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Block Rotations in Palliative Medicine

Overview

Welcome to the Palliative Care Medicine Service. The Palliative Care Medicine Service addresses issues of pain and symptom management, psychosocial distress, and end-of-life care for the population of Southeastern Ontario. The service is comprised of Palliative Medicine Physicians and an interprofessional health care team who provide in-patient consultative services at the Kingston General Hospital and Providence Care Hospital, and out-patient consultative services for cancer patients through Palliative Medicine Clinics in the Cancer Centre of Southeastern Ontario. The Service also offers telephone consultation to community physicians throughout the region. Primary palliative care is provided to patients in 3 designated Complex Palliative Care beds on Kidd 9 at KGH and 10 designated beds at St. Mary’s of the Lake, and community patients requiring enhanced palliative skills. 


To ensure an adequate orientation to the rotation, we encourage residents to consider not taking the first few days of the rotation as vacation.

Please review the General Orientation PresentationKGH/CCSEO Stream and PCU/COMM Stream prior to the start of your rotation.

Office 
Location: 34 Barrie Street 
Office hours: 8:00 – 17:00 Monday to Friday 

Contacts 
Ruili Fang* 
Telephone: 613-549-6666 x3223 
Email: fangr@kgh.kari.net 
*contact for scheduling, on call 

Cortney Longfield ** 
Telephone: 613-548-2485 
Email: longfiec@kgh.kari.net
** contact if you are ill, coming late, etc. 

Michelle Maloney ***
Telephone: 613-549-6666 x 6204
Email: maloneym@kgh.kari.net
*** contact for updating patients of community

First Day 
On the first day of your rotation, please come to the Palliative Care Medicine Office, 34 Barrie Street, at 8:00 to meet with the team. 

Weekly Team Meetings 

Weekend Turnover Rounds (All residents)
• Monday 8:00 (Tuesday if Monday is a holiday) at 34 Barrie Street 
• Review of patient issues that occurred over the weekend, followed by brief resident presentations. Please note the date of your presentation under "schedules" for your block of rotation.

Interprofessional Team Meeting (Residents KGH/CCSEO Stream)
• Wednesday 0915 in the KIDD 9 conference room 
• Meet with SW, volunteer coordinator, dietitian and spiritual care to review KGH inpatients being followed by consult team


Interprofessional Team Meeting (Residents PCU/COMM Stream) 

  • Thursday 0800 in the 2nd floor Conference Room
Academic Palliative Medicine Rounds
• Fridays 08:00 – 09:00 (September to June) in the conference room at 36 Barrie Street 
• Various topics of relevance to Palliative Care (http://meds.queensu.ca/programs/palliativecare/rounds)

Patient Lists 
Cortney Longfield maintains a current patient list for KGH & Providence Care Hospital PCU. Michelle Maloney maintains the community list. A complete list for all sites is distributed at weekend turnover rounds on Mondays. An updated list is available Fridays for those on call on the weekend. To ensure the list is accurate, it is important to advise Cortney and Michelle as to new consults, deaths, sign-offs etc.

Suggested Pre-reading:

  • Therapeutic Reviews. Series Co-Editors: Andrew Wilcock, DM, FRCP, and Robert Twycross, DM, FRCP - Stimulant Laxatives and Opioid-Induced Constipation. Robert Twycross, Nigel Sykes, Mary Mihalyo, and Andrew Wilcock. Journal of Pain and Symptom Management Vol. 43 No. 2 February 2012: 306-313 PDF
  • Understanding Physicians' skills at Providing EOL Care - Perspectives of Patients, Families, and Health Care Workers. J. R. Curtis, M. Wenrich, J. Carline, S. Shannon, D. Ambrozy, P. Ramsey. Journal of Gerneral Internal Medicine Vol16(1) Jan 2001: 41-49 PDF
  • Ten Commandments for Effective Consultations. L. Goldman, T. Lee, P. Rudd. Arch Intern Med Vol 143 Sep 1983: 1753-1755 PDF
  • Self-care of Physicians Caring for Patients at the End of Life:"Being Connected ... A Key to My Survival". M. Kearney, R. Weininger, M. Vachon, et al. JAMA 2009 Vol 301(11): 1155-1164 PDF

Multiple Choice Test (PDF)

Rotation Goals and Objectives

  • Family Medicine  (PDF)
  • Internal Medicine (PDF)
  • Radiation Oncology (PDF)
  • Medical Oncology (PDF)
  • Care Of the Elderly (PDF)
  • Residents 

    Family Medicine: During your rotation, you will be responsible for having field Notes completed as formative assessment. Expectations are noted in the presentation for each stream. You can download Field Notes from the Family Medicine website. Completed copies of forms are to be given to Ruili Fang for your evaluation file. They will contribute to your final evaluation.

    Internal Medicine and other residents: During your rotaion, you will be responsible for having a minimum of 2 Mini-CEX Forms completed as formative assessment. Expectations are noted in the KGH/CCSEO stream presentation. Completed forms are to be given to Ruili Fang for your evaluation file. They will contribute to your final evaluation. 

Mini CEX (PDF)

The faculty endeavor to provide informal feedback throughout the rotation, however, please ask if you wish more feedback, or feedback on a specific aspect of your performance. 

For all residents, at the completion of the rotation, one of the Attending palliative medicine physicians will meet with you in person to review your ITER. All palliative medicine physicians that have worked with you during the rotation and members of the IP team will be asked to provide input for the ITER. Once reviewed on paper face-to-face, Ruili Fang will enter it into WebEval (one45 system) where you can review and sign it off. 

Please complete rotation and faculty evaluations in WebEval as we appreciate your feedback and endeavor to make the palliative care rotation a valuable educational experience.

  • Students 
    On completion, medical students involved in observerships and electives are asked to submit a brief reflective narrative on their experience. 
  • Complex PC Bed Policy (PDF)
  • Palliative Care Consult (PDF)
  • Consultation Notes and Dictation Grid (PDF)
  • Communication Framework (PDF)
  • Preparing For Family Meetings (PDF)
  • Planning for Discharge (PDF) 
  • Palliative Performance Scale (PPS) Description (PDF)
  • Edmonton Symptom Assessment System (ESAS) Tool (PDF)
  • KGH Policy re: Writing Orders (PDF)
  • Medication Safety Bulletin - Dangerous Abbreviations (PDF)
  • Spiritual Care
  • Pamphlet re: Referrals to SW, OT, PT, Dietitian, Spiritual Care (PDF) 
  • CADD pump (PDF)
  • OMS-Intial Infusion Orders/Prescription by case manager (PDF)
  • OMS-Reorder of Cassettes (PDF)
  • OMS-Physician "Verbal" Initial Infusion Orders (PDF)
  • Facilitating ERNI- What Consultant Attendings and Residents Need to Do in The Emergency Department (PDF)  
  • Referral Path - Palliative Care (PDF)
  • Abbreviations/Acronyms/Symbols (PDF)

Overview

Fornal teaching sessions will be held Tuesday morning 8:00-9:00 at 34 Barrie Street. Informal teaching will occur to review relevant topics in palliative/end-of-life care related to daily patient care. 


There are numerous books and journals in office. You are encouraged to read and photocopy any articles of interest to you. Please do not remove any of the resource materials from the office.

Overview

You have first call responsibility during the rotation. A copy of the call schedule for your block of service is included under the “schedule” section. Call is taken from HOME. 


Weeknight call begins at 17:00 and ends at 8:00 the following morning.  Weekend call begins at 8:00 a.m. and ends at 8:00 a.m.  For weekend days or holiday, contact the palliative medicine physician on call with you prior to the start of call to ensure that you have arranged a place and time to meet.

 When on call you will cover:

1. Providence Care Hospital Palliative Care Unit patients – You are responsible for the patients in the 10 beds of the Palliative Care Unit and others who are on the weekly list for specific reasons.  On weekend days, you will round on the patients as needed. When called, if you are unsure of how to respond, take the information and indicate that you will call back after contacting the palliative medicine physician on call with you.  

2. Community Palliative Care patients – You are only responsible for community patients being followed by the palliative medicine physicians i.e. on the weekly list. (Note: The list is updated weekly on Fridays but changes can occur daily as the community palliative medicine physicians assess new patients throughout the week.  If the patient is not on the current weekly list but has been seen by the community palliative medicine physician since the list was printed, they are our responsibility.) You need to take the weekly list home for reference when on call.  Most of these patients are eligible for home visits if deemed necessary.  Calls regarding patients not followed by one of the community palliative medicine physicians, even if they are ‘palliative’, should be referred to their family physician. If you are unsure of whether you should provide advice to a patient/family/nurse, take their phone number and indicate that you will call them back after contacting the palliative medicine physician on call with you. For any calls that you receive from the community that may require a home visit (see Policy on Resident Safety During Home Visits) you must contact the palliative medicine physician on call with you to discuss further.  

At times, family physicians will call for advice regarding patients not on the weekly list.  These calls should go directly to the palliative medicine physician on call with you.  If you receive a call from a family physician for advice, take their contact information and advise that the palliative medicine physician will call them back.  

3. Palliative Care Clinic patients – You may be contacted after hours by a patient (family/nurse of a patient) who is being followed in one of the Palliative Medicine clinics.  Check the weekly list to see if there are comments related to the patient.  If not and the situation is not complex (e.g. renewal of medication), it is reasonable to respond to their request.  If the request requires further timely assessment, these patients are not eligible for home visits and need to be encouraged to contact their family physician or attend the emergency department of their local hospital if deemed necessary.  If you are unsure of what to do, take their phone number and indicate that you will call them back after contacting the palliative medicine physician on call with you.

4. Kingston General Hospital patients –  
Complex Palliative Medicine Beds: After hours, the non-take Internal Medicine resident provides first call for the Complex Palliative Medicine Beds. You are responsible for providing turnover to this resident at the end of the day and ensuring that they are aware to call the palliative medicine physician on call with you if they have questions/concerns.  On the weekends you will round on these patients daily.

Consult list patients: You should respond to calls for patients being followed as consults by the KGH Palliative Care Service for symptom control issues ONLY. Other issues, such as new onset fever or chest pain, should be addressed by the attending team.  On weekends, you will round on the patients identified at handover as needing reassessment.  You are also responsible for new consults. 

 When on call you will need:

• Blank death certificates 
• Prescription sheets 
• The weekly list of community/palliative care unit/KGH patients being followed by our team (provided Monday at turnover rounds & Friday as an updated list to persons on call for the weekend) 
• Your stethoscope 
• On-call Notes to record telephone calls or home visits* ( download from website

* You MUST document ALL telephone calls and community visits to patients using the “On-call Notes”, and give them to Ruili Fang the morning following call or Monday morning if on call Saturday or Sunday.
  • Home Visit Policy (PDF)
  • Pronouncement Information
Completion of Death Certificate (PDF)
KGH Policy re: Coroner (PDF)
When to Call the Coroner (PDF)