Palliative Care: Revised Guidelines

Govt. of Kerala has published the revised guidelines for the palliative care program.
You can download the revised guidelines from here

Salient features of the revised guidelines are as follows:

1. Ward-wise list of patients requiring long-term care must be compiled by ASHA of each ward. This list must be available as a register in each subcentre.
2. Home care must be conducted on at least 4 days per week. The timing of home-care is from 9.30 AM to 4.30 PM. At least 8 patients must be visited on each home care day.
3. One or two home care days in a month may be allotted for Ayurveda/Homoeo home care. On such days, the Ayurveda/Homoeo medical officer concerned must be part of the home-care team.
4. For LSGs with a population of more than 30000, more than one home-care team may be employed with the sanction of PMC. In such cases, the jurisdiction of each home-care team has to be separately defined, and separate registers and records have to be maintained.
5. Drugs for the care of patients requiring long-term care may be given for a period of 6 weeks at a time. 
6. Separate OP day need not be designated for palliative care in primary health centres. Patients and their bystanders must be able to approach PHC and get medicines and consumables on any working day. For such patients, a case record has to be used instead of OP ticket.
7. Waterbed, airbed, wheelchair, commode chair, air cushion etc. may be stocked at the sub-centre level and distributed to needy patients.
8. All volunteers who are part of the home care team has to be trained for at least 3 days on practical aspects of palliative care. For such training, 20-30 persons may be included per batch and training cost may be limited to Rs. 100 per person. Each primary unit must strive to train 100 volunteers every year. Resource persons from District Palliative Training Centre have to be utilized for the same.
9. Home-care report book has to be verified and signed by the Medical Officer in charge once in a month.
10. Expenses for food for home care team may be included in the project @ Rs. 80 per person for a maximum of 6 persons per home-care team.
11. The home-care vehicle can be hired on daily rent/monthly rent basis for a period of one year. If a vehicle is taken on monthly rent basis, the vehicle can be used for field activities within the LSG area by medical officers and staff nurses.
12. PMC must meet once in two months.
13. Palliative care must be included as an agenda in the Panchayat Health Review every month
14. Occupational rehabilitation can be undertaken as part of the palliative care project
15. Daycare centre for elderly or differently abled can be undertaken as part of palliative care project.
16. Funds from private individuals/organisations may be sought for the strengthening of palliative care program. Appropriate registers and cashbooks have to be maintained.
17. Funds may be advanced from HMC account for palliative care program, including honorarium of community nurse.
18. 9 Holidays are applicable to community nurses: Republic day, Vishu, Good Friday, Ramzan, Independence Day, Thiruvonam, Gandhi Jayanti, Bakrid, and Christmas
19. Each community nurse is eligible for 20 casual leave per year, and must be limited to a maximum of five in a month.
20. Actual expenditure as applicable may be reimbursed to community nurses for attending review meetings at block/district level based on attendance certificate.
21. Community nurse will be eligible for a phone allowance of Rs. 200 per month.
22. Community nurse must be given a coat for home care activities.
23. Community nurse will be eligible for paid maternity leave as per exigent rules
24. District Panchayat can fund the day to day activities and expenses of District Palliative Care Training Centre
25. Medicines/equipment for registered charitable organisations working in the palliative care sector in the LSG area may be purchased through the project and issued with the permission of PMC.

The revised guidelines clarify the activities that can be undertaken under palliative care project and expands the scope of services. It also ensures optimal program management by ensuring the availability of critical resources for the program.