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• W2913630142 abstract "•Describe the current available evidence for management of dyspnea in advanced pulmonary disease, specifically regarding the use of opioids and benzodiazepines.•Describe the steps to setting up an integrative palliative-pulmonary clinic model including as a Quality Improvement project using a PDSA model.•Describe and plan for the utilization of an opioid and benzodiazepine review board.•Identify positive outcomes of an integrated palliative-pulmonary clinic. Patients with advanced pulmonary disease including COPD report a poor quality of life. These patients also live with a great amount of prognostic uncertainty. Symptoms include dyspnea, pain, fatigue, and mood changes. Patients note changing and diminishing functional status and quality of life. Often, conversations about goals of care are not pursued early. Literature exists to support the treatment of subjective dyspnea in advanced COPD with opioids, however, studies are small and limited. We established an innovative Pulmonary-Palliative Care integrated clinic model in September 2016. Patients are most often referred by pulmonary providers, and are also referred by primary care. We have been following 37 patients since the clinic opened. Patients are seen either in tandem or joint visits, with active collaboration. Visits focus on goals of care, advance care planning and symptom management. We have been prescribing opioids for management of dyspnea with minimal exertion in approximately half of the patients. Due to the current concern around opioid use and safety, in December 2017 we established a medication review board. This board includes pulmonary and palliative care physicians and nurse practitioners, a psychiatrist, and a pharmacist. The board meets monthly to review patient cases and make medication recommendations. The board has also established universal opioid risk assessment, urine drug testing, and opioid agreements. In this concurrent session, clinicians from a multidisciplinary Palliative Care-Pulmonary clinic will use case studies, clinical literature, and pilot data from this institution’s experience to share challenges and solutions supporting patients with advanced pulmonary disease and building strong collaborative ties to a pulmonary program. We will share our experiences with advance care planning, POLSTs, symptom management and hospice referral. Additionally, clinicians will share experiences and data from implementation of an opioid assessment tool and an opioid management protocol in this population." @default.
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• W2913630142 date "2019-02-01" @default.
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• W2913630142 title "“I Am Barely Breathing”: Experiences and Outcomes of an Integrated Palliative Care-Pulmonary Clinic Utilizing an Opioid and Benzodiazepine Review Board for Safety (TH363)" @default.
• W2913630142 doi "https://doi.org/10.1016/j.jpainsymman.2018.12.084" @default.
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