Over a series of blog posts, I’ll provide an overview of the domains as well as a tool your team or organization can use to conduct a self-assessment and improvement plan to be in alignment with the guidelines.
Domain 1 of the NCP Guidelines, 4th ed. outlines the structural elements of the palliative care service, starting with the composition and competencies of the interdisciplinary team. Since the IDT is the heart of quality palliative care, the NCP Guidelines outlines the role of each team member, based upon their scope of practice. Examples of the external experts that the team may call upon based on the patient and family’s care needs, are also provided.
Additional elements of Domain 1 include:
The importance of 24/7 access to the palliative care team
IDT processes, including the purpose of team meetings
Elements of a comprehensive assessment
The palliative care planning process
Ongoing continuity of palliative care during transitions of care
Coordination of care
How the IDT interacts with providers in care settings
Essential education for the IDT
Emotional support of the team and self-care
An ongoing continuous quality improvement process
The importance of a needs assessment to identify the patient population
Strategic planning and financial management to ensure ongoing sustainability
Evidence of Practice and Action Plan
One of the benefits of a careful review of Domain 1 is that it provides an outline for anyone looking to launch, expand, or revamp their program. The elements of the domain can serve as a framework for your policies and procedures.
For example, using my NCP Clinical Practice Guidelines for Quality Palliative Care, 4th edition Evidence of Practice and Action Plan (see below) I am reviewing a programs processes and practices (they don’t have policies and procedures yet), for evidence that they meet the criteria in each guideline. For example, for Guideline 1.4 - Continuity of Palliative Care, a completed Evidence of Practice and Action Plan might reflect the following:
As you can see, the evidence of meeting the criteria doesn’t preclude the need to take additional steps to better align with the NCP Guidelines.
While it might seem overwhelming to assess your program in relation to the NCP Guidelines 4th ed., it doesn’t have to be if you break it into segments. Your team can take a month or more to finish each domain, reviewing a few guidelines each week. Or you can divvy up the guidelines and ask each person to do a review to bring back to the team.