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:  May 15th, the “curve is flattening” very well in BC, thanks to everyone’s efforts to socially distance, and all programs are coping well. Updates to this page will be much less frequent now, and hopefully we can convert it to a future pandemic planning resource page (that we never get to use again) as the pandemic winds down.

MISCELLANEOUS TOPICS

CSPCP statement on Palliative Care in the COVID-19 context to the Federal Ministry of Health, https://www.cspcp.ca/wp-content/uploads/2020/04/HESA-Brief-re-Urgent-Issues-for-Palliative-Care.pdf . The CSPCP has also been effectively advocating for a national medication supply plan to reduce the risk of vital drug shortages.

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.

Please 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 patient contact for some months, and adaptations need to be made.

Please see http://thischangedmypractice.com/peer-support-for-physicians-during-covid-19/?login for excellent short article about the importance of peer support.

SYMPTOM MANAGEMENT

COVID-19-SPECIFIC

1. Please note that this one-page symptom management guideline will be updated as more clinical experience comes in.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” 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 modeled 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. Please feel free to share. https://youtu.be/Oh1SVOQUn08  There will be Mandarin, Punjabi, and French subtitles very soon.

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.

BC OPERATIONAL ISSUES

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

2. Drug shortage information and prescribing suggestions to mitigate potential shortages Access to Drugs for Palliative Care in COVID-19 Pandemic 5-4-20

3.Interior Health’s Long-Term Care clinical decision pathway IH LTC COVID-19 Clinical Decision Pathway 9-4-20

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

5. See Drs of BC website for new billing rules. https://www.doctorsofbc.ca/news/covid-19-temporary-billing-changes. 

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/

6. Editable slide set (Robin Love) on palliative care for COVID-19 patients Slide set-COVIDSxforNRGHHospitalistsApril6 

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

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

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