How can you provide added comfort to those who are experiencing end-of-life care at home? London recently started a new initiative that is doing just that for patients and their families. With this new innovation, palliative care professionals are now able to provide better access to crucial medications in a community-based setting.
The Symptom Control Kit
The symptom control kit (SCK) was initially conceived in 2000 by London’s Citywide Palliative Care Planning Committee. The palliative care team at St. Joseph’s Health Care London, the Community Care Access Centre (CCAC), a family physician and two local pharmacies worked together to develop the new kit system.
The SCK was piloted from June 2001 to June 2002 and has since been implemented across London city and Middlesex County. On average, there are four to five kits out in the London community at any given time.
The SCK contains 13 medications commonly required for end-of-life care. Having the kit on hand in the home eliminates potentially lengthy waiting times associated with having these types of prescriptions filled and then getting them to the patient. While the family assumes responsibility for the safekeeping of the kit, only the community nurse can unlock it and access the needed medication. The community nurse visits daily while a SCK is in the home.
The process by which the SCK is obtained and used is controlled and thoroughly documented; however, it is also simple and quick-designed to remove barriers to getting required medication to the patient.
- The community nurse determines the need for the kit to be in the home and collaborates with the attending physician.
- The pharmacy is contacted. They fax a letter to the prescribing physician asking for authorization for the kit to be dispensed.
- Once approved by the physician, the kit is delivered to the home-delivery is within four hours of the request being made.
- When the nurse feels the patient needs medication, he/she contacts the physician on-call who prescribes the medication and dosages.
- As early as possible the following day, the nurse contacts the pharmacy and tells them what medication has been used. They contact the prescribing physician for a prescription. The pharmacy from which the kit is obtained must be contacted daily regarding the safe keeping of the kit and whenever a medication is removed from the kit. Note: When a medication is ordered from the SCK, the entire quantity of that medication is removed from the kit and becomes the property of the client.
A deposit of $20 for the kit is paid by the family and reimbursed when the kit is returned to the pharmacy. The family only pays for medications that are used which are not covered by the Ontario Drug Benefit plan (ODB). CCAC pays for any kit medications that are never dispensed and then expire, so need to be disposed of.
The SCK process has addressed cost and waste issues. In the past, these medications would have been purchased to have on hand in case they were needed. Even if the medication went unused, according to regulations, it still had to be disposed of. Now unused medications that remain in the kit are returned to the pharmacy for use in new kits.
The SCK system has also realized significant benefits for patients, families and health care professionals alike. The physician on-call, who may not be familiar with the patient, now has the reassurance of knowing that the patient’s regular physician has already placed the kit in the home after determining that there is a need. Should they be called, they can feel more secure in making decisions for prescribing the necessary medication and dosages.
Most importantly, the symptom control kit has eliminated delays in obtaining necessary medication in home palliative situations, which can often happen with the traditional prescription process. Maria Beadle, nurse clinician with St. Joseph’s Community Palliative Consultation team, explains, “Having the kits promotes comfort in the home for the family and the patient, as well as the attending nurse; it’s just knowing that help is there and available whenever they might need it-without the long wait.”
Laura Dockstader is a Communication Consultant with St. Joseph’s Health Care London’s Communication and Public Affairs department.