Resources for Family Physicians in Hamilton Treating Patients with Serious Illness and a Limited Prognosis
Last updated April 30, 2020
This is a collection of resources for Hamilton family physicians who will be caring for patients (virtually and in-person) in the community with serious illnesses and a limited prognosis during the COVID-19 pandemic. This is not a COVID-specific resource, although can be applied to this population. Care for all patients requiring a palliative approach will be significantly impacted by this pandemic, leaving family physicians and patients’ families to fill inevitable gaps in home care. This document aims to relieve some of the burden in navigating what will continue to be a rapidly evolving system.
Please visit the following websites for regular updates:
- Division of Palliative Care, Department of Family Medicine at McMaster University website for regular updates
- Hamilton Family Medicine (HFAM)
- Contact (for feedback): Dr. Erin Gallagher
Pain and Symptom Management
Patients with COVID-19 at home may get better, or they may not; we can never be 100% certain what will happen. The status of a patient with COVID19 can change on a dime and dramatically so (within hours). Frontline community doctors and nurses must balance palliative care needs, infection control and life prolonging treatment (if this is the patient’s goal of care). Anticipation and preparing ahead are vital, including being aware of how rapidly you can mobilize medications and supplies delivery as well as home care.
- A free pharmacotherapy tool for pain and symptom management including local formulary considerations.
- Free online modules to help provide health care teams with important knowledge and skills required during the COVID-19 pandemic response:
- Canadian Virtual Hospice is a free resource for all things palliative care, including psychosocial and spiritual resources as well as COVID-specific resources.
- Free COVID-specific and other pain and symptom management protocols through the Division of Palliative Care, including dyspnea and palliative sedation.
Palliative Care Specialist
Examples of when to phone: pain and symptom management is beyond your level of comfort or patient is in an acute symptom crisis; traditional medications become unavailable and an alternative is required; system navigation or other pain and symptom questions; suspected or confirmed COVID death; palliative sedation is being considered .
Please note that all regular palliative care services are running as usual in the hospital and community.
24/7 palliative care specialist phone support (905) 387-9495 for any physician in the community:
- Daytime (9:00-16:30) ask for the Supportive Care Service
- Evenings and weekends ask for Community Palliative Care on Call (CPOC)
Information about the Hamilton Palliative Care Outreach Team (PCOT)
Hamilton Palliative Care Outreach Team Referral form
LHIN Home Care
Shortages for palliative care medications are a significant concern during this pandemic. We are also seeing shortages for more common medications, such as Salbutamol.
Refer to the pain and symptom management protocols above. Please select medications and quantities wisely, as over-ordering will contribute to medication shortages in our region, which are already anticipated. Ordering of a 7-day supply at a time is recommended. This differs from pain and symptom management “kits” (see below), which are for the management of rapid-onset, unanticipated symptoms for patients nearing end of life and are no longer able to swallow oral medications.
24 Hour Pharmacies
Shoppers Drug Mart
510 Concession Street, Hamilton
Phone: (905) 387-8656
Fax: (905) 387-4901
Pharmacies Specializing in Palliative Care and Injectable Medications
- All medications ordered through the LHIN as they will provide the necessary supplies (subcut butterflies)
- 4-hour turnaround from order to delivery
- Require nursing support for drawing up of meds and teaching around administration
- Asking for all orders to be in by 18:30 each day
Marchese Health Care (LHIN will still need to provide supplies)
316 James St N, Hamilton
Phone: (905) 528-4214
Fax: (905) 570-0496
Pain and Symptom Management Kits
For the management of rapid-onset, unanticipated symptoms for patients nearing end of life and are no longer able to swallow oral medications. The medication is limited to support short duration of symptom management (48 hours) until further assessment and medications are ordered. Inappropriate ordering of these kits and not tailoring their components will contribute significantly to medication shortages in the region.
Oxygen delivery mechanism and implications for PPE
Prior restrictions on home oxygen therapy qualifications and funding are being waived during the pandemic
Palliative Care Facilitated Access (PCFA)
If working in collaboration with a palliative care physician (see criteria), family physicians are exempt from obtaining approval under the Exceptional Access Program (EAP) for specific palliative care medications.
Ventolin Conservation and Alternatives
Advance Care Planning and Goals of Care
- Resources for patients and families on Advance Care Planning (Speak Up Ontario)
- Conversation guide for Advance Care Planning
- Free COVID-ready communication playbook
- DNR-C order form
- Power of Attorney Kit
Inquire about funeral arrangements.
PLACE OF DEATH
Referrals to the 2 Hamilton hospices and St. Peter’s Hospital Palliative Care Unit occur through the LHIN. Both Hamilton hospices are not accepting suspected or confirmed COVID positive patients, although they have access to rapid testing (6-hour turnaround) to confirm COVID status. Access to these facilities will be challenging due to limited resources in the context of COVID. Visitor policies are also changing which makes contact with loved ones challenging. Similarly, family physicians will likely not be able to perform site visits leaving medical directors to round on patients. Many patients without appropriate home support will have to die at home or in temporary facilities that are to be determined in our region.
Time of Death
Families should be reminded NOT to call 911, but the nursing agency or family physician.
Letter of Understanding: A document sent to the family physician by the LHIN (if home care is involved) to indicate preference for who is to pronounce death of a patient in the home (nurse or physician). If the nurse pronounces, the death certificate is required by the funeral home within 24 hours.
- Death Certifications in the Community and LTC
- Coroner: 1 (855) 299 4100
- Regional Coroner: 905 546 8200