Every morning our patients are Categorized to be visited with regards to their pain management and symptom control needs. There are namely three categories of patients:
Category 3 = Very Sick/Bedridden | Category 2 = Sick | Category 1 = Not so sick and mobile.
St Bernard’s Hospice receive urgent referrals from “Oncology Departments” on a daily basis. After receiving referral documentation, we arrange to “meet and greet the patient and family” to ascertain the patient’s feelings and emotional state. It is very important to include the family as far as possible within our first meeting as they are an integral part of the Care & Support of the patient.
We then discuss the role of St Bernard’s Hospice and describe our relationship with regards to the Oncology Department. We often become the “middle man” and liaise with Oncology, Doctor’s and the Patient; all working together for the benefit of the patient, attending to their health management and symptom control needs.
PAIN, NUTRITION and CONSTIPATION are the three main discussions held at any given meeting. Patients are asked to describe their pain on a scale of 1 to 10 (1 being the lowest to 10 being the highest). If their pain is around 7/8 out of 10,the aim is to reduce the pain to 2/3 out of 10.
PAIN : The patients current pain maintenance and management is ascertained by chatting to the patient to see when pain medication was last taken and how often the medication is being taken. It is important that the patient and family understands that pain medication in cancer patients is given as a preventative medication to avoid excess pain (not like a headache when the pain arises). Thus, the management of existing pain is first discussed to ensure prescribed doses has been adhered to. If “pain requirements” have been met BUT the patients pain remains out of control, a new pain management regime is discussed and commenced; until the desired results of pain management is achieved.
NUTRITION : Patients appetite is monitored and their exact meals over the past twenty-four hours are discussed. The nutritional value of their meals are then assessed and if needed, patients are advised on supplements like Malora porridge or Ensure that are highly beneficial and should be taken daily.
CONSTIPATION : Healthy bowel movement and being free of nausea is an integral part of pain management as they are side effects of most medication taken by Cancer patients; and if not managed and addressed patients will definitely feel uncomfortable and become depressed.
The first consultation can take anything from 30 minutes to 2 hours, all depending on when we were called to assist. The date for a follow up consultation will be made with the patient and family member whilst in the first consultation.
“Our aim is to make the patient pain free (or as pain free as possible) and comfortable – if we can get that done, then we have done 75% of our job.
Palliative Care is such a holistic approach that there are many aspects of our care that have not been covered in this document. If anyone has any queries or questions please feel free to contact St Bernard’s Hospice to find out more.