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Table 3 Overview of QIs

From: Consensus on quality indicators to assess the organisation of palliative cancer and dementia care applicable across national healthcare systems and selected by international experts

1. Access to palliative care
1a. Access and availability
1. A specialist palliative care team* is available 24/7.
2. Specialist palliative care* advice is available 24/7 to professionals delivering palliative care.
3. Bereaved relatives and/or professionals involved in care of a person in need of palliative care are offered support during the bereavement process if they need or wish to have support.
1b. Out of hours care
4. Opioids are accessible and available for persons in need of palliative care 24/7.
5. Co-analgesics* for symptom control are available to treat persons in need of palliative care 24/7.
1c. Continuity of care
6. An (electronic) file of a person in need of palliative care is accessible to professionals in charge of the person 24/7.
7. At each transition between care settings, comprehensive information (including care goals and care plan) of a person in need of palliative care is be transferred to the professional(s) in charge in the next setting.
8. The professional in charge of the person is informed before a person in need of palliative care is discharged home or sent to the next setting.
9. Persons in need of palliative care have an assigned contact person who maintains regular contact with the person and their families, and ensures coordinated delivery of health and social care.
2. Infrastructure
10. Specialised equipment (e.g. anti decubitus mattresses, suction equipment, stoma care, oxygen delivery, drug administration pumps, hospital beds, etc.) is available to persons in need of palliative care.
11. Single bedrooms are available for persons who are dying and who wish to have one.
12. Family members and friends are able to visit the dying person without restrictions of visiting hours.
13. There are facilities for relatives to stay overnight with their dying relative.
14. There is a private area for saying goodbye to the deceased, nearby or on the ward/unit where the person died.
3. Assessment tools
15. There is a regular assessment of pain and other symptoms using a validated instrument*.
4. Personnel
4a. Team
16. The multidisciplinary team* that delivers palliative care services consists of at least:
a) a physician and nurse;
b) and has access to one or more of the following professionals: physiotherapist, psychologist, occupational therapist, social worker, chaplain, dietician.
17. There is a weekly multidisciplinary meeting with at least the physician and nurse in charge of the person in need of palliative care to review treatment and care plans.
4b. Sharing information
18. The file of the person in need of palliative care contains documentation of a discussion with the person or representative (if the person lacks capacity e.g. is unable to communicate) about:
a) medical condition;
b) goals for treatment;
c) the physical*, psychosocial and spiritual needs of the person and family caregiver;
d) an advance directive or advanced care plan;
e) end-of-life decisions*;
f) the intention to return home or to another facility from the place where the person is currently staying.
5. Documentation of clinical data
5a. Clinical records
19. The file of the person in need of palliative care contains a medication list that is accessible to the professionals caring for the person.
5b. Timely documentation
20. Within 48 hours of admission to the service, the file of the person in need of palliative care contains documentation of the initial assessment of:
a) pain and other symptoms, using a validated instrument*;
b) psychosocial and spiritual needs;
c) persons preferences, wishes and needs;
d) capacity to be involved in the decision making process.
6. Quality
21. Family and caregiver experiences of the palliative care service are assessed/evaluated/recorded.
22. An end-of-life care pathway (such as the Liverpool Care Pathway) was used for the last 3 days of life of a person in need of palliative care.
7. Education
23. All professionals that deliver palliative care services receive accredited training in palliative care, appropriate to their discipline.
NB Where person is stated, one can also read patient.
Glossary
Palliative care team: A home palliative care team provides specialised palliative care* to patients who need it at home (or home replacing institute) and support to their families and carers at the patient’s home. They also provide specialist advice to general practitioners, family doctors and nurses caring for the patient at home. The core team of a home palliative care team consists of four to five full-time professionals and comprises physicians and nurses with specialist training, a social worker and administrative staff. The home palliative care team works in close collaboration with other professionals so that the full range of multi-professional team work can be realised in the home-care setting. (Source: Radbruch L, Payne S: White paper on standards and norms for hospice and palliative care in Europe: part 2. European Journal for Palliative Care 2010, 17:2233).
A hospital palliative care support team provide specialist palliative care* advice and support to other clinical staff, patients and their families and carers in the hospital environment. They offer formal and informal education, and liaise with other services in and out of the hospital. A hospital palliative care support team is composed of a multiprofessional team with at least one physician and one nurse with specialist palliative care training. The team should have ready access to other professionals working in liaison with it, including bereavement specialists, chaplains, dietitians, therapists, oncologists, pharmacists, physiotherapists, psychiatrists, psychologists, social workers and speech and language therapists. (Source: Radbruch L, Payne S: White paper on standards and norms for hospice and palliative care in Europe: part 2. European Journal for Palliative Care 2010, 17:2233).
A team is hereby defined as a group of people organized to work together, which consists of at least a nurse and a physician.
Specialist palliative care: Specialist palliative care is provided by specialised services for patients with complex problems not adequately covered by other treatment options. Specialist palliative services require a team approach, combining a multiprofessional team with an interdisciplinary mode of work. Team members must be highly qualified and should have their main focus of work in palliative care. (Source: Radbruch L, Payne S: White paper on standards and norms for hospice and palliative care in Europe: part 2. European Journal for Palliative Care 2010, 17:2233).
Co-analgesics: An adjuvant (or co-analgesic) is a drug that in its pharmacological characteristic is not necessarily primarily identified as an analgesic in nature, but that has been found in clinical practice to have either an independent analgesic effect or the additive analgesic properties when used with opioids. (Source: Khan M.I.A., Walsh D., Brito-Dellan N: Opioid and Adjuvant Analgesics: Compared and Contrasted. AM J HOSP PALLIAT CARE 2011, 28(5) 378–383)
Validated instrument: Instruments such as the Visual Analogue Scale (VAS) or the Numeric Rating Scale (NRS) that can be used to indicate the severity of the patient’s pain or other symptom. (Source: Ahmedzai S, Gómez-Batiste X, Engels Y, Hasselaar J, Jaspers B, Leppert W, Menten J, Mollard JM, Vissers K: Assessing Organisations to Improve Palliative Care in Europe. Nijmegen: Vantilt Publishers; 2010).
End-of-life decisions: End-of-life care may be used synonymously with palliative care or hospice care, with end of life understood as an extended period of one to two years during which the patient/family and health professionals become aware of the life-limiting nature of their illness. End-of-life care may also be understood more specifically as comprehensive care for dying patients in the last few hours or days of life. Either way, the patient preserves his/her self-determination regarding the power of decision on place of care, treatment options and access to specialist (palliative) care. End-of-life decisions are all the decisions made by the patient/family and health professionals regarding this last phase of a patient’s life, e.g. decisions that may influence the time of death, either prolonging life (or prolonging dying) or shortening life (or let patients die). (Source: Radbruch L, Payne S: White paper on standards and norms for hospice and palliative care in Europe: part 1. European Journal for Palliative Care 2010, 16(6):278289).
Physical needs: For example if the patients physical symptoms require certain needs, such as special bed, walking aid, etc.