Date post: | 16-Dec-2015 |
Category: |
Documents |
Upload: | arline-bishop |
View: | 214 times |
Download: | 0 times |
End of Life Education End of Life Education at Touro Universityat Touro University
Kenneth Leong, OMS II
Current curriculumCurrent curriculum
Breaking bad news lectureBreaking bad news to a standardized
patientMedical ethics lectureDNR/DNI lecture2-hour lecture on End-of-Life care by a
hospice physicianElective 3rd yr rotation with Dr. West,
Sutter Medical Director.
GoalsGoals
Establish a EOL curriculum at Touro University
Nurture interest about EOL issues in students to partake in EOL elective (Colleen Fitzgerald)
Have students become active in the EOL medical community
Chronological ApproachChronological Approach
Start Middle End•Begin with 4 cases and discussing with the class what you would do if this is your family member.
o Case 1 - An 70 yo patient w/ no advance directive and never spoke of wishes. Had an MI 5 years ago.
o Case 2 - elderly patient w/ no
advance directive and never spoke of wishes. Had atrial fibrillation and a CVA that led to irreparable brain dmg and in a persistent vegetative state.• What do you do?
o Case 3 - patient with
metastatic GI cancer with mets to lungs. Patient has gone through chemo and radiation. Patient appears dyspnic, nausea and vommiting, and a distended abdomen. Pain is at a 10.
•Paint a picture to students about what curative treatment is like and how some of the treatments may not be appropriate when you are older.
o Feeding. Show what a PEG tube looks like.
o Constellation of problems seen during end of life • Show what pressure
sores look like• Contracted• Aspiration• Thrush• Delirium vs. dementia
•Address morphine stigma
•What are the costs and benefits of placing a feeding tube?
•What happens physically when a person dies?
o Scan the blue book “Gone From My Sight” into a PowerPoint
•Organize students to attend the annual AAHPM meeting. •Because of our new curriculum, we have flexibility in shaping our education. Establish ECE opportunities as soon as the first year.
•Establish an end-of-life elective course
Start Middle EndWhat happens when you code?oParticipants - Dr, RN's, RT, Lab, medical students, gawkers, crowd controloCPR w/ patient with osteopeniaoPics of central line or video of putting in oneoVideo of PEG tube
Introduce Hospice as a modality of careoWhat is hospice and what makes a patient hospice-appropriate?oWhat is the hospice philosophy?oWhat role does each member of the interdisciplinary team play?
What happens to you when you survive a code?
StartStart
Begin with 4 cases and discussing with the class what you would do if this is your family member.
Case 1 - elderly patient w/ no advance directive and never spoke of wishes. Had atrial fibrillation and a CVA that led to irreparable brain dmg and in a persistent vegetative state.
Case 2 - patient with metastatic GI cancer with mets to lungs. Patient has gone through numerous rounds of chemo and radiation. The oncologist insists upon a new trial drug that may be effective. Patient has nausea, vomiting, and has pain at a 9. Patient expresses that he is “sick and tired of feeling sick.”
Case 3 – Latino female patient who has colon cancer that has metastasized to the liver. Although she is enrolled on hospice, her family insists that she must NOT be informed of this.
Case 4 – You see in the hospital an 85 yo white male with end stage CHF. Patient has Alzheimer's dementia and was admitted to the hospital for fluid in his lungs and edema. He is on the following meds:Lovastatin, carvedilol, aspirin, Cardura,
furosemide, jet nebulized albuterol & atrovent, roxanol, senna, dulcolax, robutussin.
Start (cont’d)Start (cont’d)
What happens when you code?oParticipants - Dr, RN's, RT, Lab, medical students, gawkers,
crowd controloCPR w/ patient with osteopeniaoVideo of a central line being placedoVideo of PEG tube
What happens when you survive a code?
MiddleMiddle
Paint a picture to students about what curative treatment is like and how some of the treatments may not be appropriate when you are older.◦ Parenteral feeding◦ Constellation of problems seen during end of life
Decubiti Contracted Aspiration Thrush Delirium vs. dementia
Address morphine stigma
What are the costs and benefits of placing a feeding tube?
What happens physically when a person dies?◦ Scan the blue book “Gone From My Sight” into a PowerPoint◦ View the movie “Wit” as either an elective course (Colleen), or advertised as a school
event. Introduce Hospice as a modality of care
◦ What is hospice and what makes a patient hospice-appropriate?◦ What is the hospice philosophy?◦ What role does each member of the interdisciplinary team play?
EndEnd
Establish an end-of-life elective course
Have students become active in the EOL medical community and attend the annual AAHPM assembly
Because of our new curriculum, we have flexibility in shaping our education. Establish ECE opportunities as soon as the first year.