Palliative Care for Advanced Disease (PCAD)
Pathway: Unit Reference Manual
PCAD Introduction

PCAD Online Registration Form
Purpose
Goals
Components
Process
Flowchart

Purpose of PCAD:

PCAD was prepared to guide the interdisciplinary management of imminently dying inpatients. Please use our online registration form to access the entire PCAD Unit Reference Manual. Accompanying PCAD forms are presented in Adobe Acrobat .pdf format. You will need the free Acrobat Reader application to view and print these forms.

The Goals of PCAD are to:

	Respect patient autonomy, values, and decisions
	Continually clarify the goals of care
	Minimize symptom distress at the end of life
	Optimize appropriate supportive interventions and consultations
	Reduce unnecessary interventions
	Support families by coordinating services
	Eliminate unnecessary regulations
	Provide bereavement services for families and staff
	Facilitate the transition to alternative care settings, such as hospice, when appropriate

PCAD consists of three components (forms are available in .pdf format):

	PCAD Care Path – the interdisciplinary plan of care
	PCAD Daily Patient Care Flowsheet – an interdisciplinary documentation tool for daily assessments and interventions
	PCAD Healthcare Provider/MD-Order Sheet – a documentation tool and suggestions for symptom control approaches

Process for utilization of PCAD Pathway (See Flowchart below):

Step 1: Patient Identification
Identification of a patient that is likely to die during this hospitalization (i.e., likely to die within minutes to days) by any staff member. Any staff member or others listed may suggest a patient for PCAD.

Step 2: Interdisciplinary Assessment
Interdisciplinary assessment of the patient for PCAD and discussion with the primary healthcare provider – The unit leadership assesses the appropriateness of the patient for PCAD and initiates an order for PCAD with the primary healthcare provider.

Step 3: Provider Clarification
Clarification of goals of care with the patient/family by the primary healthcare provider – The primary healthcare provider clarifies the goals of care with the patient and/or family and orders PCAD if end-of-life supportive care is the primary goal of care.

Step 4: Implementation
The primary healthcare provider orders PCAD using the PCAD Provider Order Sheet and rewrites the orders for the patient. Nurses complete the demographic information on the PCAD Pathway and initiate a PCAD Daily Patient Care Flowsheet.

Step 5: Discharge
The patient is discharged to an alternative care setting or dies on unit. A family bereavement policy is initiated (e.g., condolence card and educational materials sent) and a staff debriefing session is conducted.

Register now to access or download PCAD professional tools and instructions.