Fostering patients and families during end-of-life care.

Abstract

150 Background: Hunterdon Palliative Care Program is a service owned and run by Hunterdon Medical Center, a non-profit, Magnet-recognized, community hospital of 178 beds for the residents of Hunterdon County in New Jersey. The program strives to provide the highest quality patient and family-centered care for seriously ill and terminal patients. Our goals include respect for patient autonomy, values and personal decisions, as well as minimizing of symptom distress, optimizing supportive interventions and services for patients and their families. The individual need of each patient is determined by an interdisciplinary process that includes the ongoing clarification of goals of care. In order to achieve this we have developed several tools to capture the unique needs of each patient and encourage a daily interdisciplinary process. Methods: Three tools were developed to incorporate and utilize the expertise of each individual team member which includes physicians, nurse practitioner, social worker, chaplain and a reiki master. Results: The tools are currently being used by all in-patient palliative care patients. The psych-social-spiritual assessment and care plan sheets are completed within 24 hours of the initial consultation. The documents are placed on the chart next to the written consult. Daily rounding sheets are placed in the progress notes section of the chart. All members of the patient’s treatment team are encouraged to utilize the forms. Both the care plan note and the daily rounding sheet include a section for input from other disciplines. A hot pink strip is located at the bottom of each sheet to make it easy for others to identify forms for integration into additional patient care plans. Conclusions: The Palliative Care Program was awarded Certification by The Joint Commission, with no recommendations for improvement! The interdisciplinary approach to a patient’s end of life needs was sited as "superior" for clinical documentation with special attention to the psycho-social spiritual assessment as a “best practice” standard.