The Common Sense Guide to Improving Palliative Care > 1.2 Better Care for Patients and Families: Make It Happen

This extract from the online edition of The Common Sense Guide to Improving Palliative Care is used with permission.

Better Care for Patients and Families: Make It Happen

Many clinical teams with whom we have partnered have focused on one or more of four areas that are well tested and offer good starting points. Eventually, you may want to work on all four areas. At first, though, focus on the one area that seems to cause the greatest distress for patients in your care — and on one that seems changeable for the better. Most groups find that they can do the following.

• Improve comfort by preventing or treating pain, shortness of breath, pressure ulcers, and other symptoms.
• Enhance continuity of care by reducing unnecessary transfers and being sure to transfer the care plan with advance directives. Generally, people should be able to die "in place," where they live.
• Improve advance care planning so that everyone involved in caring for a patient is aware of preferences and decisions about treatments, including ventilation, nutrition, hydration, and plans for care.
• Attend to the emotional and spiritual needs of patients and families, from the practical (Are you still sending bills to the deceased patient?) to the spiritual (Does the patient want to see a clergy member or spiritual adviser) to the emotional (Do you know what a patient needs to feel happy as life draws to an end?).

Here, you will find practical information about how to make such improvements. At the most general level, effective improvement requires the following:

• a QI team;
• a clear and significant aim;
• a way to measure, track, and report progress;
• a list of changes worth trying;
• the will to improve within your organization.