Download Free Medical Palliative Care For Heart Failure Patients-Practical Tips For Home Based Programs PowerPoint Presentation

Palliative Care For Heart Failure Patients-Practical Tips For Home Based Programs PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "PALLIATIVE CARE FOR HEART FAILURE PATIENTS: PRACTICAL TIPS FOR HOME BASED PROGRAMS" by Parag Bharadwaj, MD, Anjali Chandra, MD, Donna Stevens, BS and Ernst R. Schwarz, MD, PhD.

This medical PowerPoint presentation talks about palliative care for heart failure patients.

Palliative care is a multidisciplinary approach to improving the quality of life of patients and their families facing serious illnesses. Heart failure is a chronic condition that affects millions of people worldwide and can be a life-limiting disease. Palliative care can play an essential role in improving the quality of life for heart failure patients.

The goal of palliative care for heart failure patients is to relieve symptoms, reduce suffering, and improve quality of life. This can be achieved through a variety of interventions, including pain management, symptom control, emotional support, spiritual care, and end-of-life planning.

Tags : palliative care for heart failure patients, heart failure, cardiology, cardiology PowerPoint presentation

Published on : Mar 17, 2023 | Views : 888 | Downloads : 1

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Slide 1-

National Hospice and Palliative Care Organization’sPalliative Care Resource Series PALLIATIVE CARE FOR HEART FAILURE PATIENTS: PRACTICAL TIPS FOR HOME BASED PROGRAMS Parag Bharadwaj, MD Anjali Chandra, MD Donna Stevens, BS Ernst R. Schwarz, MD, PhD
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INTRODUCTION More than 5 million people suffer from heart failure (HF) in the US Half the people who develop HF die within 5 years of diagnosis HF has a high symptom burden Palliative care intervention provides comfort and optimization of treatment plan and goals
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OVERVIEW HF Definition Pathophysiology Clinical Features Disease Management Palliative Care in HF Patients at Home
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DEFINITION OF HEART FAILURE HF is a pathophysiologic condition in which the efficiency of the myocardium is reduced through damage and overloading, resulting in decreased cardiac output (CO) and circulatory failure Characterized by recurrent decompensation and persistent symptoms
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RELEVANT PATHOPHYSIOLOGY Heart fails to pump adequate blood to meet the requirements of the metabolizing tissues Types Systolic HF Impaired contractile function of the heart with reduced ejection fraction (EF) EF < 40% might indicate systolic HF Diastolic HF Impaired ventricular filling during relaxation phase Normal EF of 55 – 60%
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CLINICAL FEATURES Predominant Symptoms Shortness of Breath Exceptional Dyspnea Orthopnea Paroxysmal Nocturnal Dyspnea Acute Pulmonary Edema Pain around the chest and other parts of the body is under diagnosed
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CLINICAL FEATURES Other Common Signs and Symptoms: Fatigue Weakness Weight Gain Nausea and Bloating Sexual Dysfunction Insomnia Lack of Concentration Cognitive Decline Memory Loss Muscle Wasting Cachexia
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DISEASE MANAGEMENT Non-Pharmacological Interventions Exercise Diet Sodium Restriction Fluid Restriction Nutrition
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DISEASE MANAGEMENT Pharmacological Interventions Diuretics Vasodilator Inotropes Beta Adrenergic Receptor Blockers Angiotensin-Converting Enzyme Inhibitors (ACEIs) Angiotensin II Receptor Blockers (ARBs) Supplemental Oxygen
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DISEASE MANAGEMENT Invasive Strategies Electrophysiologic Intervention Devices: CRT and pacemakers Ventricular Assist Device (VAD) Revascularization Procedures: CABG and PCI Valvular Surgery: valve replacement or repair, ventricular restoration
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PALLIATIVE CARE FOR HF PATIENTS AT HOME Meeting the patients’ needs at home lessens the patient and caregiver burden and prevents avoidable hospital admissions Delivery of this type of care requires intense planning and care coordination between all involved medical specialties and additional support Team involved includes Palliative Care, Primary Care, Cardiology, as well as some additional community partners such as Home Care, Parish Nurses and Area Agency on Aging
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CLINICAL: AREAS OF FOCUS Vital Signs, with special attention to: Oxygen Saturation 5th vital sign - pain Physical Exam Labored Breathing Fluid Overload Jugular Venous Distention (JVD) Auscultation of Lungs: Crackles Pedal Edema
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CLINICAL: AREAS OF FOCUS Weight and Fluid Input/Output Weight Gain – Fluid Overload Input should be less than output Insensible Water Loss: 600 – 900ml/day Functional Status (use one tool consistently) Suggest Palliative Performance Scale (PPS) Monitor for change – fluid overload, progression of disease Prognostic implications
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CLINICAL: AREAS OF FOCUS Screening for Symptoms (use one tool consistently) Suggest Edmonton Symptom Assessment Scale (ESAS) Medication Reconciliation Assess ability to manage medications Ensure understanding, purpose and importance of each medication Ensure adequate supply of medication to optimize compliance
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CLINICAL: AREAS OF FOCUS Hardware Check (pacemakers, ICDs) Relevance of the devices in relation to goals needs to be revisited on a regular basis Intravenous Inotrope Infusions Requires higher level of maintenance Fixed dose, usually not titrated
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CLINICAL: AREAS OF FOCUS VADs and Post Transplant Patients Experienced multi-disciplinary team must be involved in management Protocols placed in advance, including turning off the device at home Review of Records Essential to know baseline of clinical parameters in order to identify significant changes
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CLINICAL: AREAS OF FOCUS Any changes in the areas of focus will require a more thorough assessment to determine changes needed in the home regimen or to escalate care to the next level, such as setting up an appointment with the cardiologist or transfer to the hospital All changes should be implemented in collaboration with the HF service
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ADDITIONAL NEEDS ASSESSMENT: AREAS OF FOCUS Emotional and Financial Support Screening Request social worker follow-up, if needed, in addition to routine social worker visits Spiritual Needs Screening Request chaplain visit, if needed, in addition to routine chaplain visits Caregiver Screening Ensure social worker and chaplain support to caregiver(s) Monitor for burnout
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PATIENT GOALS: AREAS OF FOCUS Care plan and patient goals should be reviewed frequently with the patient and caregiver to ensure the appropriate care is being delivered Every patient should have an advance directive completed, preferably a POLST (Physician Orders for Life Sustaining Treatment) Any changes should be promptly reflected in the document Documents should be readily available to patient, caregiver and paramedics (if called)
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PATIENT GOALS: AREAS OF FOCUS Depending on the patient’s clinical status, options and goals should be readdressed on a regular basis Informing the patient and the caregiver of options, including hospice, is necessary
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REVIEW AND EDUCATION: AREAS OF FOCUS Any changes in the treatment plan should be given to the patient and caregiver in writing and reviewed with them during the visit Before leaving the patients’ residence, patients and/or caregivers should be instructed to call the palliative care service with any questions or concerns. A back-up plan must be in place when the service is not available. Ideally, a call to the primary physician/cardiologist should be made from the patient’s home during every visit and the plan of care should be reviewed
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OPERATIONAL Outline scope of practice of each team member Optimization of care requires team function as one unit with team members being able to rely on each other Routine Interdisciplinary Team (IDT) meetings are essential
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OPERATIONAL Role delineation is vital Meet with primary care colleagues and the cardiology team to establish parameters Strong relationship with cardiology and primary care is essential Involve all specialties during regular patient care meetings Operational communication is vital for discussing changes such as protocols and practice personnel
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OPERATIONAL Emergency strategy needs to be set up Off-work hours plan needs to be in place if your service is not 24/7 Clinical and operational data, patient/family satisfaction and referring entity satisfaction should be collected and reviewed routinely Additional support from cardiology is essential if palliative care becomes involved with VAD patients
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OPERATIONAL Expected Outcomes Improved continuity and quality of care Decrease in ER visits and hospitalizations Increased adherence to patient goals Improved patient and provider satisfaction
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SUMMARY: LESSONS LEARNED AND BEST PRACTICES A well-coordinated team is required, preferably with a shared electronic medical record Frequent team meetings allow other insights and techniques; each home setting is unique and requires attention and respect for the environment Focus should be on keeping the patient comfortable and meeting patient/family goals, versus just avoiding hospitalizations. Some hospitalizations may be appropriate
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SUMMARY: LESSONS LEARNED AND BEST PRACTICES Prevention and preventative plans are vital Home is where the heart is; figuring out how to eliminate obstacles for patients is part of the terrain Social interactions and being able to give to others in some way is good medicine
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SUMMARY: LESSONS LEARNED AND BEST PRACTICES An office nurse coordinator who will work with the palliative care provider(s) and triage phone calls, provide clinical input, assist with care coordination and manage referrals maximizes the providers’ time Relationships develop in a different way when in the home; resiliency and self-care must be part of this work