Harnessing the power of telemedicine in palliative care from childhood to adulthood: The why and how
acute disease
Objectives *Explain the rationale for incorporating telemedicine into the care of palliative care patients and its associated benefits. *Describe common challenges, proven strategies, and best practice recommendations for successful and sustainable integration of a telemedicine program into palliative medicine programs. *Appreciate the ease of telemedicine and discuss patient-centered benefits of implementing telemedicine into palliative care practice. Although Pediatric Palliative Care (PC) Programs are increasing in number across the country, "deserts" still exist in which access to PC interdisciplinary teams is challenged. Many families elect home-based PC, and the expectation of travel to a clinic or hospital for appointments is not universally appropriate, practical or patient-centered. Many children who receive PC are medically fragile and dependent on technology. Transporting these patients can increase stress, adversely impact quality of life, and increase caregiver burden and the risk of infectious exposure. The result is poor adherence with follow-up and, at times, delays in seeking care during acute illness. In this presentation we will propose a concise, evidence-based, and patient-tailored approach to overcoming these obstacles through the utilization of telemedicine (TM) encounters. Common challenges in the development and implementation of PC TM programs will be shared. Two pediatric institutions will compare and contrast the evolution of their TM programs, describe strategies employed to overcome challenges, and share outcomes. Through a casebased approach we will address billing, technological aspects, privacy and security of data, team engagement and program sustainability. We will demonstrate the ease of a TM encounter live during the session, and explore the perspective of a young adult PC patient in how TM has enhanced his care. A panel discussion will focus on successful and collaborative solutions to optimize care for children at home through TM and invite questions, success stories and challenges in the use of TM from attendees. Audience members will gain insight and appreciation for how TM can broaden and improve patient care, and will obtain concrete ideas for overcoming challenges in developing PC TM programs in their home institutions.
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Ajayi T; Doshi A; Thienprayoon R; Bower K; Tate M; Short R
Journal of Pain and Symptom Management
2018
<a href="http://doi.org/10.1016/j.jpainsymman.2017.12.003" target="_blank" rel="noreferrer noopener">10.1016/j.jpainsymman.2017.12.003</a>
Risk Stratification For Opioid Misuse In Children, Adolescents, And Young Adults: A Quality Improvement Project
BACKGROUND: The Pediatric Palliative and Comfort Care Team (PACT) at Cincinnati Children's Hospital Medical Center (CCHMC) provides opioids to a large population of patients in the ambulatory setting. Before this project, PACT had no reliable system to risk stratify patients for opioid misuse. METHODS: The global aim was safe opioid prescribing by the palliative care team. The specific, measurable, achievable, realistic, and timely aim was as follows: "In patients who present for follow up with PACT, we will use the "opioid bundle" to increase risk stratification for opioid misuse from 0% to 90% over 5 months." The opioid bundle includes a urine drug screen, Ohio Automated Rx Reporting System report, pill count, and screening history for drug abuse and mental health disorders. The setting was multiple CCHMC ambulatory clinics. Participants included all PACT members. RESULTS: Since implementing the new system, we have increased risk stratification for opioid misuse among outpatients from 0% to >90%. Results have been sustained for 12 months. Key processes have become reliable: obtaining informed consent and controlled substance agreements for all new patients and obtaining the opioid bundle to enable risk stratification in a consistent and timely fashion. A total of 34% of patients have been stratified as high risk, and an additional 27% have been stratified as moderate risk. CONCLUSIONS: A system to ensure safe opioid prescribing practices to all patients is critical for providers. Identifying key processes and executing them reliably has enabled the palliative care team at CCHMC to risk stratify >90% of patients receiving opioids in the ambulatory setting for opioid misuse.
Thienprayoon R; Porter K; Tate M; Ashby M; Meyer M
Pediatrics
2016
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
10.1542/peds.2016-0258
Risk Stratification For Opioid Misuse In Children, Adolescents, And Young Adults: A Quality Improvement Project
Pediatrics; Drug Use; Narcotics; Young Adult; Teenagers; Children & Youth
BACKGROUND:
The Pediatric Palliative and Comfort Care Team (PACT) at Cincinnati Children's Hospital Medical Center (CCHMC) provides opioids to a large population of patients in the ambulatory setting. Before this project, PACT had no reliable system to risk stratify patients for opioid misuse.
METHODS:
The global aim was safe opioid prescribing by the palliative care team. The specific, measurable, achievable, realistic, and timely aim was as follows: "In patients who present for follow up with PACT, we will use the "opioid bundle" to increase risk stratification for opioid misuse from 0% to 90% over 5 months." The opioid bundle includes a urine drug screen, Ohio Automated Rx Reporting System report, pill count, and screening history for drug abuse and mental health disorders. The setting was multiple CCHMC ambulatory clinics. Participants included all PACT members.
RESULTS:
Since implementing the new system, we have increased risk stratification for opioid misuse among outpatients from 0% to >90%. Results have been sustained for 12 months. Key processes have become reliable: obtaining informed consent and controlled substance agreements for all new patients and obtaining the opioid bundle to enable risk stratification in a consistent and timely fashion. A total of 34% of patients have been stratified as high risk, and an additional 27% have been stratified as moderate risk.
CONCLUSIONS:
A system to ensure safe opioid prescribing practices to all patients is critical for providers. Identifying key processes and executing them reliably has enabled the palliative care team at CCHMC to risk stratify >90% of patients receiving opioids in the ambulatory setting for opioid misuse.
Thienprayoon R; Porter K; Tate M; Ashby M; Meyer M
Pediatrics
2016
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
DOI: 10.1542/peds.2016-0258