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CAPC Palliative Care Discussion Forum
Designing a Program

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Post Starting upa program
Author: LisaFrostRN
Date: May 26, 2012 11:52 am
I am a RN finishing my CNS who is currently beginnng a new Palliative Care service in a 250 bed acute care hospital. A few questions we are currently facing are: 1. Do most programs start with nurse driven consults or by primary physician order only? 2. Is it acceptable to start in the ICU seeing patients or has it been more beneficial to start housewide?
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Re:Starting upa program (by SharolHerr on 06/01/2012)
Lisa, congratulations on finishing your CNS. That is a great accomplishment. Starting a program is much more than hanging out a shingle. CAPC and PCLC encourage hospitals to go through a planning process that encourages completing a system assessment and mission alignment, establishing and education and marketing plans, creating a financial case for having a palliative service, establishing partnerships and collaboration and then developing an infrastructure that includes policies, job descriptions and routine processes for the service. The answers to your questions would be revealed once you complete the assessment I've described below. Some institutions start with a nurse led programs and others start with a physician. Certainly emphasizing ICU is important but you need to be able to repond to needs throughout the hospital. I would encourage you to talk with an administrator or physician leader who supports the development of the program about the feasibility of attending a PCLC training. This would give you a significant jump-start to having a successful and structured program. More information about the training and sites that offer the training are available on the CAPC website.
Sharol Herr, RN, BSN, MSEd, CHPN; Palliative Clinical Manager; Mount Carmel Health Palliative Care Leadership Center; Columbus, Ohio.
Re:Starting upa program (by ndarmstrong on 06/14/2012)
Lisa, I echo Sherol's comments: I am now 2 years out from starting an IN-Patient PCCS. We did the assessments recommended by CAPC to the letter, and we determined the greatest need was with the Hospitalists and the PCPs. Working in a scatter-bed design took us to the ICUs but that has been slow compared to the other services.

From my perspective, there are several advantages to a scatter-bed design when starting a PCCS:

(a)teaching opportunity, PC is a new service and most physicians, hospital staff, patients and community are not familiar with the concepts or the benefits; you have to develope a PC Culture;

(b) support service, allays fears that we are not intruding in the ICU physician/PCP's expertise but acting as a support for the physician, staff, patient and family;

(c) customer satisfaction - administration sees the satisfaction scores from patients and families as well as the physicians and employees, excellent marketing tool - garners additional support for the program;

(d) financial benefits, cost avoidance - new concept that needs to be emphasized for administration as we are not a major revenue source, although we have been able to bill and support the budget costs.

Being visible in many areas is the greatest internal marketing tool, develops rapport, generates consults, supports program growth; allows ICU, ER, NICU, Peds, to experience benefits of PC, and allows the program to set future goals for PC Teams in these specialty departments.

These are my reflections from the past 2 years, thanks for allowing me to share them with you.
Bernita Armstrong, DNP, APRN-BC

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