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Best Practice

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Document Typology: Training course
Target groups: Health Workers,Caregivers,Policy Maker and Administrators
country Where It Took Place: Romania
Name of compiler: Gabriel Saulescu
name of institution: CECMA
role: Researcher
language Of The Description: English
title: Quality standards for palliative care services
description Of The Best Practice:
The National Programme of Palliative Care proposed by HOSPICE Casa Sperantei was presented on 8 august 2012 at the Ministry of Health and was followed with great interest. The national programme proposes short and medium term objectives to support the coordinated development in Romania of palliative care services to meet the need for care in a uniform way in all counties. This will involve informing and educating medical professionals, developing the legal framework and developing the care services.
The document is based on treaties ratified by Romania and recommendations, resolutions of relevant international bodies for Romania.
This is a document in which standards for  palliative care services
in Romania are presented. The project drafted the minimum quality standards that were born from the desire to improve medical care provided to very vulnerable patient groups and assisted insufficiently, ie those with incurable diseases. Standards resulted in a set of criteria to be met by any potential palliative care service about to be established and can also be used by health authorities and donors as a practical tool for assessing palliative care services in Romania.
Based on a minimum quality standards in palliative care the costs of palliative care in Romania (February 2010) were calculated. 
Also there have been proposals for norms  for the personnel working in palliative care services;  for palliative care providers authorized 
and to train nurses in palliative care. 
The palliative care standards are the result of cooperation between Hospice „Casa Speranţei” Braşov and the National Association of Palliative Care (ANIP) within a project financed by the Open Society Institute New York – The Public Health Programme.
The aim of the programme is to achieve a coordinated and accelerated development of palliative care services, at national level, in order to improve the life quality of patients with progressive or incurable chronic diseases, as well as the life quality of the family and relatives of these patients. 




More information at http://www.studiipaliative.ro/STANDARDE%20INTERIOR.pdf 



Results:
The proposed qualitative results consist in: Informing, Regulating, Educating, Developing structures/services that should ensure the care on competence levels. The objectives of the programme, on short and medium term, in the period 2013-2015, are: 1. Assuming the National Strategy of Palliative Care, by informing (INFORMING) and consulting the stakeholders Result: strategy known, adapted and assumed by the end of 2015. Indicators for Objective 1: - 56000 brochures and flyers produced and disseminated by means of the national strategy and 10 key messages - 50000 CDs - 10 meetings with stakeholders 2. Normative and legislative adjustments (REGULATING) Result: normative framework and adequate financing mechanisms for the development of palliative care Indicators for Objective 2: - 12 working meetings - 6 normative documents elaborated and implemented 3. Developing the competences of staff (EDUCATING) Result: teams of professionals, family doctors, carers adequately trained according to their level of competence in order to be able to offer quality assistance Indicators of objective 3: - 40 doctors accredited, 100 specialized nurses, 25 teams trained in 12 courses with 350 participants, 15 new trainers, 500 family doctors trained in palliative approach, 14000 patients and families educated, publications 4.Developing the capacity of specialized services in palliative care (ASSISTING) Result: Gradual increase of covering with specialized services at the level of non-pilot counties, integrated network of palliative services in the county of Brasov with over 50% covering of needs, integrated oncology centres in Cluj, Bucharest, Iasi Result: functioning at maximum capacity of the existing services Indicators of Objective 4: Development of new structures: - 29 new teams of home palliative care - 5 new teams of ambulatory palliative care - 4 new sections of palliative care in the pilot counties - 2 centres of phone consultancy. 5.Development of palliative approach in the pilot medicine (ASSISTING) Result: 15% covering in the non-pilot counties and over 30% covering in the pilot counties Management Units - Central management unit - MS+HCS+consultative board, - County management unit - DSP+consultative board for providers Implementation units
Quality indicators:
Use of strategies to collect narrative descriptions
Comment:
The standards emerged from a previous analysis on the needs of the vulnerable patients together with the personnel working in this area. Research has been made though different means such as interviews with patients under home care or palliative care centres. The standards are updated on a regular basis as the programme offers also courses to the specific target groups. Within these courses, feedback is received and more improvements can be made.
Evaluation:
The National Programme of Palliative Care proposed by HOSPICE “Casa Sperantei” proposes short and medium term objectives to support the coordinated development in Romania of palliative care services to meet the need for care in a uniform way in all counties. This will involve informing and educating medical professionals, developing the necessary legal framework and developing the services.
An essential principle of palliative care says that patients should have timely access to care and in an environment adequate to their clinical needs and personal preferences. In essence, palliative care should be available to all patients whenever they need.
The quality standards ensure that services in palliative care provided are of a good quality and that health workers are aware of these standards when performing their job. These standards are the result of the opinions gathered from both patients, doctors, nurses and home health carers on the actual health care system at home and in specialized homes.
This document represents the second standardization of palliative care services (home, units with beds and ambulatory) in Romania. The project of writing of certain quality standards arose from a desire to improve medical care given to a category of patients that is very
vulnerable and insufficiently assisted, ie those with chronic diseases. Standards can provide a set of criteria that should be met by any potential palliative care service about to be born and can also be used by the health authorities and donors as a practical tool for assessing palliative care services that began to develop in Romania.
Based on these quality standards in palliative care, the costs of palliative care in Romania were calculated (February 2010). Also there have been legislative proposals for staffing norms in various palliative services for authorizing home care providers.

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