Surgical Department

Hospital Tuanku Fauziah, Kangar

MEMBERS
Name Position

Mr. Junaidi Dr. Lee Joo Ann Dr. Valliappan Dr. Punithavathi Dr. Malini Dr. Areffuddeen Dr. Zarina SN. Duratulhanani SN. Lailatul Qamariah

Leader Member Member Member Member Member Member Member Member

Problem List
1. Poor bowel preparation leading to cancellation of colonoscopy 2. Cancellation rate of DJ stenting in HTF 3. Improvement in management of palliative care in cancer patients 4. Awaiting time of emergency surgery 5. Monitoring of critical/acute patients in general surgical ward 6. Improvement of clinic procedures on clinic days

Prioritisation
Nominal group technique (NGT) - Positive

SMART criteria
Proposed topics Bowel prep DJ stent Palliative care Emergency Surgery Serious 18 9 25 18 Measurable 18 18 27 9 Appropriate 18 9 25 18 Remedialable 27 9 27 9 Timeliness 18 9 27 9 TOTAL 99 54 131 63

Acute monitoring
Clinic procedures

18
9

18
27

18
9

27
27

18
9

99
81

Pain service Pain medication Pain Symptom free Pain chart

Oncology
Surgery

Palliative Treatment Given

Private

QOL AFTER OPTIMUM PALLIATIVE CARE RECEIVED BY CANCER PATIENTS Intensive Counseling And Education Patient Family

Government

Welfare Services

Good Nursing Care

Palliative Unit Home Visit

Experienced staff/ proper course

Advance Cancer

Diagnosis confirmed Counseling

Options of Palliative treatment

Surgical

Palliative Treatment

yes

no

Non Surgical Intervention

Pain Management Palliative Unit Nursing Care Home Visit

Palliative Care Patients

Satisfaction

MODEL OF GOOD CARE

STEP PROCESS OF CARE CRITERIA STANDARD

01

Diagnosis Counseling Patient Family

By histopathology Counseling done by: Specialists Medical Officers Hospital counselors Options discussed with the patients by: Specialists Medical Officers
Surgical intervention by: Surgeons Medical Officers

100 %

02

100 %

03

Options of Treatment

100 %

04

Palliative Treatment (Surgical)

90 %

MODEL OF GOOD CARE cont..

STEP PROCESS OF CARE CRITERIA STANDARD

05

Palliative Treatment (Non surgical)

Offered by Oncology Department

Pain management by pain service staffs and doctors Adequate pain relief, types of pain relief available Good nursing care by staff nurses, doctors and family members Home visits by palliative team Patient satisfied with the treatment given -symptom free -quality of life

80 % 90 %

06

Palliative Care

90% 80%

07

Patients satisfaction

90%

MANAGEMENT OF PALLIATIVE CARE

Management of advance cancer is challenging and forms a part of the

major workload to the Surgical Department as we dont have a proper palliative team as well as palliative unit. (INTRODUCTION) Patients with advance cancer should be treated promptly and they

need adequate care for them to have better quality of life (DESIRABLE OUTCOME/ EXPECTATION) There are ample of opportunities to make this possible in our setting.

(OPPORTUNITIES) We hope to identify areas that can be improved by carrying out a

study using certain indicators. (INTENT TO IMPROVE)

9. Main Indicator
Indicator: Percentage of satisfaction of palliative care among the Advance CA patients on palliative care

Number of Advance CA patients receiving best palliative care Total number of Advance CA patients

 Inclusion Criteria
All advance CA patients that: Diagnosis have been made with histopathology Age > 18 years old Staying in Perlis

Exclusion :
Patient who are receiving treatment in other hospital but only come for acute treatment in HTF

10. Objective
General objective
To evaluate the palliative care services provided at HTF

Specific objectives
1. 2. 3. 4. To determine the quality of life among Advance Breast and Colon CA patients who are receiving palliative care treatment in HTF To identify inadequate services provided to Advance Colon and Breast CA patients in HTF To analyze the psychological and emotional care among dying Advance Colon and Breast CA patients and family To identify the approaches towards optimization of palliative care

11. Topic

Introduction
Quality of life (QOL) is a core outcome of palliative care yet in our setting, there is lack of evidence on patients level of QOL. We aim to describe the QOL among patients with incurable progressive breast and colon CA receiving palliative care in our hospital. We hope that with this study, we can improve our services to improve QOL among breast and colon CA patients.

12. Methodology of study

Type of study Definition
Cross-sectional Survey using MVQOLI questionnaire Advance CA Advance stage when curative treatment is no longer useful. Palliative Care Approach that improve quality of life of patient and family members facing problems associated with life threatening illness (WHO 2002) MVQOLI Missoula Vitas QOL Index (Byock et. al). Participating palliative care service including home care, day care, outpatient clinic and inpatient units. Descriptive statistics

Analysis

Pre intervention study Post intervention study

13. Data collection

WHAT WHO WHERE SOPD/Ward WHEN Monthly WHY Denominator HOW Cancer Registry Palliative and cancer registry book Questionnaire

Total no. of advance 1 breast and colon CA patient

No. of patients 2 receiving palliative care 3 MVQOLI Questionnaire

SOPD/Ward SOPD/Ward

Monthly Pre and post

Numerator To identify QOL

13. Data collection cont..

WHAT 4 Methods of palliative treatment WHO WHERE SOPD/Ward Home SOPD/Ward Home/Ward WHEN Monthly Daily Daily Monthly WHY To identify cause To identify the QOL To identify QOL To identify QOL HOW BHT Palliative team BHT Questionnaire

5 Palliative Visits 6 Pain treatment 7 Psychological

GANTT CHART
ACTIVITY 1
2 3 4 5 6 7 8

RESPONSIBLITY Dr. Nasir

Mr. Junaidi Mr. Junaidi Dr. Joo Ann Dr. Punitha GM GM GM

AUG

SEPT

OCT

NOV

Committee Briefing
Planning Staff Briefing Data Collection Data Analysis Remedial Action

Re evaluation
Report Writing

GM Group Member