Health region puts added emphasis on palliative care options
Palliative care isn’t just about dying — it’s about living.
“Our program looks to help support people to live until they die,” said Tricia Engel, director for Palliative Care Services with the Regina Qu’Appelle Health Region (RQHR).
As a result of feedback from the public, the region recently made changes in an attempt to provide better care for palliative care patients and their families.
Now palliative nurse co-ordinators are available daily from 8 a.m. to 4:30 p.m. They assess patients to determine their eligibility for admission into the palliative care program and provide supports to manage patients’ physical and psychosocial symptoms.
Eligibility criteria includes the patient’s prognosis, estimated life span, mobility needs and proximity of family.
“Those things all contribute to complexity and quite often influence symptom management,” Engel said. “The goal is to keep people as independent as possible and free of pain — physical pain, emotional pain and financial pain. There are all different kinds of pain that impact a person’s quality of life.”
Another change is the availability of five palliative community nurses seven days a week from 8 a.m. to 4:30 p.m.
“We found that most of our visits took place during the day time, but we had very limited nursing coverage on the weekends,” Engel said. “People need care seven days a week, especially in palliative care.”
At any given time, between 150 and 200 clients are in the palliative care program. Not all receive treatment every day or even every week, but some require care three to five times a day.
For consistency of care, Regina has been divided into zones and nurses are assigned to a zone.
“We’ve lined up our areas in the city to match homecare network boundaries,” Engel said. “We’ve recognized for a long time that palliative care needs to happen at every care opportunity in health care, not just by the palliative care specialist team.”
Realigning areas allows home care staff to easily consult palliative care nurses about their patients.
“Maybe the two even go out to see the client together,” Engel said.
There have also been technological changes. A new phone system went live at the beginning of September.
For easier contact, patients and families call one number and are transferred to the nurse working in their area. Sometimes calls can’t be answered immediately because the nurse is driving or treating another patient.
“If the call isn’t returned in a timely manner, the manager is notified,” Engel said. “We’ve reduced the opportunity to miss calls.”
A full-time nurse practitioner and two part-time family physicians, who will maintain their community practice, have been added to the Palliative Care Unit rotation.
Palliative care physicians have always provided night and weekend coverage. With more people sharing the job, it’s hoped there will be less burnout and Engel hopes that will lead to an expansion of palliative knowledge in the community.
Despite the advances, there are only nine beds on the Palliative Care Unit at the Pasqua Hospital.
Engel doesn’t expect beds will be added in the foreseeable future, but believes more are needed.
At any given time, there are significantly more than nine palliative patients in other wards throughout Regina’s hospitals.
“Our docs go to whatever unit they’re on,” Engel said. “Not everybody makes it to the nine beds on the palliative care unit. We would look at those nine beds on the unit as caring for the sickest of the sick people.”
Patients come and go from the palliative care unit — sometimes a number of times.
“The unit is really an acute symptom management area where people are admitted, we get their symptoms under control and we send them back home,” Engel said.
Years ago, the Pasqua unit was more like a hospice.
“Most of the people who were admitted to the unit died on the unit,” Engel said. “The length of stay averaged five to seven weeks. Now the average length of stay on the unit is from five to seven days and the majority of people go home.”
When patients have eight weeks or less to live and have complex symptoms that can’t be managed at home, a referral is made to Regina Wascana Grace Hospice, which has 10 beds.
“Most people want to stay at home and so we try and support people to do that, but sometimes their symptoms reach a point where they need to be in a facility environment,” Engel said. “Lots of palliative care happens in longterm care facilities as well. I think we just don’t talk about it.”