2002
Pain and Palliative Medical Unit "Salvador Zubirán"
National Institute of
Medicine and Nutrition Mexico City.
About the Clinic.
In 1993 Palliative Medicine Pilot Program began as part of the Pain Control Clinic of the "Salvador Zubirán" National Institute of Medicine and Nutrition in order to attend to the needs of the terminally ill patients.
The Clinic is staffed by two physicians trained in Pain Management, a physicians specializing in Palliative Medicine, a psychiatrist, a psychologist, a social worker and two nurses. Furthermore, we have six residents (specialists in Anesthesia) with university training in the Pain Control Clinic and two psychologists studying a masters degree in Clinical psychology. We also have interdisciplinary physiotherapy service and a spiritual and religious consulting service.
The Palliative Medical Unit has always been characterized by offering its patients the best possible medical attention. While keeping a professional outlook, it bases its therapy on medical evidence. All of the terminally ill patients’ needs are met with warmth and humanism and we strive to continually improve the medical care offered.
Evaluation Methods and Clinical Indicators.
The population that we target is made up of the Institutes’ patients that are referred to our Unit generally by Hematology, Oncology, Geriatrics and Infectious Disease Department (advanced stages of HIV) as well as other departments. Patients with different organ insufficiencies (not able to receive transplants) that fulfill the terminal criteria are also treated.
The program is based on outpatient management treated at the Palliative Medicine Outpatient Program, where an initial evaluation is performed followed by subsequent scheduled appointments. We also give care to hospitalized patients which meet the necessary clinical criteria to enter the program. If the patient’s physical conditions prevent him or her from going the hospital, we teach the family how to prepare a symptom’s log, such as a management guide.
In selected cases we provide home visits, conducted by the specialist physician, psychologist and social worker. Furthermore, a twenty-four hour a day help line, through a radio service, is available to emergency and hospital physicians, as well as to out-patients.
In 2000 the treatment for the terminally ill patient was formalized. Likewise we have modified the evaluation format and have included the following scales: Mini-Mental State (Folstein modified), Palliative Performance Scale (PPS – Anderson et al), Edmonton Symptom Assessment Scale (ESAS – Bruera, E) and Functional Assessment Staging (FAST).
One of the most important activities that we carry out is working together with other medical specialties and have established periodical meetings to discuss problematic clinical cases or topics such as 1) the patients and relatives’ emotional, social and economic situation; 2) grief evolution; 3) possible psychiatric complications; 4) how to inform (how, when and why to tell the truth); and 5) the impact of the terminal situation on the patient, family and therapy team. As a result of these meetings we have reached consensus and algorithm of the specific situation management in the terminal context with different groups of specialists.
Quality Control Mechanisms.
As a parameter of quality control we take into account the improvement in our patients’ symptom profile, their quality of life as well as the patients and relatives’ level of satisfaction. Moreover, we also take into consideration the reduction in the number of visits to the Emergency Room. Currently all of the information is being incorporated to a computerized database in order to facilitate research in the near future.
Community Outreach.
The Palliative Care Unit of the "Salvador Zubirán" National Institute of Medicine and Nutrition has a teaching program for physicians (anesthesiologists) that wish to specialize in the pain and palliative care treatment. Likewise within its academic program, the Unit offers guidance to doctors in other areas; trains nurses and students studying to become nurses in the care of terminally ill patients.
The Unit offers programs to doctors with other areas of expertise (oncologists, geriatrics and anesthesiologists) so that they may briefly stay and complement their academic studies. Those studying to become geriatrics are offered different courses on Palliative Medicine related to their area.
Furthermore, the patients’ relatives are also trained in the basic care required for a terminally ill patient and house visits are carried out to improve treatment at home.
Objectives and Long term Goals.
One of the principal objectives of this Unit based on fundamental ethical principles consists in sensitizing heath professionals in regard to the care that must be offered to the terminally ill patient.
The Unit’s goal is to promote palliative medicine, educate and train physicians to continue to develop it within our population while keeping in mind the highest international standards.
The Unit’s mission is to advance excellent quality in assistance, research and teaching Palliative Medicine with the scientific and technological resources at hand. We strive to respect ethical and humanistic principles while becoming a highly efficient therapeutic team at our community’s service.
Finally, our goal is to offer the best possible clinical, emotional, spiritual and social care for terminally ill patients and therefore serve as a model for other medical institutions.
| Main |
Entrance
to Unit |
 |
 |
Day Care
Consultation |
Day Care
Consultation |
 |
 |
| Medical Team |
Social Worker
Psychology Team |
 |
 |
| Waiting Room |
Outpatient Clinic |
 |
 |
Contact information:
Unidad de Medicina del Dolor y Paliativa del Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubiran".
C/ Vasco de Quiroga No. 15.
Col. Sección XVI, Tlalpan.
México 14000 D. F.
Phone/Fax: (52 – 55) 54 85 43 33.
Email: clinicadolor_incmnsz@hotmail.com
Dr. Uriah Guevara MD
Professor and Chairman
Dr. Argelia Lara MD
Assistant Professor
Email: argelara34@hotmail.com
