NCP Guidelines: Domain 2 - Physical Aspects of Care

The National Consensus Project Clinical Practice Guidelines for Quality Palliative Care, 4th ed. outlines the essential elements of a palliative care team / service.  In a series of blog posts, I’m exploring each domain and sharing my Evidence of Practice and Action Plan.
 
Domain 2

The Physical Aspects of Care domain outlines the fundamental elements of an assessment and care planning process that seeks to relieve symptoms while improving or maintaining functional status and the patient’s quality of life.  The domain outlines training that palliative care clinicians need related to safely prescribing opioids and pain management for patients with, or who are at risk for, substance use disorder.

Domains 2-5 detail the elements of the palliative care screening and assessment, treatment, and ongoing care needs of patients and families.  Of specific interest are the following:

• Using only validated assessment tools*

• Assessing the “onset, quality, severity, provoking and relieving factors, response to prior treatment, level of burden, impact on functionality and quality of life, and meaning of distressing symptoms, as well as the patient’s goals of care”

• Determining if the patient and/or caregiver has cognitive or physical challenges hindering the ability to implement the plan of care

• Actively engaging patients and families in the care planning process 

• Anticipating symptoms with the goal of preventing them 

• Completing a caregiver assessment

• Integrating community service providers to meet the patient and family’s unique needs

• Ongoing medication reconciliation, justification, and optimization

For patients who have ongoing care needs, Domain 2 lists processes that the team can implement to support these needs.

Evidence of Practice and Action Plan

Domain 2 provides a framework to review your staff training topics, policies and procedures, and your documentation system for evidence that you are in alignment with the NCP Guidelines.   

As you can see in the example below, your “evidence of practice” doesn’t have to be extensive. The goal is to find areas to improve the care you provide patients and families. The evidence of meeting the criteria doesn’t preclude the need to take additional steps to better align with the NCP Guidelines.   

Assessing your program in relation to the NCP Guidelines 4th ed., doesn’t have to be done all at once.  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.

Download a PDF of my Domain 2 NCP Clinical Practice Guidelines for Quality Palliative Care, 4th edition Evidence of Practice and Action Plan, read the blog post about Domain 1 to download that Evidence of Practice and Action Plan, and stay tuned for blogs about domains 3-8.  

* Appendix II includes dozens of assessment tools and other resources specific to Domain 2, with links to websites where you can learn more about tools and download them.