Friday, August 11, 2017

That's the word

"Not plastics. Fast Facts!'"

I recently read a post by an experienced nurse who was both eager and apprehensive about starting her new job in hospice. She wanted some advice, and probably a little  encouragement.

She could be making the worst mistake of her life, though I hope it's not the case, and doubt that it is.

I have no data, but it seems to me that a nurse with a diverse clinical background has acquired a rich set of skills for working with patients and families facing serious illness and end of life. A nurse not just out of school also seems more likely to have the kinds of life experiences, including death and loss, that can inform the best care.

The simple act of her reaching out counts for a lot.

Since she framed her request as, "What's the one (best, most)...?," I suggested the wisest, richest, most coherent, informative, credible, and accessible clinical resource I have ever encountered - Fast Facts.

I've used Fast Facts to read up on a topic I wasn't familiar with, like pseudoaddiction (#69), or the use of psychostimulants (#61).

I've turned to them for help, like the first time a patient presented with an implanted defibrillator (#112), and have shared them with the team, like that time we were challenged by the angriest patient any of us had ever seen (#59).

A colleague often tried to bring them to the attention of her part-time medical director at team meeting, though unfortunately without success. The agency only hired physician contractors who knew nothing about palliative and end of life care, and who strictly adhered to their 3-S Model: Show up, Shut up, and Sign.

I've even used Fast Facts for patient education with a dual-PhD couple, both highly-qualified in math and physics, and experienced as teachers, researchers, consultants, and textbook authors. They were completely involved in their care, and not inclined to just accept advice or follow directions.

One spouse had advanced cancer of the small intestine, and had already experienced two acute obstructions when they came on service. Pain was not well-managed with transdermal fentanyl and oral oxycodone prescribed by the oncologist - the patient had been applying and removing 25mcg patches as often as every few hours, and didn't keep track of how much oxycodone was being used.

We developed a plan to better address pain, along with persistent low-grade nausea and the risk of further obstruction, including scheduled oral glycopyrrolate, haloperidol, and methadone.

When we sat down to review the plan, I had already printed out Medical management of bowel obstruction (#45) , Causes of nausea and vomiting (#5), and both Methadone for treating pain (#75), and Dosing methadone (#86).

I told them the team used Fast Facts as one resource for developing the plan. They carefully read each of the single-page/two-sided documents, looked at each other, nodded, then simply said, "OK."

Fast Facts is hosted and supported by the Palliative Care Network of Wisconsin - PCNOW. Their mission is to "support the growth of palliative care services in Wisconsin through education, systems change, and advocacy."

They're on it for the long haul, with the recent release of Air travel at the end of life (#338). Remember what Walter Brooke said.