Symptom Relief Kit: Innovative Symptom Control in Palliative Care

Symptom Relief Kit: Innovative
 Symptom Control in Palliative
           Care
                 Suzanne d’Entremont RN, BScN
        District Executive Director, VON Tri-County, NS
        Chief of Practic, VON Canada, Eastern Canada

The Issue

• The notion of a SRK (Symptom Relief Kit)
  was developed subsequent to the need
  identified by frontline nurses providing
  palliative care
• Client takes a quick, unexpected turn,
  condition deteriorates rapidly
• Med management for acute episodes and
  treatment had not been determined yet
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The Issue

• Nurse not able to reach/contact physician
  to get meds/orders to relieve acute
  symptoms of the dying client
• Client destined to either die an agonizing
  death at home, with support folks/family
  agonizing as well, or chose to be
  transported to hospital to end life on a
  stretcher in ER, not at home surrounded
  by loved ones at home as was their wish
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SRK Committee formulation

• Discussions with district palliative care physician
  and district palliative and supportive care team
• Multi-disciplinary committee formed comprised
  of:
   –   Dr. Leahey, Palliative Care Physician
   –   Thelma Newell, RN, VON Nurse
   –   Ellen Pothier, RN, VON Nurse
   –   Sheila d’Eon, District Palliative Nurse
   –   Nancy Castlebury, Supportive Care Manager
   –   Denise Roman, Long Term Care
   –   Bruce Johnson, Pharmacist, local pharmacy
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Goal of SRK committee

• Work together in partnership to develop a
  SRK to reduce the time delay in control of
  symptoms experienced by palliative clients
  in their home by having selected
  medications readily available for palliative
  emergencies

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Symptom Relief Kit

• The kit has been designed to provide 24-48 hour
  supply of commonly used medications in end-of-
  life care at home for crisis managment
• The kit is only to be used for emergency
  situations, however it’s use has been modified
• Meds contained may be given by nurse on a
  PRN basis as indicated by physician following
  doctor’s order sheet

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Guided by VON Mission

• Leadership in community based care,
  demonstrating the core values of VON
   – Respect to the needs of the dying client and
     family
   – Participation of the client and family, nurse
     and physician in decisions made to affect care
   – Responsiveness to an identified need
   – Courage to take the challenge and make a
     difference
        • Hope for a “good death”
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SRK and VON Care and Service Model

• Core of Care and Service Model is person, family
  and social network, community and society
• The process has encompassed the core utilizing
  practice, policy and the research to promote the
  desired outcomes
• Process has an evaluation component, which
  includes the family/support network of the client
  as well as other health care providers involved in
  care
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Process….

• December 2006 – committee is formed
• We know what is needed…how do we make it
  available to nurses 24/7?
   – Partnership with 8 long term care facilities to house
     SRKs (in three counties covering a large geographical
     area)
   – Process developed
   – Education to district team members, ie. Physicians,
     nurses, LTC
   – Pharmacy to develop, maintain and refill kits
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We need money…..

• Provincial government DOH has
  medication coverage in 10 year plan,
  however, not able to provide financial
  support at this time
• District Health Authority approached and
  supports initiative with $5000 for first year
  and $10,000 for second year

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First kit in place October 2007

• Nurse determines need for SRK use
• Call or fax physician to request SRK
   – Ensure MD signs Expected Death at home and DNR
     forms
• Receipt of order sheet from physician
• VON nurse infomrs LTC of name of family
  member (or advocate) who will be picking up kit
• VON nurse signs release form for SRK for family
  member to bring to LTC
   – Sign out sheet is kept at the LTC facility
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Testament…

• Kits have been utilized at least 140 times since
  October 2007
• “SRK has been transformational in providing
  best care to our patients with terminal illnesses
  who chose to spend the end of their life at
  home”. Dr. Leahey
• “medical colleagues have benefited from this
  program as well. They have enhanced their
  knowledge of best options for palliative
  symptom relief and become more familiar (and
  appreciative) of VON services” Dr. Leahey
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Accreditation Canada…

• “The SRK was developed and implemented
  across the continuum of care with input from
  doctors, nurses, specialists, the Victorian Order
  of Nurses, Continuing Care and patients. It is
  stored in the nursing home venues and
  accessible 24 hours per day. The availability of
  these kits has dramatically reduced the need for
  admission for sudden pain control of the
  palliative care population. It is a great success
  story”
   – Accreditation Canada, South West Nova District
     Health Authority, October, 2008

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Testament….

• “nurses utilizing the kit have found it to be
  comprehensive, accessible, responsive and
  realistic. It has helped to clarify the necessary
  processes required to effectively care for clients
  who wish to die at home”
• “the accessibility of the kit, availability of
  necessary meds and practicality of its
  implementation has enhanced the quality of life
  for palliative clients and their families’
  experience of death in the home”
   – Margaret O’Neil, RN, BScN, NP, staff nurse, VON
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