Providing ‘Virtual Care’ during the Pandemic

by Palliative Care Team, Rajagiri Hospital, Ernakulam

Dr. Biju Raghavan, Sr. Consultant and Head of the Department, Pain and Palliative Medicine, Rajagiri Hospital, Aluva, Ernakulam, Kerala shares the experience of Palliative Care Team.

Attending phone calls throughout the day to discuss issues of patients as well as to find a solution, meeting emergency requirements by visiting patient’s home by taking extra effort like PPEs for self-protection, sanitizing the entire vehicle and home care kit, requesting the carers to keep distance from the visiting home care team for mutual protection, documentation by audio recording to avoid risk, managing procedures and removing waste with additional care to avoid any chance of infection, and assuring the regular supply of medicines or dressing
materials…the team is struggling to maintain service to the needy.

Department of Pain & Palliative Medicine, Rajagiri Hospital, Aluva, Ernakulam, Kerala, operates Palliative Home Care service in an area of 15 kms around the hospital since 1st March 2018 with the support of ‘Rajagiri Karunya Trust’. In the past 2 years, 500 patients have been provided home care. Presently 118 patients are on active care. Patients being cared for includes terminally ill with advanced cancers, those who are suffering due to organ failures, bedridden due to debility of age and chronically ill. The team also see patients with distressing pain- post-surgery or post trauma and those with refractory breathlessness with cardio-respiratory diseases.

Shifting to Virtual Care

One week prior to the Nationwide ‘Lockdown’, considering the surge of cases in Kerala, at the advice of Rajagiri Hospital Management Committee, Palliative Care Team decided to restrict ‘Physical ‘Home Visits and started ‘Virtual’ Home Visit by phone.

We explained our patients and families that we were restricting our home visits to only urgent needs like sever symptoms, or to change catheters and to do other procedures, which cannot be managed over phone and assured that we would be available on our dedicated contact number. We also promised our patients that regular supply of medicines or dressing materials would be maintained.

The measures adapted during Lock Down to Provide Palliative Care
  • Number of patients under home care were 118,
  • All of them were contacted over phone before lockdown to explain the situation,
  • Out of 118 patients & families, 79 requested for weekly telephonic follow-up,
  • Each of them/their family members, were called in the 1 st week of lockdown. Out of them, 10 patients & families were comfortable and informed that they would call us if needed.
  • Families of remaining 39 patients informed us that they would call us if needed
  • Sixty nine patients/ families were called in the second week.
  • Twenty eight of them requested continuation of weekly telephonic follow-up.
  • Others told us that they would contact us if needed
  • Six patients & families did not attend the call.
  • 4 Patients expired during lockdown
  • One Patient was hospitalized locally.
The following precautions are being followed for Physical Home Visits:
  • We call patient’s home to confirm before we start from hospital.
  • Sanitize the interiors of the vehicle with Virex disinfectant sprays.
  • Home Care Kit (Bag, Bio-medical equipments) are being disinfected with Bacillol disinfectant Spray.
  • We keep adequate quantity of hand sanitizers, surgical masks, gloves, and other PPEs in the vehicle.
  • Spill proof Biohazard Bins (Red & Yellow) &biohazard bags (Red & Yellow) and puncture proof container for Sharps to bring back to the hospital for safe disposal are kept in the vehicle.
  • Only essential team members are allowed to travel.
  • Sanitize our hands before entering vehicle and each team member wears surgical mask while travelling.
  • Hospital ID tags, drinking water and snacks are taken.
  • At the patient’s home, the team leader explains the need to maintain social distancing (6 feet/ 2 meter), before entering the home (except on physical examination of patient).
  • Documentation- by audio recording. File documentation is done when the team reaches Hospital.
  • Procedures are done with appropriate protection.
  • All biohazards are put in appropriate bags and placed in appropriate bins.
  • All bio-medical equipment and bags are disinfected with Bacillol.
  • Again sanitize our hands before entering the vehicle.
Services provided in Home Visits
  • Pain management,
  • Changing catheters,
  • Constipation management,
  • Dressing materials,
  • Food kit.

Our plan is to continue this model, till the lockdown gets lifted.

New patient registration is presently being managed over phone. We plan to start seeing new patients in Home Care once the regular Home Care service is re-established.

The dedicated telephone helpline at the department is attended by Social Workers. They call each patient and their family, enquire about their wellbeing, listen to their concerns, and provide psychological support. Social worker transfer the call to the Nurse or Palliative Care Physician whenever their intervention is needed.

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