and remembering his life.  I learned he was a lifeguard who taught others how to save lives, and it seemed like everyone I'd ever seen in the ocean was in that floating circle. I cheered and splashed, and threw my flowers into the water. As I caught a wave in, I said a little prayer of thanks for Davey's life and for the community that gathered to celebrate it that day, and I felt gratitude for his presence.

Paddle outs are a part of who we are as surfers, a part of our culture. I know there are lots of communities of all types that celebrate people's lives and deaths in unique and interesting, yet sacred ways. I hope to continue to learn from my colleagues and patients these cherished bits of culture that make us all part of a fascinating human story. Hopefully we can get a few more "culture" posts highlighting some of these as we go along. If there are particular ones that pique your interest, let us know and we'll try to shed some light on them. Wishing you all a wonderful next chapter in this adventure called life in 2015!

Special thanks to Kai Buanoi and Unko Mo for helping me with this post.

Image credit: Illustration by Christian Sinclair for Pallimed, original photo "One on One" by Bryce Bradford , shared under Creative Commons CC BY-NC-SA 2.0
Photo credit: Sunset Wave by Holly Yang, used with permission, All rights reserved

Tweet

by Holly Yang, MD

Dear HPM colleagues,

For those of you who celebrate Christmas (and for those of you who are waiting patiently for the after Christmas sales), you'll be happy to know that there is still a chance to ask your friends and relatives for a gift, one they can get online without going to that crazy mall or fighting through traffic. Heck, give the present to yourself!

Ask CMS to pay providers for having advance care planning conversations. There are codes now (yay!), just no reimbursement (insert frowny emoji here).  BUT... the comment period to CMS is open until Dec. 30th, so if you are a procrastinator, not to worry. You still have time!

Ask your non-HPM friends to do it. It matters to them too! Do you think a primary care doc can fit in an ACP conversation into a 10-15 min. visit for their patient scheduled for another problem? Or an annual exam where they are supposed to do a full H and P, counsel against smoking, promote healthy eating, exercise, ask about gun safety, screen for domestic violence, and catch up with major events in a patient's life? What about the specialist who also has to fit it into a busy clinic day packed to the brim with scheduled and urgent, unscheduled visits? We love our patients. It's just that often it doesn't come to the forefront of conversation until it becomes an urgent issue or a true crisis. We need to have these conversations valued as "separately and identifiably" necessary part of providing high-quality, patient-centered care.

Besides, commenting isn't just good for our patients... all the cool kids are doing it. AAHPM, CAPC and AGS submitted. Paul Tatum, Kyle Edmonds, Laura Petrillo, and Alex Smith did too. Lots of people did. Patients, doctors, lawyers, academies, associations... you can too!

For those who like info short and sweet, I've already annoyed you. Quit reading and go here.
Push Ctrl-F on a PC (Command-F on a Mac) and search "99497" or "99498" to read what CMS is currently planning to do.

At the very top of the webpage click the "Submit a Formal Comment" button.

For the detail people, please see the HPM blog trifecta on the subject by my esteemed colleagues Gregg VandeKieft, Paul Tatum, and Phil Rodgers, which are very rich resources:
AAHPM
Geripal
Pallimed

For those who are more politically motivated or feeling a bit cranky from all the relatives in your house and need a way to vent, read Laura's Geripal post here.

Your opinion matters. It really, really does. CMS is listening (until Dec. 30th, that is...) No complaining that you don't get reimbursed for having advance care planning conversations if you don't avail yourself of this opportunity. Just think... wouldn't it be awesome to have one less barrier to patient-centered care?

It's Christmas Eve! The Elf on the Shelf is watching you to see if you are naughty or nice...

Photo credit: Alan Dow (used with permission)

Tweet

Happy World Hospice and Palliative Care Day everyone!

Photo via Abaconda (cc) via Flickr

I just wanted to mark this day, October 13th, 2012, as events happened all over the world to recognize our field and bring attention to the patients and families we care for. Events occured internationally and in the United States.

On the international version of ehospice.com website, it reported that the WHO estimates that "24 million adults require palliative care at the end of life each year... Despite this growing need, 42% of countries still have no identified hospice and palliative care service, while 80% of people live in countries with little to no access to medication for the treatment of moderate to severe pain." There are so many patient who need us to advocate and care for them, so the events of today are exciting...

There was a run in Addis Abbaba, Ethiopia, a walkathon in Kerala, India, a human chain in Dhaka, Bangladesh, a flashmob in Cimislia, Moldova, a short film festival in Taipei, Taiwan, and many, many other concerts, celebrations, and workshops. There were also film screenings of the Life Before Death movie , which is something that is relative easy to do whereever you are, especially as they are discounting the DVD set 50% for the month of October.

I hope you had a good World Hospice and Palliative Care Day! Let's keep it going this month and all year round!

Tweet

World Cancer Day is February 4th, and in honor of this day, I'm posting about a critical issue we have written about on Pallimed before... access to medications. There are three developments in the last few days I think are worth knowing about...

Tweet

Tweet



(From http://www.thedesignwork.com/)



Tweet

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"

Tweet

If you are a med ed geek like me, you L-O-V-E the Interactive Educational Exchange which has been a fun and exciting part of the Americal Academy of Hospice and Palliative Medicine (AAHPM) Annual Assembly for the past two years. It's not your ordinary concurrent session. No! Instead, you listen to a quick overview of the different presentations and then you zip around to learn more about the ones that you find most intriguing. I have always come away with at least one interesting idea to try or tweek to fit my teaching style and audience. So... if you're students are yawning, you can A) buy them coffee or B) go to the Interactive Educational Exchange on March 9th, 2012 from 3:30 to 5:00 pm. 


If you've got an exciting way to teach palliative medicine to any discipline, please do share!  Submit it for the 2012 Interactive Educational Exchange at the AAHPM Annual Assembly in Denver! Hurry! Submissions are due by 5 pm PST August 2, 2011! Heck! They make it easy by even giving you previous year's submission examples.

Hope to see you there!!!

Photo by Elizabeth Thomsen via Flickr



Tweet

Tweet

"Each year more than 3000 men and women die in U.S. prisons."

"It is estimated that 20% of the U.S. prison population will be elderly by 2025."

These are the sobering figures presented at the end of one of the trailers of Prison Terminal, a documentary about the prison hospice in the Iowa State Penitentiary, where inmates care for their own terminally ill. The film, directed and edited by Edgar Barens, spans a 6-month time period, and follows the lives of the patients, inmate volunteers, and staff. Here's one of the trailers (it starts after the first 15 seconds).

PRISON TERMINAL: THE LAST DAYS OF PRIVATE JACK HALL from Edgar Barens on Vimeo.

Prison Terminal is nearing completion, but needs some money to finish the project. Edgar started a fundraising campaign on Kickstarter March 1st, so if you want to see the full length film, consider a donation. By the way, the very cool thing about Kickstarter is that the money doesn't leave your pocket unless the project reaches its fundraising goal in the specified timeframe. So if, you want to be a part of seeing this project through, please do so by clicking here by Friday, April 15th.

This powerful story while being about the experience of dying and caring for the dying in prison, also makes me think of all kinds of important topics for our field and our country, like

- How we will cope with an ever-growing prison population, especially with increased health needs and costs of elderly inmates?

- Compassionate release is not the norm, but even if it becomes more frequent, how will inmates access health care after their release?

- How can we provide compassionate care to those who are dying in the prison system, or support the hospice initiatives that start on the inside?

- How can we help families have increased contact with the dying inmates?

- What are the special psychosocial, emotional, and spiritual needs of dying prisoners and their families?

- What is the best way to train the inmate volunteers, and what kind of bereavement care do they need afterwards?

Or something that I have struggled with in some of my palliative consultations for hospitalized inmates returning to prison...

- How should I change my prescribing practices to fit the correctional facility health care systems? (For example, no PRN doses of pain medications between certain hours at night because of lack of medical staff. Another example, no fentanyl patches allowed, because they could be removed and used by other inmates.)

Inmate Hospice Volunteers: Bertram Berkett, Michael Glover, Michael Williams, Charles Watkins  (from www.PrisonTerminal.com)

The Prison Terminal website has links to many interesting essays, and the National Prison Hospice Association has links on their site to articles which address a few of these questions.

One other interesting note, Edgar Barens has made two other films, the first, Angola Prison Hospice: Opening the Door, many Pallimed readers may be familiar with. The second, A Sentence of Their Own, is a documentary about a family impacted by one member's incarceration.

Usually a documentary is not just a story, it is an attempt to instigate cultural and societal change, something us hospice and palliative care types embrace wholeheartedly. So, in the spirit of providing compassionate, patient-centered care for everyone who suffers from serious illness, please visit the website, comment on this post, like or share the Vimeo videos, donate to get the movie finished (and maybe even get your own copy), and discuss it with your colleagues, family, and friends.

The more we spread the word about Hospice and Palliative Medicine, whether inside the walls of a prison or outside, through whatever platform we choose, whether it be social media, movies, radio, TV, print, or old-fashioned conversation, the more the public understands the value of what we do.

You can find Edgar and more on Prison Terminal at the website, Facebook and Twitter (@prisonterminal) and of course Kickstarter (where you can donate to the project).
(Edited: Updateed the video embed 12/21/2013)

Tweet

Image from www.painpolicy.wisc.edu

The Pain & Policy Studies Group (PPSG) at the University of Wisconsin recently released its figures for 2008 comparing the opioid consumption of all the countries reporting to the INCB (International Narcotics Control Board).  I am always fascinated by these reports.  One because I always find it shocking, and it helps my palliative care advocacy flame burn brighter.  Two, because the information makes a great graphic for talks on why palliative care is necessary world-wide.  Some day, I hope to not find them so interesting, but unfortunately I think that day is still distant.  


Let's face it, almost everyone wants to avoid the experience of severe pain personally and for their loved ones.  The reality, as illustrated by the interactive DCAM (Drug Control and Access to Medicines) Consortium Opioid Consumption Map, is that most of humanity does not have that luxury.

Tweet

Ok, all you twitterphobes!  Find a person, possibly your local teen or tween to teach you how to use it and join in the fun on November 17th 6 pm PST/8 pm CST.  (We do these weekly, but I'm encouraging hesitant newbies to come to the party together to avoid any sensation of social awkwardness.)

No RSVP necessary, you can watch from outside the party (aka lurking), but if you want to join in the lovely conversations you need to use Twitter.

Cue typical protest: "I'm too busy!"

I agree, you are busy!  I know it deep in my core that all you hospice and palliative medicine (#hpm) folks are busy doing good work, caring, listening, relieving suffering, teaching, researching, promoting the field, and having a life yourselves.  I am too.  But, let me tell you why I bother with twittering about hospice and palliative medicine.  (By the way, translations are at the end.)
1)  Christian Sinclair does it. (@ctsinclair)

Tweet

Going through training at the University of Minnesota, I think I had more exposure to left ventricular assist devices (LVADs) than the average internal medicine resident in the U.S.  Our university had (and continues to have) a very active program, and I remember the conference they had the interns attend to learn what to do and what not to do with LVADs. 

What NOT to do:
Don't remove both battery packs at the same time.
Don't let the driveline get infected.  
Don't do chest compressions, or you'll dislodge the tubes.

What to do:
If their heart stops, use the hand pump instead of chest compressions.
Call the VAD team if you have any problems.

At this point, I think my eyes were as big as saucers, knowing that as one of the "black cloud" interns that I could soon be dealing with problematic drivelines and trying to figure out how to hand pump someone's heart.

Tweet

[I would like to introduce a new contributor to Pallimed, Holly Yang, MD  from San Diego Hospice and The Institute for Palliative Medicine. I have been courting Holly for a while to get her to blog for us, so I am glad to see her debut today! You can also find this web- and ocean-surfing doctor on Twitter by the handle @hollyby.  As with all of our contributrs all posts are her own and not the opinion of her employers.  Please welcome her with a few comments - Sinclair, ed. ]

As one of the comments on the Economist website said, “What the heck do they want to promote now – Death Tourism?” As much as I love traveling, I’m not packing my bags just yet. But, I will give you the low-down on the 39-page Quality of Death (QOD) report by the Economist Intelligence Unit and commissioned by the Lien Foundation, which ranks end-of-life care across 40 countries.  Go get your travel kit ready... here we go!