Hospice staff from the Kaiser Permanente-San Diego team identified several problems: At admission, more than half of the patients admitted to the hospice had significant, uncontrolled pain. There were no standard methods for pain assessment or for follow-up on pain management. To improve this situation, the team began to hold biweekly meetings, creating for the first time a sustained effort between hospice, continuing care, and oncology professionals.
The group focused on three aims for end-of-life patients visiting oncologists' offices:
The team changed what had become routine by:
At the first follow-up phone call, most patients who had been in pain still reported problems - but nearly all could be managed over the phone by a nurse. By the end of the project:
The team was so successful that the project is now being expanded throughout the department and southern California Kaiser Permanente plans.
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This online version of the book Improving Care for the End of Life: A Sourcebook for Health Care Managers and Clinicians is provided with permission of Americans for Better Care of the Dying [ www.abcd-caring.org ] and Oxford University Press. All rights reserved.
For further information on quality improvement in end-of-life care visit The Palliative Care Policy Center [ www.medicaring.org ].