Original articleDevelopment of a Pediatric Palliative Care Team
Section snippets
Background
CMHC routinely provides supportive services to the dying child and his or her family during the end of life and bereavement period. However, inconsistencies in health care delivery resulted in a lack of coordination in care and services and incomplete conversations between health care providers and families at the time of diagnosis. Although supportive services were available at times of crisis, these services were not used appropriately or in a coordinated manner. This resulted in few
Assessment of the Problem
Records of patient deaths at CMHC indicate that the number of deaths ranges between 150 and 185 per year. Estimating the number of children who might benefit from a palliative care program was more difficult. Candidates were identified by both internal survey and physician representative from every CMHC section. Children were placed into one of four categories: (a) acute life threatening, or conditions requiring either pediatric or neonatal intensive care and a risk for death or significant
Clinical Aspect
The palliative approach toward care would allow children with life-threatening and life-limiting conditions to live well through the end of life with the use of advanced care planning and care coordination interventions. This program aims to avoid fragmented care, prevent ethical crises throughout the disease course and/or at the end of life, and adequately treat pain. The program was named the PACCT to avoid the term “palliative care,” because this term carries a negative stereotype in the
Clinical Program Implementation
Piloting of the PACCT program occurred in two medical sections at CMHC. These sections were selected because of collaborative relationships already existing between these health care professionals and members of PACCT. Piloting the program in clinical areas where few children require palliative care services controlled the growth of the program and avoided duplicating services already available at CMHC.
Initial implementation began among seven children receiving care from the Gastroenterology
Program Evaluation
A retreat, 8 months after the initiation of palliative care services, was attended by the original ITF members, health care professionals on the current PACCT team, and other invited personnel. A review of the clinical outcomes and an evaluation of PACCT services occurred. During this time frame, 25 children had their care coordinated through PACCT. Outcomes from this service included care consistent with individual values, which was coordinated to prevent duplication and overlap. Anecdotal
Implications
The need for palliative care services was clearly identified by the AAP (Field & Behrmen, 2002) and by personnel at CMHC. The PACCT service was developed by a dedicated multidisciplinary task force, with the support of hospital administration. The ability to provide PACCT services to any child with a life-threatening illness and his or her family decreases the fragmentation and confusion that frequently surround these diagnoses. Providing a unified, coordinated, and appropriate plan of care
Peggy Ward-Smith is Associate Professor, University of Missouri–Kansas City School of Nursing, Kansas City, Mo.
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Cited by (26)
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2009, Journal of Pediatric Health CareCitation Excerpt :Information regarding established programs, such as that available from Cardinal Glennon's Footprints program (Toce & Collins, 2003) and the Palliative Care Program of Children's Hospital and Regional Medical Center in Seattle, Washington (Seattle's Children's Organization, 2005), together with recommendations from the American Academy of Pediatrics (Nelson, 2000), were reviewed in developing the palliative care program for CMH. The PACCT team was developed 5 years ago in response to a perceived deficit in meeting the health care and psychosocial needs of children with a life-threatening or life-limiting health condition (Ward-Smith et al., 2007). Since its inception, the PACCT has been available in the hospital Mondays through Fridays.
Peggy Ward-Smith is Associate Professor, University of Missouri–Kansas City School of Nursing, Kansas City, Mo.
Jill Burris Linn is Education Coordinator, Pediatric Advanced Palliative Care Team (PACCT), Children’s Mercy Hospital and Clinics, Kansas City, Mo.
Rebecca M. Korphage is Program Operations Manager, Pediatric Advanced Palliative Care Team (PACCT), Children’s Mercy Hospital and Clinics, Kansas City, Mo.
Kathy Christenson is Pediatric Nurse Practitioner, Gastroenterology and Pediatric Advanced Palliative Care Team (PACCT), Children’s Mercy Hospital and Clinics, Kansas City, Mo.
C. J. Hutto is Senior Director, Allied Health and Support Services, Children’s Mercy Hospital and Clinics, Kansas City, Mo.
Christopher L. Hubble is Medical Director, Pediatric Advanced Palliative Care Team (PACCT), Children’s Mercy Hospital and Clinics, Kansas City, Mo
Financial assistance was received from the Educational Development Center, Inc., which provided salary support and educational opportunities for PACCT members during initial implementation. Program growth and development was possible because of funding from the Paul Patton Charitable Trust-Bank of America, Earl and Elizabeth Toutz Charitable Trust, The Bisarya Family Foundation, Mr. and Mrs. Jerry P. Erding, Mr. Brian K. French, Dr. and Mrs. Richard A. Hines, Mr. Joseph L. Robertson, Mr. Jeffery W. Crouch, Mr. and Mrs. Peters Christian Wind, Mr. and Mrs. Robert M. Johnston, and Mr. and Mrs. Fred Merrell.