Coronavirus Response

The Coronavirus pandemic is leading to great challenges in delivering high quality end of life care to patients with and without COVID-19. If anyone would like to post a document or link that may be useful to health care professionals here, please contact the Division Head: Pippa Hawley (phawley@bccancer.bc.ca).

Please also note that the BC Centre for Palliative Care also has many relevant items on its website and maintains a calendar of COVID-19-related webinars and resources at https://bc-cpc.ca/cpc/all-resources/covid-19-resources/#1586313525063-2d4eb83e-58c3.

MESSAGE BOARD:  December 2020: sadly the previously flattened curve has now shot up alarmingly with relaxation of previously good social distancing. This is the “new normal” and we need to adjust to it being for the winter. The good news is that there are at least 4 vaccines nearing final stages of preparation and testing. Vulnerable people should start to receive vaccination early in January. In the meantime we have to be extremely vigilant in infection control procedures.

The care and communication tools developed this Spring are all still entirely applicable. PPE is in short supply but well-organized with central distribution, and we are all now fairly well accommodated to stringent hygiene and social distancing. Keep up the good work!

MISCELLANEOUS TOPICS

Check out “Serious Illness Conversations in Pediatrics: A Case Review”

Please take a look at “Serious Illness Conversation Guide – PEDS”

Check out Amy Mabie’ lovely book for children ~4-8 yrs old to understand Coronavirus https://www.youtube.com/watch?v=nOAHvTdwza8&feature=youtu.be and a news article about it https://bit.ly/3enuKXk, and a similar book from the WHO for older children https://www.who.int/news-room/detail/09-04-2020-children-s-story-book-released-to-help-children-and-young-people-cope-with-covid-19.

See excellent CFPC guide to teaching in current context: applies to all levels of learner; https://portal.cfpc.ca/resourcesdocs/en/Supervision-of-FM-Learners-for-Virtual-Visits-final.pdf.  It is unlikely that students will be able to have normal patient contact for the rest of this academic year and adaptations need to be made.

VIRTUAL CARE TOOLS

See BC-specific Virtual Care Toolkit from Drs of BC https://www.doctorsofbc.ca/sites/default/files/dto_virtual_care_toolkit.pdf

Accreditation Canada also has a free downloadable guide available from https://store.accreditation.ca/products/virtual-care-toolkit

SYMPTOM MANAGEMENT

COVID-19-SPECIFIC

1. This one-page symptom management guideline has been tested in multiple settings and providing the relevant drugs are available it has not required modification since its original posting. Multiple other jurisdictions ave suggested the same or very similar interventions. Symptom management for adult patients with COVID-19 receiving end-of-life supportive care outside of the ICU

2. FraserHealth’s “Actively Dying Protocol”, with new Appendix for COVID-19 patients. Actively Dying Protocol Part 1,  Actively Dying Protocol Part 2,  FH Actively Dying Protocol COVID-19 Addendum 3-4-20. See also  discharge planning tool and medication kit for expected EOL at home from COVID-19 FHDischargeChecklistforExpectedEOLinC19 patients and FH-C19EOLkit

3. VIHA’s Order Set for COVID-19 Palliative Management VIHACOVID-19PalliativeCareandSymptomManagementwithSOB0Mini-Sets VIHACOVID-19PalliativeSedationandEndofLifeM1.M2Module

4. VGH’s inpatient Order Set for COVID-19 Palliative Management VGHPalliativeCareComfortCareOrdersForCOVID-19WATERMARK

5. Link to Pallium webinars featuring our clinical faculty: Doris Barwich and Shalini Nayar on dyspnea https://youtu.be/Z_Pu2peHeHI, also Pippa Hawley and Dave Williscroft on a palliative approach to care for CVID-19 (everything but dyspnea) https://www.youtube.com/watch?v=mlf83Ddat_g&feature=youtu.be

“NORMAL” (i.e. non-pandemic) PALLIATIVE CARE GUIDELINES

1. The BC Guidelines and Protocols Advisory Committee 3-part Palliative Care       Guideline

2. BC Inter-professsional Palliative Symptom Management Guidelines – BC Centre for Palliative Care – see https://bc-cpc.ca/cpc/publications/symptom-management-guidelines/

ADVANCE CARE PLANNING

ACP TOOLS FOR HEALTH CARE PROVIDERS

1. Ariadne Labs have provided COVID-19-specific adapted materials for the Serious Illness Conversation Guide https://www.ariadnelabs.org/coronavirus/clinical-resources/covid-conversations/

2. Providence Health Communication Guide (including video) for Serious Illness Conversation, adapted for use by health care professional with a patient or patient’s SDM concerned about COVID-19, and links to other appropriate communications resources. http://covid19.providencehealthcare.org/resources/tools-covid-conversations-patientsdms

3. Fraser Health has various existing and new Advance Care Planning & Serious Illness Conversation resources. Health care Provider Serious Illness Resources (Adapted Guide and Mini Clinician Reference Guide). FH  Medical Staff site http://medicalstaff.fraserhealth.ca/Clinical-Resources/#ACP), Patient and Family Advance Care Planning and Serious Illness Resources.  Should you require more support around these conversations in Fraser Health, please call 1-877-TALK-034 (1-877-825-5034) or for consultative support email FHAdvanceCarePlanning@fraserhealth.ca

ACP RESOURCES DESIGNED FOR DIRECT PATIENT USE

1. BC-specific (but editable) 1-page patient handout for self-guided Advance Care Planning in current COVID-19 pandemic context, suitable for any person with chronic illness or frailty. Please edit as appropriate for local circumstances (i.e. resource links) and pdf before distribution to patients. Thanks to FH ACP team and Mino Mitri for assistance with development. LetsTalkforACPinCOVID-19PandemicwithChronic Illness23-3-20

2. Similar 2-page and 4- page documents can be found on Amy Tan’s blog (Alberta) at http://www.amytanmd.ucalgaryblogs.ca

3. A serious illness discussion video made in BC is now posted on Pallium’s YouTube channel. It is modelled as a serious illness discussion that a physician (in this case Morgan Lam) might have with a patient face-to-face, with a pandemic spin to make it  more specific to the COVID situation. It is intended help open a conversation with a patient that can be done remotely, whether geographically or or from outside a patient’s room. https://youtu.be/Oh1SVOQUn08

4. A free, easy to use, evidence-based app designed for the creation of legacy video recordings from Recordmenow.org. An iphone, Windows or Mac computer/laptop required.  Legacy support RecordMeNow.org (604) 418-8906.

OTHER PATIENT AND FAMILY-DIRECTED RESOURCES

Patient Care Tasks ●      How to move someone in bed (video): https://www.mariecurie.org.uk/help/support/being-there/caring/moving-someone-bed

●      How to change your love one’s brief (video): https://www.youtube.com/watch?v=NMlw5dBk9LE

●      Helping someone to use the toilet (written instructions): https://www.northshorecare.com/blog/how-to-help-with-toileting-diapering

●      Feeding elderly or swallowing difficulties (written instructions): https://www.elderly.gov.hk/english/carers_corner/diet/feeding.html

●      Mouth care (video): https://www.youtube.com/watch?v=3tzS9mbKm0o

Medication Administration ●      How to draw up medication from a medication vial (written instructions): https://www.stjude.org/treatment/patient-resources/caregiver-resources/patient-family-education-sheets/home-care-guidelines/withdrawing-medicine-from-a-vial.html OR https://www.mountsinai.org/health-library/selfcare-instructions/drawing-medicine-out-of-a-vial

●      How to give yourself a subcutaneous injection (written instructions): http://www.bcchildrens.ca/rheumatology-site/Documents/HowToGiveYourselfASubcutaneousInjection.pdf

Procedures ●      ASEPT draining (videos):

Chest: https://www.youtube.com/watch?v=c3984mrTnbI

Ascites: https://www.youtube.com/watch?v=E_y67bT26dQ&feature=youtu.be

Over all caregiver support https://hospicetoronto.ca/PDF/Acaregivershandbook_CHPCA.pdf

Using other available videos

 

BC OPERATIONAL ISSUES

1. Process for accessing PPE https://news.gov.bc.ca/releases/2020PSSG0023-000609

2. Prescribing suggestions to mitigate potential drug shortages Access to Drugs for Palliative Care in COVID-19 Pandemic 5-4-20

4. Coroner’s advice on completion of death certificates, and funeral regulations  DeathCertsand FuneralsCovid19

REFERENCES/RESOURCES

1.Meet My Loved One-2 pager for print

2. COVID-19-specific BC Palliative Benefits and Expected Death in the Home forms (thanks to Nicola Macpherson) BC Pall Care Benefits (COVID-19) NM 30-3-20  Notification of Expected Death in the Home (COVID-19) NM 30-3-20

3. Personal Protective Equipment procedure advice Home Visit PPE Full Procedure v.7. Removal of PPE procedure (NB Lots of hand washing!)  COVID19_MOH_BCCDC_Doffing. Video demonstrating PPE procedure for a home visit https://www.youtube.com/watch?v=vpoiGcJ1_0U

4. Review of COVID-19 for physicians caring for patients in a non-ICU approach, by Lawrence Chow; BC internist/palliative care physician. COVID-19 Non-ICU Approach to Care LChow 1April 2020

5. Pallium are offering LEAP-Mini courses online for free during the pandemic. https://www.pallium.ca/course/covid-19-response-free-online-modules/  Leap Core is now available for group bookings in combined self-directed module completion and webinar format.

There are currently no scheduled LEAP facilitator training courses being run, but please contact Pallium to discuss if you have a group of future facilitators who would like a course.

7. CMAJ article March 31, 2020 on Palliative Care in a Pandemic. PandemicPalliativeCareCMAJ

8. UK palliative care resource list (including some international resources) https://www.palliativedrugs.com/download/Palliative_care_collated_COVID_resources_V02_200327.pdf

9. US Center to Advance Palliative Care COVID resources https://www.capc.org/toolkits/covid-19-response-resources/