The Common Sense Guide to Improving Palliative Care > Assuring Comfort > 5.8 Common Barriers to Good Symptom Management

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

Common Barriers to Good Symptom Management

Team Breathe-Easy

Initially, Team Breathe-Easy struggled to meet its goals. Within a few weeks, the group learned that self-care training would not yeild a readmission rate of zero patients, no matter how rigorous or responsive the home management that was provided. Patients and families tended to panic when their efforts seemed to be failing and were unwilling to take chances by staying home. Instead, they continued to rush to the hospital. To counter this, the team developed a system to provide a 24-hour-nurse hotline and put medicine kits in the home to provide caregivers with resources to manage symptoms at home. While this improved things, families still felt anxious all the time and panicked after a few hours of trying to reverse deteriorating symptoms at home. This ­suggested the need to be able to promise to have a competent nurse at the home within two hours. Finally, ER visits decreased.

All improvement efforts encounter barriers. Anticipating and preparing for them will allow your team to overcome problems while simultaneously staying focused on your aim. Barriers associated with improving symptom management may include the following:

Most of these have a fairly obvious response, once you recognize that the problem exists. Set high goals, be sure you have expertise, educate everyone involved, and try things out on a small scale.

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