Reply To: End of Life Care issues and staffing

  • Deborah Lafond

    Member
    February 10, 2021 at 7:21 pm

    At Children’s National in DC we developed an intensive education and mentoring program (PANDA Cubs). This occurs over a 12 month period (2 days similar to ELNEC-PPC, 2 hour quarterly education sessions, and a 1 day final intensive). All participants complete an application and are chosen based on unit needs and their own essay of why the my want to attend.  Each participant is also expected to complete a unit based QI project to establish meaning and improve unit based outcomes. We have established unit based palliative and EOL champions who then serve as resources to other staff on the unit. To date we have trained 271 frontline interdisciplinary clinicians throughout the hospital and community hospices. (In 5 cohorts). Outcomes have been phenomenal for improving knowledge, attitudes, and skills.  In staffing for EOL care, we try to have 1:1 or 1:2 ratios when possible with resource help from the unit based PANDA Cubs as needed.  Happy to talk more about this program if anyone is interested.  dlafond@pandaedcon.org.  This program has been replicated in several other hospitals around the country with similar outcomes.

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    Deborah Lafond, DNP,CHPPN,CPON,PPCNP-BC
    Chief Executive Officer
    Bartow, FL
    United States
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    Original Message:
    Sent: 02-10-2021 04:03 PM
    From: Laura Bermudez
    Subject: End of Life Care issues and staffing

    Hi Linda,

     

    Thank you for your detailed feedback.  I would love to be able to see the material/conference you have set up.  We are in such a huge need to establish standards of care for our EOL patients.  Is that possible?

    Thank you.

    Laura B. Ramos

     

    Original Message:
    Sent: 2/10/2021 12:45:00 PM
    From: Linda Ritter
    Subject: RE: End of Life Care issues and staffing

    ​We worked really hard 8 years ago to establish EOL standards of care on our Hematology/Oncology/Stem Cell Unit. We started with a survey of the nurses to understand and establish baseline education level and found that we were all over the board. so then we started educating the nurses using ELNEC (End-of-Live Nursing Education) Materials to raise our knowledge base by hosting a 2 day Pediatric Palliative Care and End-of-Life Conference. We spoke with our managers about the practice (then) of staffing End-of-Life patients as a forth in a 3:1 pt:nurse ratio. We felt that this time, like birth, was one of the most important times in this families lives and to honor the child we wanted to intensify our nursing care. Our managers listened and we now staff our patients for End-of-Life as 2:1 or even 1:1. We encourage nurses to be aware and accept the assignment if they are able and to speak up if they have difficulty with this. We have “expert nurses” on our staff who know how to manage symptoms including pain, dyspnea, secretions, and have worked to establish standard orders sets for the physicians. Our nurses know to help with legacy building/making memories with drawings, hand prints, and photos and they work together with our Child Life Specialist, our Social Workers, our Chaplains, and our Physicians to help the patient and family along this journey that will form their memories of this time. This work is ongoing because we have new nurses coming on all the time, so we have a committee that communicates with the staff on current events and helps to debrief. It’s a work in progress but most importantly, we as nurses came up with the idea to raise our standards and to speak up  and step up to provide the care that is needed to the patient and the family during this time. Hope this helps!

    Linda

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    Linda Ritter, RN, CPON
    Pediatric Oncology RN Coordinator
    Lucile Packard Children’s Hospital, Palo Alto California
    650-721-6650
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    Original Message:
    Sent: 02-10-2021 10:47 AM
    From: Laura Bermudez
    Subject: End of Life Care issues and staffing

    Hello everyone,

    I would like to know a couple of things.  How do you manage your end of life care?  What Nurse patient ratios do you observe? Spiritual care?  Family support?

    Thank you for any feedback,
    Laura B. Ramos

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    Laura Bermudez, RN
    Winters, CA
    United States
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