FAST Dementia Scale

Hospices use the FAST Dementia Scale to qualify patients for Hospice.

Here's a link : http://geriatrics.uthscsa.edu/tools/FAST.pdf 

Poetry Helps us Embrace Death

In an article called "How to Get Ready for Death," Rob Ruff says that "Poets have a unique and insightful way of helping us embrace the not-easily embraceable truth that death will come, without fail, for each of us." Some of his favorite poems on the subject are :

The Death Deal by Ron Padget
The Poet struggles against but eventually begins to look forward to his own eventual death.

When Death Comes by Mary Oliver, in which the poet voices her wish to live fully, with amazement, curiosity, and joy before death comes for her "like the hungry bear in autumn ..."

The Last Thing by the Irish poet Monk Gibbons.  The Poet reminds us that death is an experience common to all people.  Thus we can approach death's door bravely, trusting that "where so much greatness and gentleness have been already, you should be glad to follow." 

Pediatric Advanced Care Planning and Life Review Tools

5 Wishes : Aging with Dignity    Link to this Website.

Advance care planning for children with special health care needs: a survey of parental attitudes.

Wharton RH, Levine KR, Buka S, Emanuel L.   Pediatrics. 1996 May;97(5):682-7.   PMID:   8628607. 

Link to this Article. (HealthSource Nursing via EbscoHost)   

Care of the dying adolescent: special considerations.

Freyer DR.   Pediatrics. 2004 Feb;113(2):381-8.  PMID: 14754953.

Link to this Article. (AAP Website)

The Decision-Making Tool : Information for Families.  Seattle, WA : Seattle Children's Hospital ; 2003. 
Link to this Document.

Development, feasibility, and acceptability of the Family/Adolescent-Centered (FACE) Advance Care Planning intervention for adolescents with HIV.    Lyon ME, Garvie PA, Briggs L, He J, McCarter R, D'Angelo LJ.   J Palliat Med. 2009 Apr;12(4):363-72.   PMID:   19327074.  
Link to this Article. (PubMed Central)

End-of-life care preferences of pediatric patients with cancer.

Hinds PS, Drew D, Oakes LL, Fouladi M, Spunt SL, Church C, Furman WL.

J Clin Oncol. 2005 Dec 20;23(36):9146-54. Epub 2005 Sep 19.  PMID:  16172453.

Link to this Article (JCO Website).

How I wish to be remembered: the use of an advance care planning document in adolescent and young adult populations.    Wiener L, Ballard E, Brennan T, Battles H, Martinez P, Pao M.

J Palliat Med. 2008 Dec;11(10):1309-13.   PMID:  19115889.  

Link to this Article. (PubMed Central)

Is it safe? Talking to teens with HIV/AIDS about death and dying: a 3-month evaluation of Family Centered Advance Care (FACE) planning - anxiety, depression, quality of life.

Lyon ME, Garvie PA, Briggs L, He J, Malow R, D'Angelo LJ, McCarter R.

HIV AIDS (Auckl). 2010;2:27-37. Epub 2010 Feb 18.    PMID:  22096382. 
Link to this Article.   (PubMed Central)

Life's Toughest Moments : A Parent's Guide When Facing End-of-Life Decisions with Their Child.
Smith J, Kvinsland B.  Seattle, WA : Global-HELP ; 2006.
Link to this eBook. 

Memories Life Review Template.   Davis, Kathy.  University of Kansas Medical Center.
Link to this Document.  (Affinity Access Only)

Pediatric advance care planning.

Hammes BJ, Klevan J, Kempf M, Williams MS.   J Palliat Med. 2005 Aug;8(4):766-73.   PMID:   16128650.

Link to this Article.  (Academic Search Premier) 

What do adolescents want? An exploratory study regarding end-of-life decision-making.

Lyon ME, McCabe MA, Patel KM, D'Angelo LJ.    J Adolesc Health. 2004 Dec;35(6):529.e1-6.    PMID:   15581537. 
Link to this Article. (ScienceDirect)

Why Palliative Care and Hospice is the Ultimate Gift

This beautiful article was posted to The KevinMD Blog.   It was written by Deb Discenza.

Dear Doctors:
I am writing no less than 45 days after my mother died from a GI bleed from ovarian cancer.  Not once did my mother’s team of doctors mention palliative care.  It was not until days and even hours before her death that hospice was discussed and implemented. Our family was blind sighted by this.   
Read more ....

Healing Touch

I especially love the distinction between the e-patient and the actual patient.
Although our current health care reimbursement system measures mostly our e-patient care, we must take good care of both.
Nancy


Abraham Verghese : A Doctor's Touch on TED

Modern medicine is in danger of losing a powerful, old-fashioned tool: human touch. Physician and writer Abraham Verghese describes our strange new world where patients are merely data points, and calls for a return to the traditional one-on-one physical exam.

Tools for Documenting Capcity

These are great tools for documenting capacity.
--Nancy

Does this patient have medical decision-making capacity?

Sessums LL, Zembrzuska H, Jackson JL.

JAMA. 2011 Jul 27;306(4):420-7. Review.   PMID:  21791691.

     Link to this Article. 

Aid to Capacity Evaluation (ACE)
     Link to PDF
     Disclaimer to use the ACE Tool.

Terminal Velocity

This article offers a nice discussion of the dying process.
Nancy

Terminal Velocity on Journal of Palliative Medicine : a Multi-disciplinary Blog to Advance Palliative Care by Author VJ Periyakoil, MD, Senior Associate Editor, JPM

Article of Interest : The Quagmire

The Quagmire : How American Medicine is Destroying Itself.   CALLAHAN D, NULAND S.   New Republic [serial online]. June 9, 2011;242(8):16-18. Available from: Academic Search Premier, Ipswich, MA.  Accessed August 30, 2011.

Link to Full-text Article.  

Summary :   The article discusses what the authors consider to be an unsustainable trajectory in American medicine. In their view too many resources are being committed to the pursuit of cures for chronic illnesses not likely to be remedied for many years to come. They believe that medicine should adopt new priorities, starting with the goal of bringing everybody's life expectancy up to the age of 80. They maintain that geriatric care should focus less on postponing death and more on increasing the quality of life during one's final years.

Pain Resource Team Topics

Affinity Health System’s Pain Resource Nurse Team consists of RNs from the hospitals and clinics working to promote pain education for all staff at all sites and improve patient care. Dr. Nancy Homburg co-chairs this team and provides valuable input for us.

The Team has developed several topics to address some of the common side effects of opioids, treatment of pain in the older adult, and the Fentanyl patch. These evidence-based practice topics are for your reference and will also be available at each Nursing station and in the Clinics.

The Current Pain Topics are linked below on the "Pain Resource Team"  Webpage (35708)

Treating Pain in the Older Adult    (35702)

Opioid-Induced Nausea and Vomiting  (35705)

Opioid-Induced Constipation  (35706)

Transdermal Fentanyl   (35707)

If you have any questions or suggestions for other topics, please contact:

Caroline Alterman, MSN, RN, CNL - AHS Pain Management

Office phone: 223-1229 - Mercy Medical Center

738-2089 - St. Elizabeth Hospital

calterma@affinityhealth.org

Concurrent Care for Children Implementation Tool Kit by the NHPCO

On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act (PPACA) into law enacting a new provision, Section 2302, termed the “Concurrent Care for Children” Requirement, the CCCR.  This means all children with a life threatening illness can receive full treatment and still have the support of hospice care. See links below for the tool kit.

Nancy

The National Hospice and Palliative Care Organization has a wonderful resource on concurrent care for children. You can find their toolkit on their website, or use this direct link.  

This can be a wonderful resource for developing guidelines, policies or procedures for implementing concurrent care for children.