The Common Sense Guide to Improving Palliative Care > Assuring Comfort > 5.7 Identifying and Testing Changes

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

Identifying and Testing Changes

Team Breathe-Easy

The team began with three changes, which it introduced sequentially, over a three-month period. (Introducing all three changes at once would be too hard and would make it difficult to know which changes were worthwhile.) They eventually saw the need to try two more changes. The overall changes were the following:

1. Having respiratory therapists educate patient and caregiver on specific self-care skills for the home.

2. Approving a new standard order sheet for drug treatment by the pulmonary physician.

3. Increasing referrals to pulmonary rehabilitation services.

4. Having medication kits at home and available by phone from the 24-hour nurse.

5. Arranging to have a nurse at the home within two hours of worsening symptoms.

Team Breathe-Easy made each change on a small scale. For example, they trained one nurse to try out the new processes on a few patients and first worked out the standard order with one physician. By trying one change at a time, they gathered insight into which changes led to improvements. When they were satisfied that a change was working well and leading to improvement (after reviewing data), they spread the change to more patients, more doctors, and more units. In the first few months of the program, the team was disappointed to find that its readmission rates were not improving. Team members spent time on the unit, observing how the changes were being implemented, and talked with families at follow-up visits.

Here are some strategies for change that you can consider to improve symptom management in your organization.

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