St. Peter's Palliative Care Inpatient Program

Our Purpose:

To provide expert, interprofessional palliative /  end of life care to people experiencing any life threatening illness, within an environment that fosters clinical excellence, education and research.  Our Palliative Care Program promotes:

  • Patient/family-driven decision making to maintain the comfort, quality of life, spirituality, autonomy and dignity of each dying person while supporting families through this difficult period and in bereavement
  • A seamless system of care for the dying

Program Criteria - Our Patients Must Meet All Six Criteria:

1. Require the expertise of an on-site, palliative care interprofessional team to manage symptoms and distress:

  • Require a treatment regime to address pain and symptom management
  • May be experiencing complexities associated with their end-stage disease including delirium, aggression, agitation, etc.
  • Require involvement of a palliative trained physician 1 to 2 times per week / daily skilled nursing interventions / active interprofessional goals involving some other professionals, such as: SW / OT / PT / Chaplain / Pharmacy / Dietitian / SLP / Therapeutic Recreation, etc.
  • Significantly decreased functional abilities (Palliative Performance Scale (PPS) score of 50% or less)

AND

2.  Are in the final stages of a life threatening illness (e.g.- metastatic cancer, end-stage cardiac or lung diseases, end-stage neurological disorders, end-stage organ failure, end-stage HIV/AIDS, etc.) -

AND

3. Have goals of care promoting a comfort approach rather than aggressive treatment (a completed POST / Advanced Directives is encouraged)

AND

4. Have a life expectancy ranging from several hours up to several months duration

AND

5. Have care needs that cannot be met at home or in another setting with the available resources (cannot be eligible or referred to LTC)

AND

6. Are aged 18 years or older

Our patients may have any of the Following Goals of Care:

  • To receive comprehensive assessment and ongoing management of distressing symptoms: pain, nausea/vomiting, shortness of breath, restlessness, confusion, etc.
  • To receive short-term intervention to bring symptoms under control and allow discharge home.
  • To receive 24 hour supportive care during the actively dying phase of illness.
  • To receive temporary placement to provide caregiver relief/respite.

 Our patients may have very Complex Care Needs, such as:

  • Various modalities for pain management (including - epidurals & PCA Pain Pumps)
  • Management of IV therapy (peripheral & central lines)
  • Hypodermoclysis
  • TPN
  • High flow oxygen therapy + BIPAP & CPAP
  • On-site blood transfusions
  • Management of complex skin wounds
  • Ongoing management of chest tubes
  • Specialized ostomy care (including - pigtail catheters & nephrostomy tubes, etc.)
  • Specific complimentary therapies for pain management (including - acupuncture, Jobst pump application, TENS, etc.)
  • Determination of specialized therapeutic mattresses, seating & support surfaces
  • On-site bloodwork, X-rays & EKGs

Our patients may be receiving Shared Care, coordinated by us, such as:

  • Day visits for Palliative radiation therapy and/or chemotherapy at the Juravinski Cancer Centre
  • Follow-up visits with their specialist physician

Referrals:

Any individual in a patient's care, who has obtained appropriate patient / substitute decision maker consent, may make a referral:

  • Family Physician
  • Specialist Physician
  • CCAC Case Manager or community based health care professionals
  • Health care professionals from Hospital or Long Term Care
  • Family member or friend
  • Self-referral

Urgent admissions from home to the St. Peter's Palliative Care Program can usually be arranged within 48 hours following a referral.

Complete SPH Palliative Care Application Package

SPH PC Program Information Booklet

SPH PC Program – Referral Q & A Guide

PPS Instructions Definitions

SPH PC Program After Hours Procedure for Referral Sources