FEDERAL DEMOCRATIC REPUBLIC OF ETHIOPIA

MINISTRY OF HEALTH 1
 Learning objective
 Introduction
 Operational standard
 Implementation guidance
 Assessment checklist
 Indicators

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 At the end of this presentation the participant will able to:
◦ Explain Concepts, principles & process of Rehabilitation and
Palliative Care management and organization
◦ Describe resources, work force plan & infrastructure needed for
Rehabilitation and Palliative Care
◦ Identify tools and methods used to measure Rehabilitation and
Palliative Care against the standard
◦ Describe indicators to measure Rehabilitation and Palliative Care
quality

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 What is rehabilitation and palliative care?
 Is this services available in your hospitals?
 How is pain monitored in your hospitals?
 What pain control medication do you use in your own hospitals?
 PRN,STAT

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 Two relatively new separate hospital services
 Rehabilitation of people with disabilities is
◦ a process aimed at enabling them to reach and maintain their
optimal physical, sensory, intellectual, psychological and social
functional levels.
 Palliative care is an approach that improves the quality of life
of patients and their families facing the problem associated
with life-threatening illness, through the prevention and
relief of suffering.
◦ achieved by treating pain and its components, physical,
psychosocial and spiritual.

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1. The hospital should have a rehabilitation and
palliative care service with necessary equipment,
aids and appropriate human resources.
2. With regard to rehabilitation, the hospital should
at least provide a physical therapy/physiotherapy
service and if possible, occupational, speech,
Prosthetics & Orthotic Technology.
3. With regard to palliative care services, the hospital
should at least provide good pain and symptom
control for both in and out patients.
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4. The hospital should have a written standard
operational procedure and patient record
management for all rehabilitative and palliative
care services.
5. The hospital should establish a mechanism for
referral and transfer of rehabilitation and palliative
care services through in-patient and outpatient
and in the case of palliative care, linkage to
services that provide home-based care.

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3.1 Organization of Rehabilitation and Palliative Care
Services
Rehabilitation & palliative team leader should work

in parallel with other team leaders,

◦ i.e. emergency team, in-patient, outpatient
A rehabilitation team may consist of
◦ physiotherapists, occupational therapists, orthopaedic appliances,
medical social workers, health education practitioners and speech
therapists.
A palliative care team may consist of
◦ physicians, nurses, pharmacists, dieticians, social workers and
spiritual leaders.
Outpatient clinics run by rehabilitation and palliative
care staff.
Discuss patient cases, regular ward rounds

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 Each rehabilitation & palliative care professional is
responsible
◦ Work with rehabilitation/palliative care team, to form
overall goals and plan for patient
◦ Collaborate with patient, family & carers
◦ Collaborate with other health care professionals in
teaching, consulting, management and research
activities.
◦ Make referrals
 Specialized rehabilitation/palliative care professionals
 other clinical staff and
 Community services.

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3.2 Rehabilitation and Palliative Care work force plan
The hospital should establish a rehabilitation and

palliative care workforce that:

◦ Identifies priority areas of patient need
◦ Takes the skill mix of professionals into
consideration
◦ Establishes procedures for collaboration with
other rehabilitation/palliative care health care
professionals & cross-referral in the unit.
◦ Establishes procedures to refer patients to
specialized services.
 .

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 3.3 Provision of resources
 Hospitals should ensure rehabilitation and palliative care
healthcare professionals
◦ have access & trained on how to use equipment/resources correctly
and efficiently.
◦ are responsible for keeping up to date about current equipment
and resources available for hospital use.
 With regards to palliative care, good pain and symptom control
is an important aspect
◦ hospital supply of morphine and other relevant palliative care drugs

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 Standard equipment/consumables for rehabilitation
services i
◦ Physiotherapy mats
◦ Massage couch
◦ POP , POP cutter, Splinting materials
◦ Balance boards
◦ Walking rail/ parallel bars,
◦ Sticks, Crutches
◦ Walking aids/ walking frames (adjustable)
◦ Pulley
◦ Orthotics
◦ Mirror

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 3.4 Rehabilitation and Palliative Care process
◦ systematic/holistic approach & is patient-centered.
◦ Both involve assessment/referral to pertinent health
care
A. Rehabilitation Process
 Aim of treatment is to encourage patients to

optimum independence
 patient referred from central

triage/inpatient/outpatient
 patient’s relevant information will be recorded

◦ to ensure he/she is referred to the appropriate practitioner.

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Rehabilitation Process cont …..
◦Once the appropriate practitioner (s) have been identified
◦identify the patient’s specific problems through full and
detailed assessment
◦Factors that should be considered
 Activity of daily living (ADL) limitation
 Deficit in the functioning of limbs & cognitive systems
 Change in behavior, Emotional stress
 Problems with pain
 Delayed development
 Withdrawal from family, community, etc.

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 Plan of care
◦ All care documented specific to patient’s problems or
needs.
◦ needs to be continuously evaluated.
◦ As problems resolve, new goals/activities set
◦ Patient then discharged from the service.
◦ Referred to appropriate service If further specialist
treatment
 Factors to be considered
◦ Therapeutic relationship
◦ Adaptive techniques
◦ Promoting independence through functional therapy
◦ Education of patient and family
◦ Managing pain, Diversion therapy
◦ Design, Provide prosthesis, Orthoses, splints

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B. Palliative care process
involves assessment, treatment/support for the

patient/their family.
Also offers bereavement care (Grief Counseling) for

the patients’ loved ones after death.

A palliative care patient

◦ referred by other clinical services

inpatient/outpatient
◦ receive patient on ward or in a palliative care
outpatient clinic.
◦ make a full/detailed assessment and identify the
patient’s specific problems.

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Factors to be considered when making a Full assessment.
Firstly,assess ‘Total Pain’ Pain is not only a physical
◦ has psychological, spiritual and social components
◦ A baseline pain assessment score during the initial
assessment (pain is the 5th vital sign) and
◦ reassessed regularly by the palliative care team
Activity of daily living (ADL) limitation

Dietary needs

Emotional distress, withdrawal from family, community, etc.

Economic factors

Family needs

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 Factors to be considered when implementing care
include:
◦ Good communication between staff, patient and
family
◦ Place of care: hospital or home
◦ Psychological support required for carers
 Care plan
◦ should be specific to patient’s problems or needs
◦ Should be documented on follow-up sheet
and/or patient’s chart.
◦ Needs to be continuously evaluated.

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 As problems are resolved new goals and activities
are set.
 If patients deteriorate end of life care
◦ Patients continue to be cared for in hospital
◦ Discharged & follow up at palliative care
outpatient clinic
◦ Referred to community services, such as home
care as available

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