Asking patient about the extent of pain and assessing systematically.Continue reading “Pain Assessment- ABCDE Mnemonic Approach (Reading & Sharing)”
The prevalence of pain varies by dx, stage of disease, and setting of care. Approximately 1/3 of patients with cancer experience pain at the time of diagnosis, while 2/3 with metastatic disease report pain. Less is known about the prevalence of pain in those with diagnoses other than cancer.
Pain is described by the World Health Organization as a “multidimensional phenomenon with sensory, physiological, cognitive, affective, behavioral and spiritual components.” Pain is a complex biopsychosocial phenomenon, an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in these terms. (Pain is whatever the patient says it is.)Continue reading “Pain Management at the End of Life (Reading and Sharing)”
- Quality improvement is not a department or a single entity, but an ongoing conglomeration of approaches for improving cost reduction, efficiency, satisfaction scores, and overall outcomes. Research-based outcomes are now the standard for implementing changes within an organization. Bechmarking against successful organizations is another tool used in quality improvement, as well as surveys, root cause analysis, and a continual re-evaluation process.
- Medicare is very particular as to what is covered under hospice care. The patient’s prognosis must be 6 months or less to live. Focus is not on heroic intervention or expensive testing for simple symptom management. Also, keep the goals of care in mind when considering orders, and continue to discuss the patient’s case at interdisciplinary meetings.
- Veracity is the duty to tell the truth
- Beneficence is the duty to act in a way that would best benefit the patient
- Non-maleficence is the duty to do no harm
- Justice is fairness for all
- The HITECH Act’s modification to the HIPPA Privacy Rule, effective January 2018, grants access to a patient’s personal health information (PHI) 50 years after a patient has died.
- Risk factors for complicated grief include a history of mental illness, substance abuse, previous loss, and sudden unexpected death. Medicare pays for bereavement counseling for up to 1 year after the patient’s death. Additional grief counseling would then be through a local support group. Studies have shown that men are less likely than women to openly express emotions or openly cry. This is felt to be a reflection of social norms for males having to show strength, and crying being perceived as a sign of weakness. Men often prefer to grieve alone or in private.
- Portal hypertension often occurs in the presence of cirrhosis. Increased intrahepatic vascular resistance, and increased blood flow through the portal venous system, leads to the development of portosystemic collateral veins. With medium to large veins in the esophagus, the patient has up to a 30% chance of bleeding out within 2 years.