The document discusses the goals of implementing a new Goals of Patient Care (GOPC) form across hospitals in Western Australia to improve end-of-life care and decision making. It provides background on the form's trial implementation at various sites. The new form aims to have goals of care discussions with patients or their surrogates to determine appropriate treatment based on probable outcomes, not just resuscitation status. It outlines the form's structure with sections on baseline information, goal of care selection, discussion summary, and extended use. The document emphasizes improving communication around goals of care and ensuring treatment aligns with patients' values and preferences.
Importance of infection control in ICU
Ventilator-associated Pneumonia definition and bundles, Central line-associated infection and its bundles and foley's catheter-associated infection and its bundles
this presentation in reference to CDC and IMO
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Ventilator-associated Pneumonia definition and bundles, Central line-associated infection and its bundles and foley's catheter-associated infection and its bundles
this presentation in reference to CDC and IMO
A "bundle" is a
group of evidence-based care components
for a given disease that, when executed together, may result in better outcomes than if implemented individually.
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Dr. James MacDonald, Chief Administrative Officer or the RI Board of Medical Licensure and Discipline presents to the RIAPA on controlled substance prescribing in RI.
A "bundle" is a
group of evidence-based care components
for a given disease that, when executed together, may result in better outcomes than if implemented individually.
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Dr. James MacDonald, Chief Administrative Officer or the RI Board of Medical Licensure and Discipline presents to the RIAPA on controlled substance prescribing in RI.
Decide treatment - a new approach to better healthØystein Eiring
Better treatment, better health! People often experience suboptimal health because treatment is not optimal. A new approach is being developed - enabling patients and doctors to improve treatment and improve health.
The SAFER patient flow bundle, Red2Green days and #EndPJparalysis are all examples of simple rules to help reduce unnecessary patient waiting (especially within inpatient wards).
The slide set contains lots of links to supporting information e.g. videos, evidence and guidance.
Remember to localise your approach and avoid the temptation to use performance management. It's much better to adopt an improvement approach and test things to see if they work.
Start with the patient and front line teams and work from there.
I hope you find the slide set useful.
Pete
TEST BANK For Critical Thinking, Clinical Reasoning, and Clinical Judgment A ...robinsonayot
TEST BANK For Critical Thinking, Clinical Reasoning, and Clinical Judgment A Practical Approach 7th Edition by Rosalinda Alfaro-LeFevre, Verified Chapters 1 - 7, Complete Newest Version.pdf
TEST BANK For Critical Thinking, Clinical Reasoning, and Clinical Judgment A Practical Approach 7th Edition by Rosalinda Alfaro-LeFevre, Verified Chapters 1 - 7, Complete Newest Version.pdf
TEST BANK For Critical Thinking, Clinical Reasoning, and Clinical Judgment A ...rightmanforbloodline
TEST BANK For Critical Thinking, Clinical Reasoning, and Clinical Judgment A Practical Approach 7th Edition by Rosalinda Alfaro-LeFevre, Verified Chapters 1 - 7, Complete Newest Version.
TEST BANK For Critical Thinking, Clinical Reasoning, and Clinical Judgment A Practical Approach 7th Edition by Rosalinda Alfaro-LeFevre, Verified Chapters 1 - 7, Complete Newest Version.
TEST BANK For Critical Thinking, Clinical Reasoning, and Clinical Judgment A Practical Approach 7th Edition by Rosalinda Alfaro-LeFevre, Verified Chapters 1 - 7, Complete Newest Version.
The business of providing treatment for obstructive sleep apneaBradley Eli
sleep treatment specialists is a specialty practice in San Diego dedicated to treating sleep disordered breathing. CHAP accredited and provides all non surgical treatments for sleep apnea, snoring and sleep disordered breathing. Dr Bradley Eli DMD, MS is the specialist director and owner of the facility
Patient safety is the most important thing in any hospital. Everyday, every hospital staff do their best to ensure no harm to any patient in the hospital. The root cause of every patient safety incident is primarily due to poor, ineffective or lack of communication. This is communication between the hospital staff as well as between hospital staff and their patients.
How do you effectively address the communication problem? The healthcare industry has learned from the aviation industry. Taking a flight has been safer than being in the operating theater or ICU of a hospital. The airline industry, following major crashes, have managed to make air travel the safest thing to do. Key safety-related domains that emerged in the airline industry and adapted by healthcare included Checklists, Training, Crew Resource Management, Sterile Cockpit, Investigation and Reporting of Incidents and Organisational Culture. SBAR is one of the practices adapted from the airline industryas well.
Introduction to SBAR for effective communication in hospital. Ineffective communication is the root cause of all errors, adverse incidences in hospital. Structured communication between personnel helps reduce this root cause.
Similar to Goals of patient care introduction (20)
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
2. Outline
• Brief background about Goals of patient care
(GOPC)
• Some tools
• Patient identification
• Communication
• The new form structure
• Timelines
• Resources
3. Background
• The GOPC form is still in it’s trial state
•14 sites across WA now using the GOPC trial form
instead of a Not For Resuscitation Form (blue form)
• Previous pilot of the trial form in 2017
• Wards G53, G63, C17 (SCGH)
• Ward 4 (OPH)
4. Current situation
2/3rd of MET calls are after hours – Where difficult
decisions are made quickly by clinicians who do not
know the patient & without patient / surrogate
decision maker input.
Of MET calls are
repeatMET calls
5. Synergies
•Fits in with Choosing
Wisely initiatives
•Part of Sustainable
Health care is providing
appropriate the goal of
care to patients
•Links in with advanced
health care directives
6. Considerations
• Estimated 70% of patient deaths are now expected.
• In WA, an average of 8 admissions in last year of life
• Over half of all deaths occur in hospital
• Many decisions to limit treatment occur in crisis situations,
especially during MET calls
7. Pathways to death
-- Multiple co-
morbidities, each hosp
adm leads to poorer new
baseline
-- Frail – not expected to
survive even single organ
failure
MOST ADMITTED
PATIENTS AND THOSE
SEEN FREQUENTLY IN
OUTPATEINTS FALL INTO
THE ABOVE CATEGORIES!
8. GOPC rationale
• A medical decision making based on determining
the patient’s goals of care.
• Assigned according to realistic assessment of
probable outcomes
•Not the same as Advance Health Directive –
which is made by the person in their own voice and
utilised when capacity is lost
•Conversation is shared with the patient or their
surrogate decision maker
9. GOPC – patient identification tools
Does your patient have two or more of the following?
1. Reducing function
2. Two or more hospital admissions in 6 months
3. Weight loss of 5-10%
4. Refractory symptoms
5. Dependent on others for care needs
11. The SPICT Tool
2 part tool:
6 General
indicators
Patient
requires
2 or
more
indicators
from this
section
12.
13. Change in forms
4 main sections
(1)Baseline information
(2)Goal of care
- All life sustaining tx
- Life extending tx
- Active ward based mx
- Comfort care
(3)Goal of care summary discussion
(4)Extended use of form
15. Section 2 – Registrar or Consultant
LHS –
what is
NOT
being
done
RHS –
tailoring
what IS
to be
done
16. All life sustaining treatment
• Aim is cure
• Is there reasonable chance the patient will leave hospital
with a similar life span?
• Probably the quickest discussion / decision.
• No limitations on interventions / treatments
FOR
CPR
MET calls
ICU
17. Life extending treatment
• With probable treatment ceiling
• Aim is for prolonged disease remission or restoration of pre episode
health status.
• Returning to previous level of function
• For life sustaining treatments as needed.
• May require ICU review / consult
Not for CPR
18. Active Ward based care
Consider in patients who may have:
• Incurable and progressive disease
• Advancing disease: anticipating death
• Life expectancy months, possibly years Remember the “surprise
question”
• Aim of treatment:
• Length of survival not sole determinant
• Comfort, quality and dignity
• Treatment underlying disease still appropriate
Not for CPR
Symptom /
comfort care
19. Optimal comfort treatment
•Including care of the dying person
•Death imminent
•Would you be surprised if they died during this
admission.
•Should be on Care Plan for the Dying Person
Aim is comfort,
quality of life and
dignity
20. NOTE! To make the form valid P.T.O
None of what’s been
completed in section 2 is valid
unless section 3 is signed
overleaf.
21. Section 3 = Most crucial section
The Goal of
patient care
summary of
discussion
Area to be signed to
make the form valid
22. Section 4 = Extended use of form
This section can be completed in outpatients
and valid if the patient is then subsequently
admitted to hospital for example
If signed, then
the form is valid
for 12 months*
* Team are working with HIMS on
how a valid form can be pulled
from the medical record in to the
medical notes
23. GOPC narrative
• It’s all about communication
• It’s also a clinical decision tool
• Understand what’s important to the patient
• Understand what lifestyle limitations / treatments would
be unacceptable to them
24. • Do you want us to do everything?
• Resuscitation is futile
• The medical team have decided
•There is nothing more we can do
Importance of use of languageWe might say
25. • Do you want us to do everything?
• Resuscitation is futile
• The medical team have decided
•There is nothing more we can do
What the patient/family hears….
• Do you want us to try?
• Your loved one is worthless
•We don’t care what you think… we’ll decide for you
•We are going to abandon treatment and care
26. • Do you want us to do everything?
• Resuscitation is futile
• The medical team have decided
•There is nothing more we can do
Reframing the discussion
• Do you want us to try?
• Your loved one is worthless
•We don’t care what you think… we’ll decide for you
•We are going to abandon treatment and care
• We want to work out what is the right thing to do….
•Treatment that is ineffective and distressing
•The treatment is not working
• We will do everything possible to ensure comfort
and dignity…
28. Video 1 = NFR
CPR decision – first step
Done just before death
Emphasis is on
what “won’t be done”
Sub-optimal care
Misses patient preferences
Treating team perform
Emphases what “will be
done”
Consensus care
Seeks patients preferences
Breaks the ICE
Video2 = “Goals of
care”
29. Ask Tell Ask Framework
• Ask For opinions and thoughts – open questions / Fears
• Tell “To make sure we are on the same page, can you tell
me what is your understanding of your illness?”
• Ask Can we talk about what we should do if things don’t
go as well as we hope?
• If your illness gets worse, what things would be most
important to you?
• Who are you going to tell about this conversation?
31. On change over day
Patients who have
a current “blue”
form will require
the details of the
form updated on
to the GOPC form
and the “blue”
form to be
cancelled.
32. Next steps
• Feedback from all areas of use
will shape how the final from
will look like
• We will be formalising dates
for focus groups in due course
33. Overall aim
• One form across the
whole of WA
• Linked form with the
community
34. GOPC resources
• GOPC.SCGH@Health.Wa.Gov.Au
SCGH:
• Annie Brinkworth – MET Co-Ordinator
• Anil Tandon – Palliative Care Physician
OPH
• Brendan Foo – Rehab and Aged Care
https://ww2.health.wa.gov.au/Articles/F_I/Goals-of-
patient-care
http://www.spict.org.uk/using-spict/
36. Take home messages
•Consider for all admitted patients
•End of life = last 12 months
•You are NOT saving time by avoiding these
conversations but may be increasing
suffering.
•Communication is key!
•Make a home team decision