Developing the section of palliative care at St Paul's Hospital Iloilo
Developing the section of palliative care at St Paul's Hospital Iloilo
Developing the section of palliative care at St Paul's Hospital Iloilo
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
<strong>Developing</strong> <strong>the</strong><br />
Section <strong>of</strong> Palli<strong>at</strong>ive Care<br />
<strong>at</strong> <strong>St</strong> Paul’s s <strong>Hospital</strong> <strong>Iloilo</strong>,<br />
Philippines<br />
Dr. Jesus Eugenio G. de Jesus<br />
Consultant, Dept <strong>of</strong> Family Medicine<br />
<strong>St</strong>. Paul’s s <strong>Hospital</strong><br />
<strong>Iloilo</strong> City, Philippines
Project Background<br />
• Cancer<br />
– 3 rd most frequent<br />
disease in <strong>the</strong><br />
Philippines<br />
– 70% <strong>of</strong> Filipino cancer<br />
p<strong>at</strong>ients are deemed<br />
incurable upon time <strong>of</strong><br />
diagnosis<br />
– comprises 10% <strong>of</strong><br />
de<strong>at</strong>hs in <strong>the</strong><br />
Philippines and <strong>at</strong> <strong>St</strong>.<br />
Paul’s s <strong>Hospital</strong> <strong>Iloilo</strong>
<strong>St</strong>. Paul’s s <strong>Hospital</strong> <strong>Iloilo</strong><br />
• A hospital th<strong>at</strong> is<br />
Christ-centered,<br />
dynamic, committed<br />
to providing holistic<br />
quality health <strong>care</strong><br />
• To be <strong>the</strong> first<br />
C<strong>at</strong>holic medical<br />
facility in Western<br />
Visayas to propag<strong>at</strong>e<br />
<strong>palli<strong>at</strong>ive</strong> <strong>care</strong>
SPH Palli<strong>at</strong>ive Care Section<br />
General Objectives:<br />
• To elev<strong>at</strong>e <strong>the</strong> quality <strong>of</strong> life <strong>of</strong> terminally<br />
ill cancer p<strong>at</strong>ients<br />
• To allay <strong>the</strong> concerns <strong>of</strong> <strong>the</strong> family as to<br />
<strong>the</strong> p<strong>at</strong>ient’s s end-<strong>of</strong><br />
<strong>of</strong>-life <strong>care</strong><br />
• To coordin<strong>at</strong>e with o<strong>the</strong>r services<br />
providing continuing <strong>care</strong> for p<strong>at</strong>ients<br />
and <strong>the</strong>ir families
SPH Palli<strong>at</strong>ive Care Section<br />
Services:<br />
• Access to medical experts<br />
• Counseling with regards to issues <strong>of</strong> de<strong>at</strong>h,<br />
dying and bereavement<br />
• Assistance to families in arranging home <strong>care</strong><br />
• Spiritual <strong>care</strong> for <strong>the</strong> p<strong>at</strong>ient and family<br />
• Coordin<strong>at</strong>ion with home <strong>care</strong> teams<br />
• Continuing educ<strong>at</strong>ion for health <strong>care</strong><br />
pr<strong>of</strong>essionals in caring for terminally ill p<strong>at</strong>ients
SPH Palli<strong>at</strong>ive Care Section<br />
The Clients:<br />
• Terminally ill<br />
p<strong>at</strong>ients and <strong>the</strong>ir<br />
families<br />
• Concerned<br />
individuals<br />
The Team:<br />
• Family Medicine<br />
resident physicians<br />
• Nurse Clinicians<br />
• Pastoral Care Provider<br />
/ Medical Social<br />
Worker
SPH Palli<strong>at</strong>ive Care Section<br />
In-P<strong>at</strong>ient<br />
Consult<strong>at</strong>ion<br />
Service<br />
In-P<strong>at</strong>ient<br />
Hospice<br />
Components <strong>of</strong><br />
Palli<strong>at</strong>ive Care<br />
Section<br />
Out-P<strong>at</strong>ient<br />
Clinic
SPH Palli<strong>at</strong>ive Care Section<br />
Components<br />
In-P<strong>at</strong>ient<br />
consult<strong>at</strong>ion service<br />
– Referral system<br />
– P<strong>at</strong>ients remain under<br />
<strong>the</strong> <strong>care</strong> <strong>of</strong> <strong>the</strong>ir<br />
<strong>at</strong>tending physicians
SPH Palli<strong>at</strong>ive Care Section<br />
Components<br />
In-P<strong>at</strong>ient hospice<br />
– 2-bedded facility<br />
– Terminally ill p<strong>at</strong>ients<br />
may be warded if<br />
dying or deemed too ill<br />
to be sent home<br />
– Advanced directives<br />
must be executed<br />
prior to transfer
SPH Palli<strong>at</strong>ive Care Section<br />
Components<br />
Out-P<strong>at</strong>ient clinic<br />
– Open on weekdays,<br />
<strong>of</strong>fice hours<br />
– Palli<strong>at</strong>ive <strong>care</strong> consults<br />
– O<strong>the</strong>r services:<br />
Ostomy <strong>care</strong>, wound<br />
<strong>care</strong>, nasogastric tube<br />
or urinary ca<strong>the</strong>ter<br />
insertion/replacement
SPH Palli<strong>at</strong>ive Care Section<br />
Care P<strong>at</strong>h For<br />
<strong>the</strong> Terminally Ill<br />
To In-P<strong>at</strong>ient Hospice<br />
To Home<br />
With Follow-up<br />
At Palli<strong>at</strong>ive Care Section<br />
Out-P<strong>at</strong>ient Clinic<br />
To Home<br />
With Support From<br />
Palli<strong>at</strong>ive Care Section
SPH Palli<strong>at</strong>ive Care Section <strong>St</strong>aff<br />
Physicians<br />
Nurse Clinicians<br />
Pastoral Care/<br />
Medical Social Worker
SPH Palli<strong>at</strong>ive Care Section <strong>St</strong>aff<br />
• Physicians:<br />
– Palli<strong>at</strong>ive Care<br />
Consultant<br />
– Family Medicine<br />
Resident Physician -<br />
Palli<strong>at</strong>ive Care rot<strong>at</strong>or<br />
– Residents from o<strong>the</strong>r<br />
departments willing to<br />
learn <strong>palli<strong>at</strong>ive</strong> <strong>care</strong><br />
are welcome
SPH Palli<strong>at</strong>ive Care Section <strong>St</strong>aff<br />
• Nurse Clinicians:<br />
– Interested to learn<br />
Palli<strong>at</strong>ive Care Nursing<br />
– Willing to remain in <strong>the</strong><br />
program<br />
– Training to be provided by<br />
Palli<strong>at</strong>ive Care Consultant<br />
or through short courses<br />
– Temporary <strong>at</strong>tachment to a<br />
<strong>palli<strong>at</strong>ive</strong> <strong>care</strong> <strong>section</strong> or<br />
home hospice should be<br />
considered
SPH Palli<strong>at</strong>ive Care Section <strong>St</strong>aff<br />
• Pastoral Care Provider<br />
– Preferably a SPC nun<br />
trained in counseling<br />
– Provide Christ-<br />
centered psycho-<br />
spiritual <strong>care</strong> <strong>of</strong><br />
terminally ill p<strong>at</strong>ients<br />
and <strong>the</strong>ir families<br />
– Help facilit<strong>at</strong>e social<br />
services in case no<br />
medical social worker<br />
available
SPH Palli<strong>at</strong>ive Care Section <strong>St</strong>aff<br />
• Medical Social Worker<br />
– Provide counseling and<br />
psychological support<br />
to p<strong>at</strong>ients and <strong>the</strong>ir<br />
<strong>care</strong>givers<br />
– Facilit<strong>at</strong>e social<br />
services and<br />
appropri<strong>at</strong>e placement<br />
<strong>of</strong> p<strong>at</strong>ients
Proposed Phases <strong>of</strong> Development<br />
• Phase I: to start upon approval by <strong>the</strong> <strong>Hospital</strong>’s<br />
Executive Committee<br />
– Physicians: Palli<strong>at</strong>ive Care Consultant, Family<br />
Medicine Resident - Palli<strong>at</strong>ive Care Rot<strong>at</strong>or<br />
– Nurses: Senior staff nurses interested in <strong>palli<strong>at</strong>ive</strong><br />
<strong>care</strong> nursing<br />
– Pastoral Care/Social Worker: May ei<strong>the</strong>r be from a<br />
nun from <strong>the</strong> SPC community or social worker<br />
sourced elsewhere<br />
– Focus <strong>of</strong> Care: initially solely on terminally ill cancer<br />
p<strong>at</strong>ients
Proposed Phases <strong>of</strong> Development<br />
• Phase II: from 2010 onwards<br />
– Physicians: Palli<strong>at</strong>ive Care Consultant, Family<br />
Medicine Resident - Palli<strong>at</strong>ive Care Rot<strong>at</strong>or<br />
– Nurses: A full-time Nurse Clinicians, Senior staff<br />
nurses interested in <strong>palli<strong>at</strong>ive</strong> <strong>care</strong> nursing<br />
– Pastoral Care/Social Worker: May ei<strong>the</strong>r be from a<br />
nun from <strong>the</strong> SPC community or social worker<br />
sourced elsewhere<br />
– Focus <strong>of</strong> Care: To progress to all terminally ill p<strong>at</strong>ients<br />
in need <strong>of</strong> <strong>palli<strong>at</strong>ive</strong> <strong>care</strong>
Cost <strong>of</strong> Running <strong>the</strong> Service<br />
• Equipment<br />
– Not dependent on high technology equipment<br />
• <strong>St</strong>aff<br />
– Palli<strong>at</strong>ive <strong>care</strong> staff can be sourced from<br />
inside <strong>the</strong> hospital<br />
– Training and employment <strong>of</strong> nurse clinicians<br />
should be considered
SPH Palli<strong>at</strong>ive Care Section Benefits<br />
• The first priv<strong>at</strong>e and<br />
C<strong>at</strong>holic institution in <strong>the</strong><br />
Western Visayas th<strong>at</strong><br />
provides consistent and<br />
holistic quality health <strong>care</strong>,<br />
even <strong>at</strong> <strong>the</strong> end <strong>of</strong> life<br />
• Ensure continuous <strong>care</strong><br />
for terminally ill p<strong>at</strong>ients<br />
• Increased turnover <strong>of</strong><br />
hospital beds<br />
• Increased p<strong>at</strong>ient <strong>care</strong><br />
s<strong>at</strong>isfaction
Anticip<strong>at</strong>ed Paradigm Shifts<br />
• Emphasis on quality <strong>of</strong> life<br />
• Wider utiliz<strong>at</strong>ion <strong>of</strong> advanced directives<br />
• A more receptive and responsive medical<br />
and nursing staff as to <strong>the</strong> use <strong>of</strong> opioids,<br />
particularly morphine, for end <strong>of</strong> life <strong>care</strong><br />
• Researches in Palli<strong>at</strong>ive Care
Thank you for listening!<br />
Good morning!