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Table 1 Quality indicator set

From: Development of a set of process and structure indicators for palliative care: the Europall project

Definition of a palliative care service
1 All the services below are part of a comprehensive palliative care service: Palliative day care, Palliative home care support team, Hospice beds, Palliative hospital support team, Inpatient palliative care hospital beds, Palliative care outpatient clinic, Bereavement support Structure indicator All settings New developed
2 All the services below are part of a comprehensive palliative care service: Palliative day care Structure indicator All settings New developed
3 All the services below are part of a comprehensive palliative care service: Palliative home care support team Structure indicator All settings New developed
4 All the services below are part of a comprehensive palliative care service: Hospice beds Structure indicator All settings New developed
5 All the services below are part of a comprehensive palliative care service: Palliative hospital support team Structure indicator All settings New developed
6 All the services below are part of a comprehensive palliative care service: Inpatient palliative care hospital beds (e.g. palliative care unit) Structure indicator All settings New developed
7 All the services below are part of a comprehensive palliative care service: Palliative care outpatient clinic Structure indicator All settings New developed
8 All the services below are part of a comprehensive palliative care service: Bereavement support Structure indicator All settings New developed
Access to palliative care
A. Access and availability (All settings)
9 A palliative care team is available at the request of the treating professional/team in all of the following settings: Day care, at home, Hospital, Hospice, Nursing home, Outpatient clinic, Day care Process indicator All settings New developed
10 A palliative care team is available at the request of the treating professional/team in all of the following settings: Day care (excluding palliative day care) Process indicator All settings New developed
11 A palliative care team is available at the request of the treating professional/team in all of the following settings: At home (or home replacing institution s.a mental institution, prison) Process indicator All settings New developed
12 A palliative care team is available at the request of the treating professional/team in all of the following settings: Hospital Process indicator All settings New developed
13 A palliative care team is available at the request of the treating professional/team in all of the following settings: Hospice Process indicator All settings New developed
14 A palliative care team is available at the request of the treating professional/team in all of the following settings: Care home Process indicator All settings New developed
15 A palliative care team is available at the request of the treating professional/team in all of the following settings: Outpatient clinic (excluding palliative care outpatient clinic) Process indicator All settings New developed
16 For every professional/team specialised palliative care advice is available 24 hours a day, 7 days a week Process indicator All settings Changed
17 Patients in need of palliative care and their families have access to palliative care facilities: Throughout the entire duration of their disease Process indicator All settings Changed
18 Patients in need of palliative care and their families have access to palliative care facilities: With no extra financial consequences for the patient Process indicator All settings Changed
19 Patients receiving palliative care have access to diagnostic investigations (e.g. X-rays, blood samples) regardless of their setting Process indicator All settings Changed
Primary care (Home, Nursing home)
20 Palliative care is available for the patient and their family by:Phone Process indicator Primary care indicator Changed
21 Palliative care is available for the patient and their family by: Visiting the patient Process indicator Primary care indicator Changed
22 Palliative care is available for the patient and their family by: Bringing the patient to the service Process indicator Primary care indicator Changed
23 For a palliative patient in a crisis, the following can be arranged within 24 hours: Admission Process indicator Primary care indicator Changed
24 For a palliative patient in a crisis, the following can be arranged within 24 hours: An urgent discharge to patients home Process indicator Primary care indicator Changed
25 For a palliative patient in a crisis, the following can be arranged within 24 hours: Transfer to another setting of care Process indicator Primary care indicator Changed
B. Out of hours (All settings)
Staff
26 A member of a palliative care team is available 24 hours a day, 7 days a week: For palliative care consultation by phone Process indicator All settings Changed
27 A member of a palliative care team is available 24 hours a day, 7 days a week: To provide bedside care in a crisis Process indicator All settings Changed
Drugs
28 The following treatments are available for a palliative patient 24 hours a day, 7 days a week: Opioids and other controlled drugs Structure indicator Primary care indicator Combined/ Changed
29 The following treatments are available for a palliative patient 24 hours a day, 7 days a week: Anticipatory medication for the dying patient Structure indicator Primary care indicator Combined/ Changed
30 The following treatments are available for a palliative patient 24 hours a day, 7 days a week: Syringe drivers Structure indicator Primary care indicator Combined/ Changed
C. Continuity of care (All settings)
31 There is a procedure for exchange of clinical information across caregivers, disciplines and settings Process indicator All settings Changed
32 Before discharge/transfer/admission there is information transfer to the caregivers in the next setting regarding care and treatment Process indicator All settings Changed
33 There is a professional caregiver per individual palliative patient nominated as responsible ‘key worker‘ who coordinates care Process indicator All settings Combined/ Changed
34 The responsible ‘key worker‘ pays special attention to continuity of care within and across settings Process indicator All settings Combined/ Changed
Inpatient setting (Hospital, Palliative care unit, Hospice)
35 General practitioners (GP‘s) are routinely called when a patient is being discharged home or transferred to another setting Process indicator Inpatient setting indicator Changed
36 The discharge/transfer letter of palliative care patients contains a multidimensional diagnosis, prognosis and treatment plan (see indicator 48 Clinical record ) Structure indicator Inpatient setting indicator Changed
Primary care
37 The primary care out-of-hours service has handover forms (written or -electronic) with clinical information of all palliative care patients in the terminal phase at home Structure indicator Primary care indicator Changed
Infrastructure
A. All settings
Infrastructure
38 Specialist equipment (e.g. anti decubitus mattresses, aspiration material, stoma care, oxygen delivery, special drug administration pumps, hospital beds, etc.) is available for the nursing care of palliative care patients in each specific setting Structure indicator All settings Changed
39 There is a dedicated room where multidisciplinary team meetings within one setting takes place Structure indicator All settings New developed
40 There are dedicated facilities for multidisciplinary communications across settings: A dedicated room for meetings Structure indicator All settings Changed
41 There are dedicated facilities for multidisciplinary communications across settings: Facilities for video or telephone conferences Structure indicator All settings Changed
Information about care
42 There is an up to date directory of local caregivers and organisations that can have a role in palliative care Structure indicator All settings New developed
43 There are dedicated information about the palliative care service: A website Structure indicator All settings Changed
44 There are dedicated information about the palliative care service: Leaflets or brochures Structure indicator All settings Changed
45 Patient information should be available in relevant foreign languages Structure indicator All settings Changed
46 Appropriately trained translators should be available if professional caregivers and patient or family members do not speak the same language Process indicator All settings Changed
47 There is a computerised medical record, to which all professional caregivers involved in the care of palliative care patients have access: Within one setting Process indicator All settings Combined
IT systems
48 There is a computerised medical record, to which all professional caregivers involved in the care of palliative care patients have access: Across different settings Process indicator All settings Combined
B. Inpatient setting (Hospital, Palliative care unit, Hospice, Nursing home)
49 Consultations with the patient and/or family/informal caregivers are done in an environment where privacy is guaranteed (e.g. there is a dedicated room) Structure indicator Inpatient setting indicator Changed
50 Dying patients are able to have a single bedroom if they want to Process indicator Inpatient setting indicator New developed
51 There are facilities for a relative to stay overnight Structure indicator Inpatient setting indicator New developed
52 Family members and friends are able to visit the dying patient without restrictions of visiting hours Process indicator Inpatient setting indicator Changed
53 There is a private place (e.g. dedicated room) for saying goodbye to the deceased Structure indicator Inpatient setting indicator New developed
C. Home care
54 For a palliative care patient staying at home there is the possibility, if needed, to provide someone (a volunteer or professional) to stay overnight if needed Process indicator Home care indicator Changed
Assessment tools
55 There is a holistic assessment of palliative care needs of patients and their family caregivers (e.g. SPARC) Process indicator All settings Changed
56 There is an assessment of pain and other symptoms using a validated instrument Process indicator All settings Changed
Personnel palliative care services
A. Staff
57 The multidisciplinary team that provides palliative care consists of at least one of the following disciplines: Physician Structure indicator All settings Changed
58 The multidisciplinary team that provides palliative care consists of at least one of the following disciplines: Nurse Structure indicator All settings Changed
59 The multidisciplinary team that provides palliative care consists of at least one of the following disciplines: Spiritual/religious caregiver Structure indicator All settings Changed
60 The multidisciplinary team that provides palliative care consists of at least one of the following disciplines: Psychologist/Psychiatrist Structure indicator All settings Changed
61 The multidisciplinary team that provides palliative care consists of at least one of the following disciplines: Social worker Structure indicator All settings Changed
62 The multidisciplinary team that provides palliative care consists of at least one of the following disciplines: Physiotherapist Structure indicator All settings Changed
63 The multidisciplinary team that provides palliative care consists of at least one of the following disciplines: Occupational therapist Structure indicator All settings Changed
64 The multidisciplinary team that provides palliative care consists of at least one of the following disciplines: Dietitian Structure indicator All settings Changed
65 The multidisciplinary team that provides palliative care consists of at least one of the following disciplines: Bereavement counselor Structure indicator All settings Changed
66 The multidisciplinary team that provides palliative care consists of at least one of the following disciplines: Pharmacist Structure indicator All settings Changed
B. Education and training for staff/volunteers
67 New staff receives a standardised induction training Process indicator All settings Changed
68 All team members have certified (accredited?) training in palliative care, appropriate to their discipline Process indicator All settings Changed
69 All volunteers have training in palliative care. Process indicator All settings Combined/ Changed
C. Support systems
70 All team members have an annual appraisal Process indicator All settings Changed
71 All team members who professionally deal with loss have access to a program for care for the carers Process indicator All settings Changed
72 Satisfaction with working in the team is assessed (e.g. Team Climate Inventory) Process indicator All settings Changed
D. Organisation of care
73 Palliative care services work in conjunction with the referring professional/team Process indicator Inpatient setting indicator New developed
74 There is a regular interdisciplinary/multi-professional meeting to discuss palliative care patients: daily meetings to discuss day-to- day management of palliative care patients Process indicator All settings Combined/ Changed
75 There is a regular interdisciplinary/multi-professional meeting to discuss palliative care patients:weekly (inter- and multidisciplinary) meeting to review palliative care patients referrals and care plans Process indicator All settings Combined/ Changed
E. Information sharing
76 All relevant team members are informed about patients who have died Process indicator Inpatient setting indicator Changed
Documentation of clinical data
A. Clinical record (All settings)
77 For patients receiving palliative care a structured palliative care clinical record is used Process indicator All settings Changed
78 The palliative care clinical record contains evidence of documentation of the following items: Clinical summary Process indicator All settings Changed
79 The palliative care clinical record contains evidence of documentation of the following items: Physical aspects of care Process indicator All settings Changed
80 The palliative care clinical record contains evidence of documentation of the following items: Psychological and psychiatric aspects of care Process indicator All settings Changed
81 The palliative care clinical record contains evidence of documentation of the following items: Social aspects of care Process indicator All settings Changed
82 The palliative care clinical record contains evidence of documentation of the following items: Spiritual, religious, existential aspects of care Process indicator All settings Changed
83 The palliative care clinical record contains evidence of documentation of the following items: Cultural aspects of care Process indicator All settings Changed
84 The palliative care clinical record contains evidence of documentation of the following items: Care of imminently dying patient Process indicator All settings Changed
85 The palliative care clinical record contains evidence of documentation of the following items: Ethical, legal aspects of care Process indicator All settings Changed
86 The palliative care clinical record contains evidence of documentation of the following items: Multidimensional treatment plan Process indicator All settings Changed
87 The palliative care clinical record contains evidence of documentation of the following items: Follow up assessment Process indicator All settings Changed
B. Timely documentation
Inpatient setting (Hospital, Palliative care unit, Hospice, Nursing home)
88 Within 24 hours of admission there is documentation of the initial assessment of: Prognosis, Functional status, Pain and other symptoms, Psychosocial symptoms, The patient‘s capacity to make decisions Process indicator Inpatient setting indicator Changed
89 There is documentation that patients reporting pain or other symptoms at the time of admission, had their pain or other symptoms relieved or reduced to a level of their satisfaction within 48 hours of admission Process indicator Inpatient setting indicator Changed
90 There is documentation about the discussion of patient preferences within 48 hours of admission Process indicator Inpatient setting indicator Changed
91 A discharge/transfer summary is available in the medical record within 48 hours after discharge/transfer Process indicator Inpatient setting indicator Changed
All settings
92 There is documentation of pain assessment at 4 hour intervals Process indicator All settings Changed
93 The discussion of patient‘s preferences is reviewed on a regular basis (in parallel with disease progression) or on request of the patient Process indicator All settings Changed
94 There is documentation that within 24 hours after patient transfer, the responsible physician in the receiving setting has visited the patient Process indicator All settings Changed
95 There is documentation that within 24 hours after patient transfer, the new palliative care team in the receiving setting has visited the patient Process indicator All settings Changed
Quality and safety issues
A. Quality policies
96 The palliative care service has a quality improvement program Process indicator All settings Changed
97 There is documentation whether targets set for quality improvement have been met Process indicator All settings Changed
98 Clinical audit are part of the quality improvement program Process indicator All settings Changed
99 The setting uses a program about early initiation of palliative care (e.g. the Gold Standards Framework) Process indicator All settings Changed
B. Adverse events
100 There is a register for adverse events Process indicator All settings Changed
101 There is a documented procedure to analyse and follow up adverse events Process indicator All settings Changed
C. Complaints procedure
102 There is a patient complaints procedure Process indicator All settings Changed
Reporting clinical activity of palliative care services
103 The palliative care service uses a database for recording clinical activity Process indicator All settings Changed
104 The following is part of the database: Diagnosis, Date of diagnosis, Date of referral, Date of admission to the palliative care service, Date of death, Place of death, Preferred place of death Process indicator All settings Changed
105 From the database the service is able to derive: Time from diagnosis to referral to palliative care, Time from referral to initiation of palliative care, Time from initiation of palliative care to death, Frequency of unplanned consultations with the out-of-hours service for palliative care patients who are at home, Frequency of unplanned hospital admissions of palliative care patients, Percentage of non-oncological patients receiving palliative care Process indicator All settings New developed
106 Based on the database, an annual report is made about the service Process indicator All settings Changed
Research
107 There is evidence that the palliative care service is involved in research in palliative care (e.g. authorship of publications, research grants) Process indicator All settings Changed
Education
108 All health and social care students have standardised learning objectives for basic training in palliative care Process indicator All settings Changed
109 All health and social care professionals have standardised learning objectives for continuing basic training in palliative care Process indicator All settings New developed
110 There is a program for specialised training in palliative care for professionals working in a service that provides specialised palliative care Process indicator All settings New developed
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