Universal Precautions for Drug Misuse and Diversion in Hospice and Palliative Care—Could an Ounce of Prevention Be Worth a Pound of Cure? (FR434)

Abstract

Accreditation System (NAS), the ACGME is increasingly emphasizing the teaching of patient safety and QI in training programs. It is critical that palliative care practitioners of all disciplines have an understanding of QI processes and the ability to implement these processes in the clinical setting. Using a multiinstitutional, interdisciplinary team of quality experts and education leaders in palliative care, we aim to demonstrate how audience members can incorporate novel teaching methods into QI for their own learners. We will introduce a tool for reporting and assessing QI projects. Then, using this tool, we will review three examples of QI projects from several institutions in a small-group format, inviting open conversation regarding their strengths, weaknesses, and applicability. This will spur lively discussions on the challenges and barriers of QI initiatives within our field or those that integrate with other disciplines. Lastly, we will review successful methods from our own experience of integrating QI into the longitudinal curriculum of our palliative care fellowships and interdisciplinary teams, such as risk evaluation and mitigation strategies (REMS) for buprenorphine, extendedrelease and long-acting opioid analgesics, and transmucosal immediate-release fentanyl products; institutional risk reporting systems; and patient safety committees. Overall, we aim to provide audience members with an implementable action plan to take home that inspires lifelong QI. ObjectivesApply a model of integrated palliative medicine and nephrology care in the decision-making process of an elderly patient with advanced renal disease to identify palliative care needs in this population.Apply prognostic models of end-stage renal disease (ESRD) to various patient populations. Describe and contrast the effects of dialysis and conservative management on functional status and prognosis in an elderly population. Integration of palliative care services with standard nephrology practice for elderly patients with advanced kidney disease can be beneficial in the shared decision-making process regarding management options for the patient's kidney disease and its associated symptoms, as well as in facilitating transition planning during a patient's clinical course. Patients older than 75 are the fastest growing ESRD population. These patients are often burdened by multimorbidity, frailty, and other geriatric syndromes, all of which should be considered in the discussion of renal replacement therapy (RRT) versus conservative management (CM). Models of integrated palliative care and nephrology in clinical settings will be described as well as an approach to decision making. This approach includes evaluating patient and family preferences, factors important to one's quality of life, and identification of contextual features that may be important. Reviewing models of prognostication in ESRD and comparing outcomes, in terms of morbidity, mortality, dialysis, and conservative management, will be helpful for the healthcare provider in inf...