Innovations in End-of-Life Care
an international journal of leaders in end-of-life care

Practice 1A-1. Palliative care is available to patients in as wide a range of housing settings as health care and security can accommodate.

Practice 1B-1 Plans for palliative care are based on a needs assessment of the inmate population, characteristics of the physical plant, medical care capabilities, and other resources.

Practice 1B-2. An interdisciplinary team (IDT) assesses the patient’s needs and plans, delivers, and evaluates each patient's care and services.

Practice 1B-3. The interdisciplinary team (IDT) consists of appropriate representatives of all disciplines that are significantly involved in rendering care. At a minimum, it consists of a physician, nurse, mental health representative, and chaplain. Others may serve as IDT members when needed, including but not limited to dietitians, pharmacists, facility security staff, a volunteer coordinator, a patient’s family, the patient, other caregivers, and others, including volunteers, as appropriate.

Practice 1B-4. A qualified health care professional coordinates the interdisciplinary team.

Practice 1B-5. The interdisciplinary team consults with a qualified, trained professional in the area of ethical medical care whenever ethical dilemmas arise in the care of patients and families.

Practice 1B-6. A patient-centered, individualized plan of care is developed and maintained by the interdisciplinary team, in collaboration with the patient.

Practice 1B-7. A written plan of care is developed for each patient within 24 working hours of admission.

Practice 1B-8. Communication concerning the care plan and status of the patient is provided to the patient and to designated family, with consent of the patient.

Practice 1B-9. Care plans are reviewed by the interdisciplinary team, at least every two weeks or when the patient’s condition changes, and revised to reflect the changing needs of the patient and family.

Practice 1B-10. The IDT identifies and incorporates specialized professionals and paraprofessionals to meet the specific needs of patients and families as identified in the plan of care.

Practice 1B-11. Advanced care planning is strongly encouraged and may be required for participation in specific hospice programs.

Practice 1B-12. The medical director or designee reviews, coordinates, and oversees the management of medical care for all patients.

Practice 1B-13. Nursing services are based on initial and ongoing assessments of the patient’s needs by a registered nurse and are provided in accordance with the interdisciplinary team's plan of care.

Practice 1B-14. Nursing services are available twenty-four hours a day, 7 days a week to meet patients’ nursing needs in accordance with the plan of care.

Practice 1B-15. Counseling services are based on initial and ongoing assessments of the patient's and family's needs by a qualified counselor or social worker and are provided in accordance with the interdisciplinary team’s plan of care, utilizing community resources as needed.

Practice 1B-16. Spiritual care and services are based on an initial and ongoing documented assessment of the patient's and family’s spiritual needs by a qualified chaplain member of the interdisciplinary team, utilizing community resources as needed.

Practice 1B-17. The pharmaceutical needs of patients are met, consistent with all applicable regulations and acceptable standards of practice; and patients receive coordinated and accurate communication, information, instruction and education about their medication, medication profile, and the results of medication monitoring.

Practice 1B-18. The interdisciplinary team assesses and plans nutritional care with the goal of meeting the unique nutritional needs of each patient.

Practice 1B-19. Diagnostic services comply with all applicable laws and regulations and meet the needs of the patient.

Practice 1B-20. Quality care and services are delivered in a manner that is consistent with community standards.

Practice 1B-21. The physical environment meets the needs of patients and caregivers.

Practice 1B-22. Pain and other symptoms are assessed and alleviated to the greatest extent possible.

Practice 1C-1. Services and care are available, consistent with the treatment plan, twenty-four (24) hours per day, seven days per week.

Practice 1C-2. Care is fully coordinated to assure ongoing continuity for the patient.

Practice 1C-3. Transfers and releases are planned and managed in a manner that promotes coordination and continuity of care for patients.

Practice 1D-1. Every patient is evaluated to determine eligibility for medical release, furlough, medical parole, compassionate release, and other mechanisms for allowing the patient to return to the community for care and services.

Practice 1D-2. Patients who are potentially eligible for release are assisted, expeditiously, with plans and arrangements for community care.

Practice 1E-1. Patients who are receiving active or aggressive treatment of their illness are not excluded from palliative care programs and services.

Practice 2A-1. Staff is prepared for the demands of a disaster, which has a negative impact on or severely limits the institution’s operation.

Practice 2A-2. The End-of Life Program meets all federal, state and local laws, regulations and codes pertaining to health and safety, especially the applicable edition of the Life Safety Code of the National Fire Protection Association.

Practice 2A-3. A plan for fire safety and prevention is developed, implemented, and evaluated.

Practice 2A-4. Medications and nutritional products are properly stored and prepared.

Practice 2A-5. Facilities provide a safe and secure setting for patients, families, volunteers, and staff.

Practice 3A-1. A plan for reporting, monitoring, and following up on all adverse incidents is operational.

Practice 3A-2. There is a written suicide prevention and intervention program that is reviewed and approved by a qualified medical or mental health professional. All staff with offender supervision responsibilities are trained in the implementation of the suicide prevention program.

Practice 3B-1. Services and care are available to patients in a variety of custody settings to ensure that patients are not subjected to a higher level of custody and control solely to gain access to needed services and care.

Practice 4A-1. Written program admission criteria prohibit discrimination in accepting referrals.

Practice 4B-1. Confidentiality of information related to patient care is maintained.

Practice 4B-2. Patients have the right to revoke hospice election at any time for any reason.

Practice 5A-1. Psychosocial services assist the patient to avoid isolation, bring closure, find emotional peace, gain acceptance, make connections as desired, and receive human contact.

Practice 5A-2. Psychosocial and family support is available to inmates with terminal illnesses.

Practice 5A-3. Patients are provided with assistance to locate and contact family, if they choose to do so. Family members are assisted with visitation plans

Practice 5A-4. Psychosocial and spiritual care is available twenty-four hours a day, 7 days a week, to meet the needs of each patient.

Practice 5A-5. Patients are allowed to define whom they consider to be "family" and to limit or decline contact.

Practice 5A-6. Visitation rules for patients maximize access for family and significant others, including other inmates.

Practice 5A-7. Visitation is held in a setting that is appropriate to the patient’s condition.

Practice 5A-8. Volunteers who provide psychosocial support and other services do so in accordance with the patient plan of care.

Practice 5B-1. Deaths that occur in the correctional facility are handled with the utmost respect and compassion toward the patient and family.

Practice 5B-2. Bereavement services are provided through a defined program in order to help patients, families, volunteers, staff, and other inmates cope with the losses that occur during illness and after the eventual death of the patient.

Practice 5B-3. A plan of bereavement care for families and caregivers identifies bereavement problems and needs, interventions, goals and outcomes, and is developed and documented for families and caregivers. Ongoing care for family in the community may include referrals to community agencies equipped to provide bereavement support and counseling.

Practice 5B-4. Bereavement education and supportive service is offered to the larger correctional community.

Practice 5B-5. A mechanism to evaluate bereavement services on a regular basis is maintained.

Practice 6A-1. The program accurately represents its services to the institutional community, inmate families, and the public.

Practice 6A-2. All persons involved with the program acknowledge and respect each patient's and family’s values and beliefs regarding end-of-life issues.

Practice 6A-3 All persons involved with the program maintain professional boundaries and appropriate relationships with the patient, family, and volunteers.

Practice 6A-4. Patients and their families are protected from abuse and exploitation.

Practice 6B-1. Patients will be involved in all decisions regarding their treatment and services.

Practice 6C-1. End-of-life programs and services are managed by a clearly defined organizational structure that identifies the roles, responsibilities, and authority of every stakeholder and facilitates participation in decision making by individuals closest to an issue or process.

Practice 6C-2. The program’s mission, purpose, vision, policies and procedures are clearly described.

Practice 6C-3. There is a process that facilitates annual review of the program’s mission, purpose, vision, policies, and procedures.

Practice 6C-4. The program's leaders ensure compliance with professional, legal and regulatory requirements and standards.

Practice 6C-5. The program's leaders ensure effective strategic planning and resource management.

Practice 6C-6. Information needed to operate the program efficiently is identified, collected, and maintained in a manner that respects the patient’s confidentiality.

Practice 6C-7. Information is collected and disseminated to appropriate individuals in a timely manner. A comprehensive, timely, and accurate record of services provided in the institution is maintained.

Practice 6C-8. Information is protected against loss, theft, and destruction.

Practice 6C-9. Staff has access to current information on palliative care and bereavement.

Practice 6C-10. There is a well-organized review and improvement process that is implemented throughout the program, which is supported by the facility administrator.

Practice 6C-11. The end-of-life quality improvement program is part of an institutional program for improving performance.

Practice 6C-12. The planning, development, and implementation of performance improvement activities are comprehensive and collaborative.

Practice 6C-13. Performance and outcome data related to palliative care and program functions are collected and benchmarks established.

Practice 6C-14. Actual improvements in processes or outcomes as a result of the performance improvement activities are demonstrated, and the improvements are maintained over time.

Practice 6D-1. There are administrative policies that define the roles and responsibilities of all staff, contractors and volunteers.

Practice 6D-2. An appropriate number of qualified health care professionals, paraprofessionals, and volunteers are available to meet the unique care needs of the program’s patients.

Practice 6D-3. All staff receive orientation, training, development opportunities, and continuing education on end-of-life care, appropriate to their responsibilities. There is continuous education for staff, contractors and volunteers.

Practice 6D-4. A relationship exists with community hospice programs that promotes shared training, education, and consultation.

Practice 6D-5. A competency assessment for all staff and volunteers responsible for providing patient care activities is in place.

Practice 6D-6. Staff and volunteers reflect the diversity of the patients served, whenever possible.

Practice 6D-7. Adequate supervision and professional consultation by qualified personnel is continuously available to program staff and volunteers.

Practice 6D-8. Caring volunteers are provided who are specially trained in the care of the patient and in other aspects of the program’s operation and who are capable of assisting patients without making value judgments.

Practice 6D-9. Volunteers, whether they are inmates or are from the community, receive specialized training related to care giving in a correctional setting.

Practice 6D-10 Volunteers meet as a group monthly, or more frequently if necessary, to receive clinical supervision and support.