Innovation Series: The Nancy Chan Palliative Care Ambulatory Clinic
by Ingrid See, RN
A legacy. Something that will benefit patients and families who are living at home with a life limiting illness." These were the thoughts of Erica Chan, daughter of Nancy Chan, and a member of a prominent Vancouver family who has made significant donations throughout the city to support arts, healthcare, and education.
When Erica approached the Vancouver Coastal Health Foundation in 2014, she and her family were thinking back to her mother’s passing 10 years ago. The family was grateful for the home care they had received and also recognized that they were fortunate to be able to hire private care for their mother. Erica realized that not many people could afford this level of care, so she began to search for ways of finding a project that could support current gaps and honor her mother. Erica’s search ended when she met with Dr. Tim Sakaluk, Medical Director of the Vancouver Home Hospice Palliative Care Service, an advocate for services that could assist in building the capacity of primary care providers (specifically, family physicians and home care nurses), and introduce palliative care resources earlier on in a patient’s illness trajectory in order to meet the needs of those who are living with a serious illness.
The Nancy Chan Palliative Care Ambulatory Clinic was envisioned by the Vancouver Home Hospice Palliative Care Service to provide an opportunity for patients and families to be seen earlier on in their disease trajectory and assessed by an interdisciplinary team for physical, psychosocial, and spiritual support – an integral part of palliative care. The impetus behind the creation of the clinic was to better support the primary care provider, community health nurses and family physicians, who are caring for patients and families at home. These patients and families would benefit from a comprehensive assessment and care plan for concerns which are beyond the scope of practice of the primary health care providers.
This vision for the clinic was embraced by the Chan family, and in November 2014, the project charter was drawn up. In March 2015, two key project leads were identified within Vancouver Coastal Health- Mavis Friesen, Project Manager, and Ingrid See, Clinical Practice Leader. The time frame was short, with the goal of having a “soft launch” of the clinic by the end of June 2015. Friesen developed concise timelines around leasing clinic space, furniture acquisitions, telecommunications, stakeholders and communication plans, and evaluation criteria. See focused more on the clinical side with the development of patient criteria, workflows for referral, triaging, and booking of appointments, clinical documents for clinic use, and evaluation tools. Handouts about the clinic for home care staff, family physicians, patients and families also had to be designed and circulated to the various stakeholders.
A month prior to the “soft launch” of the clinic, See and Friesen took to the seven health units with brochures and referral processes to the clinic, patient information pamphlets in English, Chinese, and Punjabi, and answered questions on how the clinic would work with the local health units. Education also took place at the palliative care units, BC Cancer Agency, heart failure clinics, and other partners who often refer to the home hospice team and home care nursing. An information letter was posted on the Division of Family Practice website with the brochures and referral form for the clinic so that family physicians were aware when contacted by the community health nurses. In October, 2015, the Minister of Health and the Chan family officially launched the opening of the Nancy Chan Palliative Care Ambulatory Clinic.
Compared to other palliative care ambulatory clinics, the Nancy Chan Clinic is quite unique. At the beginning of each clinic visit, the client is asked to fill in the Edmonton Symptom Assessment Scale (ESAS) and the Canadian Problem Checklist which assesses for psychosocial and spiritual concerns. After the visit, each team member including the palliative care physician, clinical nurse specialist, social worker, and spiritual care consultant updates the patient care plan and medication record in the electronic chart so that the home care nurses have immediate access to the clinic visit. The physician consult note is faxed to the family physician with the recommendations within the week.
One of the key features is that the palliative care team at the clinic is already embedded within the home care system in Vancouver. Referrals to the clinic come from the community health nurses, in consultation with the family doctor. When a patient is homebound and requires one or more of the above disciplines to support the community health nurses and/or family physician, visits by the team are done at the patient’s home, sometimes together, sometime individually. However, if the patient is still ambulatory, he/she is encouraged by the community health nurse to come to the clinic and be seen by all four disciplines. This helps the team increase their efficiency in seeing patients and allows for the patient and family to see all four disciplines at one visit.
What further makes this clinic unique is that it hopes to reach out to individuals living with non-malignant diseases that are more difficult to prognosticate such as COPD, CHF, end stage renal, and ALS. The clinic also provides specialized consult services for patients and families who are experiencing complex symptoms, pain and/or psychosocial and spiritual distress while facing a life-limiting illness. Taking it one step further, the clinic provides grief information nights and grief counseling for the families after their loved ones have passed.
It’s hard to believe that it has already been one year since the launch. Throughout the first year, statistics were kept to evaluate the impact of the clinic. Since opening, there has been a total of 312 clinic visits by the four disciplines. This accounted for 23.56% of all visits done by the team which improved the number of visits at the clinic versus individual visits in the home setting. Further, 67 visits at the clinic were done by social work and spiritual care which primarily focused on counseling and bereavement support. In addition to clinical work, the clinic is also being used for education purposes in order to support VCH staff in improving palliative care knowledge through on site education and videoconferencing.
Future plans include caregiver education, support groups and holding mindfulness sessions to help families cope with stress. Ensuring high quality palliative care is one of the most important priorities within our healthcare system. As British Columbians continue to live longer with more complexities and life limiting illnesses, we need to continue to think of innovative ways to ensure patients and families are well supported holistically through collaboration, compassion and innovation.
ABOUT INGRID SEE
Ingrid has a background in home care nursing and has worked extensively as a Clinical Nurse Specialist in palliative care for many years in the community, acute, and residential care settings. Her role is to help mentor staff and improve clinical knowledge and standards of practice in palliative care, as well as providing clinical consultation while working with multi-disciplinary teams. Ingrid is also a diversity trainer and has a keen interest in developing education materials specifically focused around cultural competency and end of life care. She is the clinical lead for the Nancy Chan Palliative Care Ambulatory Clinic.