Sourcebook : Improving Care for the End of Life : 3.13 Develop Follow-up Procedures

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:

• Meet patient pain level goals 80 percent of the time.
• Make follow-up calls within three to five days when the patient's pain is greater than the patient's pain goal, and do this for 100 percent of cases.
• Record pain intensity for all visits for dying patients.

The team changed what had become routine by:

• Giving patients a pain questionnaire and ruler
• Assessing depression and anxiety
• Making follow-up telephone calls

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:

• 92 percent of patients had pain controlled upon hospice admission.
• 90 percent received appropriate follow-up.
• 94 percent had pain intensity documented.

The team was so successful that the project is now being expanded throughout the department and southern California Kaiser Permanente plans.

<<< Previous Next >>> [ Go Up ]

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 ].