Journal of palliative medicine
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A comparison of metal needles and plastic cannulae (winged and nonwinged) for continuous subcutaneous infusion was done during a quality improvement project to reduce device-induced complications at our hospital. Design, Setting, and Measurements: Data were collected on incidence of site reactions (bruising, swelling, erythema, and blisters); mechanical complications (kinking and dislodgement); device durability; type, and volume of medications; and incidence of needle-stick injuries. All infusion devices used for patients in the Palliative Care Service from February 3 to March 26, 2014 were studied. Devices examined were: winged metal needle (Venofix(®), 23G, B. Braun Melsungen AG, Melsungen, Germany), winged vialon cannula (BD Nexiva™, 24G, Becton Dickinson Infusion Therapy Systems Inc., Sandy, UT), and nonwinged polyurethane cannula (Introcan Safety(®), 24G, B. Braun Medical, Mundelein, IL). ⋯ The winged vialon cannula was the most durable, with no site reactions or mechanical complications, tolerating a volume comparable to that of the metal needle. We suggest its utilization for continuous subcutaneous infusions and consideration of future randomized controlled trials with an integrated economic evaluation for further in-depth comparisons of subcutaneous indwelling devices.
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An order protocol for distress (OPD), including respiratory distress and acute pain crisis, has been established for pediatric palliative care patients at Sainte-Justine Hospital (SJH). After discussion with the patient/his or her family, the OPD is prescribed by the attending physician whenever judged appropriate. The OPD can then be initiated by the bedside nurse when necessary; the physician is notified after the first dose is administered. ⋯ Data from this survey shows that respondents are in favor of using the OPD at SJH and find it effective. Further training as well as support for health care professionals are mandatory in such palliative care settings.
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A recent trend in health care is to integrate palliative care (PC) programs across multiple hospitals to reduce variation, improve quality, and reduce cost. ⋯ Early involvement of PC services emerged as advantageous to the net benefit. Given that health care's changing landscape will increasingly include bundled payment and risk holding strategies to improve quality and reduce cost in health care systems, systemwide PC will play a vital role.