Air Force Maj. Alisha Florence and Senior Airman Rachael Tuczynski, nurses assigned to the 60th Medical Group, 60th Air Mobility Wing, Travis Air Force Base, California, gather information and perform preliminary patient checks outside of Adventist Health Lodi Memorial hospital in Lodi, California, July 29, 2020. The medical team, in support of Task Force 46, Joint Force Land Component Command, U.S. Army North, helped initiate curbside checks as a way to expedite care for growing COVID-19 cases in this San Joaquin County facility (Photo by: Army National Guard Staff Sgt. Eddie Siguenza).
They also submitted a grant proposal to purchase tablets and other technology required to provide communication between patients and their families.
Migliore said that the PICO analysis and literature review identified three primary needs by staff and patients during the pandemic.
- Critical need for frontline/primary care staff to receive rapid palliative care training
- Access to existing palliative care specialists as consultants and subject matter experts
- Need for regular palliative education and training
About a year after the project began, the toolkit is now available, empowering frontline medical staff and bridging the gap in palliative care.
"The toolkit focuses on palliative care, communication, symptom management, and support of caregivers," said Migliore, who was personally affected during the pandemic and benefited from information the toolkit provided to the staff, taking care of her husband and using the means of communication the tablets provided. Her husband was admitted to Grant's ICU with cardiac issues during the pandemic.
"When I brought him to the emergency room I wasn't prepared for him to be admitted, I thought that he would get some medications, stabilize, and return home," she said.
Instead, he was admitted from the emergency room to the intensive care unit and the only means for them to communicate was through the tablets provided by the pilot program.
"The nurse taking care of my husband learned that I was one of the team leads for the project," Migliore added. "She told me how grateful the staff was for the tablets and how helpful they were for patients and staff during the visitor restrictions."
The toolkit is now available to all DHA medical professionals on the organization's internal website.
According to Migliore, the pilot is concluding soon and the results and lessons learned will be published and made available to military hospitals and clinics, incorporating the COVID-19 Palliative Care Toolkit into inpatient practices.
"We worked out some significant challenges despite constantly deploying staff and issues with inpatient internet capability," she said. "We incorporated feedback from the field to refine the contents for a simple yet relevant and practical resource."
The short-term goal of the pilot was to provide immediate palliative care resources to medical staff based on evidence and vetted by palliative care subject-matter experts for immediate use during the pandemic. The long-range objective is to develop centralized, standardized resources for palliative care use throughout the Military Health System.
"The enterprise would benefit from standard order sets, protocols, and simulation training for staff/patient communication for goals of care during high-stress crisis situations," Migliore said. "Ultimately, the impact (of palliative care) is improved quality of life, decreased suffering, and satisfied patients and families."