Abstract
The topic areas for abstract submission include:
• Innovative and emerging community-based palliative care models (e.g., home/office/clinic/long-term care) • Innovative and emerging hospital-based palliative care models • Integration of palliative care services in cancer centers/dialysis centers and other special care units • Approaches to palliative care delivery for specific population types (e.g., heart failure/cancer/dementia/frailty) or in specific settings (ICU, ED) • Pediatric palliative care program development including combined adult/pediatric models • Staffing the interdisciplinary team including staffing benchmarks and maximizing the roles of social workers/chaplains/nursing and medicine; how teams work together to maximize team health and avoid burnout; and demonstrating clinical and financial outcomes for team roles • Communication best practices (e.g., teaching goals of care conversations/advance care planning and implementation of POLST/MOLST) • Integrating palliative care services (e.g., across a health-system/patient-centered medical home/assisted living/nursing homes) • Using technology to improve efficiency and outcomes • Methods of training in primary/generalist palliative care (e.g., palliative care training for hospitalists and unit nurses in communication and symptom management) • Implementation of standardized interventions such as checklists and screening tools • Financing/benefit and payment models • Regional and national palliative care initiatives (e.g., statewide coalitions/political advocacy) • Identifying appropriate outcomes and working with key stakeholders and partners • Preparing for The Joint Commission Advanced Certification for Palliative Care or re-certification • Outcomes of interest to payors supporting palliative care service delivery across settings • Data demonstrating depth of palliative care integration in ACO/PCMH/bundling and other risk-bearing health care delivery frameworks • Other
End-of-Life Perceptions of CHF Outpatients
Allegheny Health Network
Bellevue, PA 15202
Mallory S. Ciuksza, MD
PGYIII of Internal Medicine
Allegheny Health Network
474 Teece Ave.
Bellevue, PA 15202
724-217-3650
Patient Perspectives on Primary Palliative Care
American Board of Internal Medicine
Philadelphia, PA 19106
Rebecca A. Baranowski, Med, MS
Senior Clinical Content Manager
American Board of Internal Medicine
510 Walnut Street, Suite 1700
Philadelphia, PA 19106
215-446-3546
The American Board of Internal Medicine developed a patient/caregiver questionnaire (PCQ) as part of a new Practice Improvement Module (PIM)® within its Maintenance of Certification program. PIMs are web-based tools that guide physicians through a review of patient data and support quality improvement. The Palliative Care for Primary Care and Subspecialist Physicians PIM focuses on how internists and subspecialists manage the care of patients with progressive chronic conditions or serious, life-limiting illnesses. The questionnaire is intended to provide physicians with feedback on important patient-reported measures related to goals of care; advance care planning; physician communication skills; and patients' self-reported pain, dyspnea, and emotional distress. Patients also provide an overall rating of their physician. The Global Health Scale (GHS) of the Patient Reported Outcomes Measurement System (PROMIS®) was administered as validation criterion for the new questionnaire. For this research study, ABIM partnered with PatientsLikeMe, an online community that provides a forum for discussion, information sharing, and enhanced patient engagement. Correlations between PCQ and GHS scores indicated patients' overall rating of their physician was strongly influenced by perceived mental health and being active socially but less by perceived physical health or overall health status; validity coefficients were moderate.
Health System–Palliative Medicine Collaboration
Baptist Health
Jacksonville, FL 32207
Tasha M. Schoppee, MSN, RN, CHPN
Palliative Care Program Coordinator
Baptist Health
800 Prudential Drive, Pavilion 5
Jacksonville, FL 32207
904-202-3409
In the development of a hospital-based palliative care program, there are various structures that may be implemented. One southeastern health care system is building a palliative care program in which patient care is provided in collaboration with a private medical consultative service. The system has established the roles of Palliative Care Program Coordinator, Palliative Care Chaplain, and Palliative Care Social Worker. The Coordinator has completed a system gap analysis/needs assessment utilizing the Meier and Sieger text. The analysis led to prioritized goals that are being addressed currently. The chaplain and social worker have been assigned to the system's flagship hospital where they are working closely with the palliative medicine group to provide patient care. As the collaboration has been established and grown, it has been beneficial to develop a conceptual model that illustrates the integral workings of all members of the team. Each member continually reviews their identified contributions and tasks. The collaboration, and the conceptual model, are dynamic; shifts are made as needs are identified. (The model and analysis results may be obtained from
Umbrella of Palliative Care: A Conceptual Model
Baptist Health
Jacksonville, FL 32207
Tasha M. Schoppee, MSN, RN, CHPN
Palliative Care Program Coordinator
Baptist Health
800 Prudential Drive, Pavilion 5
Jacksonville, FL 32207
904-202-3409
One of the challenges faced by providers of upstream palliative care is that our efforts are often confused with hospice care. Meaningful education is required to clarify the components of the work. Fleshing out the broader specialty of palliative care requires demonstrating the point of implementation, the domains of care, the benefits realized by recipients of the care, and the manner by which it may flow into care at the end of life. In response to the common confusion and the needed clarifications, a conceptual model and framework have been developed. This evidence-based visual depiction of palliative care has been utilized as an effective tool for communication and education with administrators, physicians, nurses, social workers, chaplains, and other professionals in both acute care and hospice environments. (The model, framework, and full list of references may be obtained from
Enhancing Palliative Care Delivery: A Hospitalist–Palliative Care Service Partnership
Baptist Hospital, Inc.
Pensacola, FL 32501
Kelly C. Markham, LCSW
Palliative Care Coordinator
Baptist Hospital, Inc.
1000 W. Moreno St.
Nursing Administration
Pensacola, FL 32501
850-469-3739
Following our team's attendance of PCLC at VCU Massey Cancer Center, we formulated a strategic plan to add physicians to our palliative care service. This was achieved through a partnership with Baptist Medical Group, the health system–owned physician group and the Palliative Care Service, operated by the hospital. The Medical Group bears the financial responsibility to fund the physician positions and receives the income from their billing activity. The hospital funds the salaries of the nurse and social worker. It is able to reap the benefits of the cost savings achieved through the Palliative Care Service. In order to begin this partnership, the palliative care team was challenged to demonstrate measurable benefit to both patients and the organization. A dashboard was devised measuring cost savings based on the top-four most frequently occurring palliative care patient diagnoses. In addition, quality measures, patient satisfaction, and consults per month are calculated. The number of referrals has increased between 10% and 40% over the previous year's monthly rate. Addition of the hospitalists to our service has resulted in an affirmative response from physicians, nurses, and staff members. Most importantly, the feedback from patients and families has been overwhelmingly positive.
Examining the Effect of an Embedded OPC for COPD Patients
Bon Secours St. Francis Health System
Greenville, SC 20601
Tracy Fasolino, PhD, FNP, ACHPN
Palliative Care Nurse Practitioner
Bon Secours St. Francis Health System
317 St. Francis Drive
Greenville, SC 20601
864-888-7158
Clinic-based palliative care for patients with advanced chronic obstructive pulmonary disease and heart failure holds tremendous promise. Our team designed the model of care for an embedded Outpatient Palliative Care Clinic (OPPC) within a pulmonary practice. We utilized the existing office staffing in the pulmonary practice to support the OPPC initiative. Patients were referred to the OPPC from the inpatient palliative care team, hospital case managers, pulmonary physicians, and transition of care appointments. During the 112 scheduled office hours (over a 6-month period), board-certified hospice and palliative care MDs and NPs completed 83 visits for 57 patients. The average age of the patients was 73 years, with twice as many male as female patients. The primary reason for referral was goals of care followed by symptom burden management. The impact of the embedded clinic on the pulmonary practice included a reduction of office visits by 53 and a reduction of triage phone calls by 92. Of the 57 patients enrolled in the OPPC, only 5 patients were readmitted to the hospital and 3 patients were seen in the Emergency Department. Twenty-three of the 57 patients enrolled into hospice services during the index appointment with OPPC.
Educating Staff through a System Palliative Collaborative
Bon Secours Virginia Health System
Richmond, VA
Aimee Schubert, RN
Palliative Nurse Navigator
Bon Secours Virginia Health System
5855 Bremo Road MOB North, Suite 408
Richmond, VA
804-288-2673
Leanne Yanni, MD
Medical Director
Providing unparalleled palliative care is part of our health system strategic quality plan. This requires all staff develop competencies to deliver primary palliative care within their scope of practice. A system-wide approach ensuring staff competencies in primary palliative care through education and developing standardized policies and procedures was needed. Buy-in was obtained from executive administration. Key representatives from hospitals, medical home, hospice, home health, case management, and senior services were identified. Weekly calls led by palliative RN with set agendas began and the collaborative was integrated in system-shared governance structure. A Share point site organizes educational handouts, power points, and articles. Initiatives include system polices for palliative care, end of life, and primary palliative education. Needs assessments were reviewed. Curriculum included: overview of palliative care, advanced care planning communication with case studies and work groups, and symptom management. Pre and post-tests were implemented, followed by a 3-month post-questionnaire. Evaluation data tracked include: appropriate referrals for palliative care service, completion of advance medical directives, and identified HCAHPS questions. Challenges include scheduling educational sessions and ensuring key representation. Planning a best practice symposium across the system for those who received education and expanding education focus to include transition of care.
Objectives:
• Describe the key steps for success in creating a system-wide palliative collaborative.
• Describe three potential barriers to successful collaborative efforts and completing primary palliative education.
• Identify two techniques for obtaining executive administrative leadership buy-in.
Our palliative team has just been certified at three of the six hospitals implementing this initiative and was the first health care system to have done this. The reviewer said this was a best practice in implementation of primary palliative care and creating enthusiasm and a systemized culture and the reviewer had not seen this in any other health care system she had reviewed.
One of our nurses at one of the hospitals was recognized as nurse of the year from ELNEC because of the amount and quality of education being done through the work of the collaborative.
The collaborative will also be working on system health stream modules for palliative care and heart failure along with primary palliative care in specialized settings. Additional future education will be focused on the outpatient settings to assist physicians and nurses to begin planning and begin communication for ACP. The next major step for the collaborative this year is integration of and implementation of POLST, to include a large-scale education and training for facilitators, a website, and policies.
Learning Together: The Palliative Care Action Community
California HealthCare Foundation
Oakland, CA 94612
Kate O'Malley, RN, MS
Senior Program Officer
California HealthCare Foundation
1438 Webster St., #400
Oakland, CA 94612
510-587-3181
As health care organizations seek to improve care for people with serious illness across the care continuum, interest in community-based palliative care (CBPC) services is growing. Although many organizations acknowledge the need for such services, opportunities to learn practical information about providing palliative care in clinic, home, and distance (telephonic) settings have been scarce.
In the California HealthCare Foundation's (CHCF's) Palliative Care Action Community (PCAC), 21 CBPC provider organizations participated in learning sessions focused on clinical, operational, and measurement issues. Through these collaborative activities, teams discussed approaches to common challenges and practical details about running their programs. As a result, we will share descriptive data on staffing models used by PCAC teams, promising practices for addressing care delivery issues such as partnering with referring providers and managing care transitions, approaches to quantifying opportunities for expanding CBPC services, and specific quality and operational aims that teams achieved in the course of the year. We will also describe resources developed through the initiative, including a comprehensive Field Guide addressing issues central to CBPC program development/management and promising practices for addressing these issues; tools for planning and evaluating services; and an online course that teaches best practices for interdisciplinary documentation in palliative care.
Person-centered Care: Considerations for a Health Plan-based Palliative Care Program
Cambia Health Solutions
Portland, OR 97201
Torrie Fields, MPH
Program Director, Serious Illness and Palliative Care Services
Cambia Health Solutions
1625 S.W. 1st Ave.
Portland, OR 97201
503-721-4064
Cambia Health Solutions has implemented a health plan–based serious illness services program for the 2.2 million members we serve, with an approach focused on respecting the patient's wishes, from diagnosis to completion of life. This program puts the patient at the center while remaining inclusive of the entire health care community. New health care services, benefits, training, and education have been created to ensure the entire health care system is engaged in putting the patient and his or her loved ones at the center—supporting the individual and family in their medical, psychosocial, behavioral, and spiritual needs. In addition, we provide necessary support and resources to caregivers and loved ones dealing with the serious illness of a loved one or in need of grief or bereavement counseling. Cambia has focused its efforts in integrating five main areas: benefit expansion, specialized care management, community and member engagement, provider reimbursement and training, and caregiver support. This presentation will provide our framework and implementation of this program, providing a structure for other payors to use in development of palliative care initiatives. We will represent initiatives within and outside of our Accountable Care Organization agreements. Example metrics and baseline statistics will also be presented.
A Palliative Care Pathway to Educate and Improve Hospitalists' and Emergency Physicians' Palliative Care Skills
CEP America
Emeryville, CA 94608
Jeffrey Frank, MD, MBA
Program Director of Quality-Hospitalist Practice Line
CEP America
2100 Powell St., Suite 900
Emeryville, CA 94608
510-704-3949
Shauna Conry, MD
Sabiha Pasha, MD
True McMahan, MD
Prentice Tom, MD
Pathway Goals:
1. Improve competencies in palliative and end-of-life care for emergency physicians and hospitalists.
2. Improve communication between emergency physicians and hospitalists to enhance coordination of care.
3. Increase referrals to PC and hospice.
Pathway Components:
A. Leadership team of PC chair, content experts, and administrative team:
1. Develop PC pathway, online materials, workshops, and clinical materials. 2. PC content experts support site champions.
B. Site PC champions roll out pathway at their sites:
1. Engage hospital's leadership to support pathway and collect PC/hospice referral metrics. 2. Develop site-specific PC/hospice resource grid. 3. Educate site partners.
Cerner's Electronic Palliative Care Program
Cerner Corporation
Kansas City, MO 64117
Hannah Luetke-Stahlman, MPA
Program Lead
Cerner Corporation
2800 Rockcreek Pkwy.
Kansas City, MO 64117
816-835-2107
Cerner recognizes a need within the industry to electronically identify, engage, and manage palliative care patients. The program has three main objectives: 1) Early Identification and Stratification—Cerner's teams of designers have developed an identification algorithm that fires based on specific diagnoses and symptoms, alerting your medical staff when a patient may benefit from palliative care. The algorithms stratify these patients based on disease burden, utilization of the health system, and overall health care expenditure; 2) Improve Quality of Care and Life—Cerner's program supports documentation of multidisciplinary team meeting notes providing a holistic approach to patient care. As a result, care teams and providers are able to accurately manage symptoms, support the patient's hope, and coordinate their care as it best supports the patient and his or her family. Joint Commission 2014 certification guidelines have also been taken into consideration to support palliative care programs in achieving quality measures and best practices; and 3) Manage Across the Continuums—Cerner's palliative care program improves the ongoing reassessment and adjustment of the patient's plan of care as the condition warrants across venues. Patient goals and plan of care are established within the acute setting and remain with the patient as he or she transitions back home or to the extended care and/or hospice setting. Communication among all care team members is improved and patient engagement is reinforced through the Member Portal. A Work List has been created so that care teams and providers can manage their palliative care patients and needs in real time; all while improving the quality of life for both patient and family.
Objectives:
1. Identify and describe the electronic content and core components of Cerner's palliative care program.
2. Analyze the efficiency and effectiveness of an automated palliative care work flow.
3. Self-reflect on how technology can impact your palliative care processes and program.
Building a Strong Counseling Foundation for Pediatric Palliative Care Services
Children's Hospital of Illinois at OSF Saint Francis Medical Center
Peoria, IL 61637
Laura Sollenberger, MA, LCPC, NCC, FT
Counseling Supervisor, Pediatric Supportive Care
Children's Hospital of Illinois at OSF Saint Francis Medical Center
530 N.E. Glen Oak Avenue
Peoria, IL 61637
309-624-9631
An incident analysis of children admitted to our institution with diagnoses typically receiving palliative care services showed that over 1000 families annually could potentially be served by a pediatric palliative care program. The foundation of the team is the counseling component. The pediatric supportive care counseling team consists of 1 clinical supervisor and 3.5 clinical counselors who are all credentialed in thanatology through ADEC. The team works collaboratively with a part-time perinatal support coordinator and members of the medical team to provide patient and family support both in the hospital and in outpatient settings. CAPC Automatic Diagnostic Triggers for children were chosen as criteria to drive counseling referrals and any team member may refer for counseling. Counseling is introduced at diagnosis and services are provided for as long as patients and families need counseling support. Bereavement care is provided for families experiencing the death of a child. In the first 3 years, counseling and bereavement support was provided to approximately 800 families. Support and education sessions for staff were also implemented. Results of family and staff satisfaction surveys indicate tremendous satisfaction with counseling support services.
Objectives:
1. Identify the initial development stages of pediatric supportive care programming at Children's Hospital of Illinois (CHOI).
2. Describe challenges and successes in program development.
3. Describe the counseling component of pediatric supportive care at CHOI.
At this time, we are in the process of building our medical consultation service as the other component of our palliative care team. Financial limitations have forced us to suspend the pursuit of a palliative care–boarded MD and APN until 2015. Starting our hospital supportive care programming first with family and staff counseling has allowed us to rapidly establish a firm base of service provision, which will be enhanced by the addition of a medical consultation service.
Hospital-based Clinical Massage Training Program
Community College of Rhode Island
Newport, RI 02840
Regina Cobb, MSW and Licensed Massage Therapist
Program Director
Community College of Rhode Island
One John Chafee Blvd.
Newport, RI 02840
401-851-1672
We are advocates for massage therapist clinical oncology massage education, skills, knowledge, and research needed to meet the changing health demands of the growing population of cancer patients and survivors. By promoting and embracing this platform, and using the tools provided, we know that massage therapists will be able to enhance and protect the health and well-being of each client/patient who is on the healing journey of cancer and its secondary diseases. Massage therapists will also be prepared to work in a hospital/clinical/medical environment and expand their practices into the palliative care direction of the health care industry.
The hospital-based massage therapy program offers specific oncology massage training. It provides all the requirements you need to address the changing health-related conditions of clients/patients dealing with cancer and the secondary ailments/conditions associated with the disease.
This hands-on course offers the unique experience of working in one of two major medical facilities in New England. The advantage of this program is that you will have the opportunity of working directly with patients who are receiving chemotherapy or radiation, recovering from surgery, or hospitalized for acute care illness. The patient interaction is extremely beneficial in helping you understand the experiences of working in a hospital setting and applying critical thinking skills in this clinical environment.
The Birth of CompassionNet's Perinatal Palliative Care Program—a Community-based Approach to Perintal Palliative Care
CompassionNet–Lifetime Care
Rochester, NY 14623
Alyssa Gupton, LCSW
Assistant Director of Operations and Family Services
CompassionNet–Lifetime Care
3111 Winton Rd. South
Rochester, NY 14623
585-214-1333
Lauren Zwetsch, PNP
CompassionNet is a community-based pediatric palliative care program that supports families facing potential perinatal and infant loss due to a diagnosis in utero that is potentially life threatening. CompassionNet provides in-home support while partnering with hospital providers to address physical, psychosocial, emotional and spiritual needs.
Through our community-based program, we recognize that these families have many unique needs and the value of identifying, validating, and responding to these needs as early in the pregnancy as possible.
We will illustrate the details of why and how our perinatal program fulfills this need, benefiting both families and the medical community by addressing the following topics:
• How and why CompassionNet started our perinatal program and who we serve. • Interdisciplinary team roles and collaboration. • How CompassionNet's partnership with community hospitals helps balance and save resources. - Specific anecdotal evidence of how we support families: - At time of diagnosis - Throughout pregnancy - At time of birth (both live and stillbirths) - At time of death and shortly after - Through grief and bereavement
Objectives:
1. Identify needs that couples and families experience when coping with a potential pregnancy and/or infant loss, the importance of supporting these families as early as possible, and types of community support that are helpful.
2. Identify ways interdisciplinary team members partner to meet the needs of families coping with a potential pregnancy and/or infant loss.
3. Describe how partnering between hospital and community programs can save resources and enhance quality for patients and families.
4. Identify signs and symptoms of complicated grief and explain possible interventions to help families coping with pregnancy/infant loss.
IT IS POSSIBLE! Implementing Concurrent Palliative Care in a Private Community Oncology Network
Dayton Physicians Network and Cedarville University
Xenia, OH 45385
Elizabeth Delaney, RN, MS, CNS, FNP-BC, OCN, AHPCN
Palliative Care Advanced Practice Nurse and Assistant Professor
Dayton Physicians Network and Cedarville University
889 Oak Dale Dr.
Xenia, OH 45385
937-520-8954
This abstract will describe creative successes of implementing concurrent supportive and palliative care services in a private community oncology practice/network in the Midwest created between 2011 and 2013. The oncology network consists of one company with 14 locations, which provides medical oncology (7 locations) radiation oncology (6 locations), urology, pathology, and prescriptive services. The network collaborates with the local health care system. After reviewing literature, professional organization standards, and a network assessment, the network committed to implementing a concurrent supportive/palliative care program. The first year of the program was dedicated to the challenges of standardization across all network medical oncology offices in the areas of patient satisfaction, patient education, advance directives, collaboration with home health care, and collaboration with a local, large nonprofit hospice organization. The second year added interdisciplinary care team meetings that include network process improvement discussions and APN palliative care concurrent visits for lung cancer patients and other stage IV cancer diagnoses with complex management from the time of diagnosis. NCCN Distress Thermometer and ESASr are utilized for symptom assessment/management. In addition to partnering with the home health and hospice agencies, the network has partnered with two local universities to be a site for graduate nursing and pharmacy research.
Objectives:
1. The participant will describe at least two potential challenges with standardization of supportive/palliative care services in a network setting.
2. The participant will outline steps in a plan for implementing a supportive/palliative care program in a community network setting.
3. The participant will produce possible names of tools utilized in assessment and outcome strategies to evaluate a supportive/palliative care program.
Using Informatics to Optimize Palliative Care Intervention
Emory Palliative Care Center
Atlanta, GA 30322
Sherika Newman, DO
Assistant Professor, Emory University School of Medicine
Emory Palliative Care Center
1462 Clifton Rd.
Atlanta, GA 30322
678-843-5289
To upstream palliative care (PC) at a 410-bed southeastern community hospital, clinicians and data analysts created an automated trigger that identifies patients admitted the previous day who came from a hospice or skilled nursing facility, have metastatic cancer, had a PC consult in the last 12 months, or had 2+ prior hospital admissions or any days in an intensive care unit in the last 6 months. The data come from our clinical data warehouse, updated each midnight. The list is e-mailed to our PC team each weekday morning; a team member places a colored paper note on the charts of appropriate patients offering a PC consult. In a 61-day sample from March through June 2014, our triggers identified 212 patients. One hundred fifty-seven (74%) had a note placed on their chart. Thirty-five (22%) of these resulted in consults; 13 consults (37%) occurred within a day of note placement, and 24 (68%) within the first week of hospitalization. Thirteen (37%) patients were discharged to hospice; 3 (9%) died. Attending physician feedback is mixed between appreciative, compelled, and unappreciative, and education on PC's role in acute patients is ongoing. This protocol both uncovered new patients for and ensured timely consults on our PC service.
Toward JCAHO: Population Quality Metrics in Cerner
Emory Palliative Care Center
Atlanta, GA 30322
Michael J. O'Neill, MD
Assistant Professor, Emory University School of Medicine
Emory Palliative Care Center
1462 Clifton Rd.
Atlanta, GA 30322
404-778-5334
To prepare our academic health system for Joint Commission accreditation in palliative care (PC), we revamped our inpatient service's clinical notes to capture key quality metrics at each consult and follow-up visit. With guidance from a more experienced health system, our physicians and nurses partnered with our dedicated PC analyst and the Cerner clinical note informatics team to make the revisions. The clinicians ensured the notes made sense and optimized work flow, the analyst ensured the notes were structured so that data could be pulled on request for the system's entire PC population, and the informatics team instituted the changes. Key measures included National Quality Forum palliative and end-of-life care metrics (pain screening and assessment, opioid bowel regimen, dyspnea screening and treatment, care and treatment preferences, and spiritual/religious discussion) and the Measuring What Matters project's metrics (pain screening and treatment, physical symptom screening, dyspnea screening and management, psychological/emotional discussion, surrogate documentation, and treatment preference discussion). Some metrics were not appropriate for our population or for capture via the clinical note. Pilot testing of the new note was smooth and the reception is positive. Consulting with experienced health systems and involving specialized data analysts ensured a successful redesign.
“Onwards and Upwards!” Program Development in Pediatric Palliative Care
Fairview Home Care and Hospice, University of MN Amplatz Children's Hospital
Minneapolis, MN
Joan “Jody” Chrastek, RN, DNP, CHPN
PACCT Coordinator
Fairview Home Care and Hospice, University of MN Amplatz Children's Hospital
2450 26th Ave. South
Minneapolis, MN
612-728-2389
Marie Rodier, MSW, LICSW
This highly interactive session will discuss one program's experience and growth as the pediatric hospital and adult-based home care organization developed a new Pediatric Advanced Complex Care Team encompassing hospice, palliative care, and complex care for children in the hospital and in the community.
After an initial short presentation about program development and lessons learned, this interactive session will request that participants share their experiences, barriers, and three future plans with the group. Using guided discussion and worksheets we aim to make the learning applicable to each unique program. The goal is that each person/program will come out with new ideas, pitfalls to avoid, and lessons learned from others experiences.
Objectives:
1. List three areas of challenges in their program and new ideas of how to address each one.
2. Describe the importance of team nurturing and explain three new ways to support their team.
3. Complete a fish bone diagram of where their program is and where they want to go with at least five steps listed.
The Role of Patient Navigators in Palliative Care for Latinos
Familias en Acción
Portland, OR 97212
Marie Dahlstrom, MA
Executive Director
Familias en Acción
2710 N.E. 14th Ave.
Portland, OR 97212
503-544-4497
Patient navigators and community health workers play an important role in assisting Latino patients in accessing palliative care.
Significant research indicates disparities in palliative care for Latinos. Under- or untreated pain, lack of knowledge of treatment options, low levels of health literacy, and cultural/language barriers limit access for Latinos to palliative care. Lack of palliative care for Latinos leads to lower quality of life for patients with severe chronic conditions and higher health care costs. Patient navigators and community health workers play an important role in assisting Latino patients in accessing palliative care. These trusted leaders have demonstrated success in supporting patients and their families by providing case management, health education, and support in health navigation. They can work closely with members of the care coordination team to support access to palliative care.
Familias en Acción is a Latino-serving community nonprofit based in Portland, Oregon, with a successful patient navigator program that provides community palliative care. Participants will understand how this culturally specific program has been successful in providing community palliative care to Latino patients. Participants will understand what cultural components are central to this program and the role of health literacy. Program successes, lessons learned, and recommendations for program replication will be shared.
Objectives:
1. Have enhanced knowledge of the role of patient navigators and community health workers in palliative care.
2. Understand the role of culture in palliative care for Latinos and other underserved populations.
3. Have knowledge of community best practices for culturally competent palliative care for Latinos.
Generalist-level Palliative Care Training for Practicing Physicians, Nurse Practitioners, and Physician Assistants
Franciscan Hospice and Palliative Medicine
University Place, WA
Mimi Pattison, MD
Medical Director of Franciscan Hospice and Palliative Medicine
Franciscan Hospice and Palliative Medicine
2701 Bridgeport Way West
University Place, WA
253-312-4790
The population of patients with palliative care needs is rapidly exceeding the resources of specialty teams. The palliative medicine department of our community health system received a 2-year grant, to establish a Palliative Care Academy for training physicians, nurse practitioners, and physician assistants in generalist-level palliative care. A 20-hour curriculum was developed based on applicable components of the National Consensus Project Guidelines for quality palliative care, a needs assessment of potential participants, and guidance from a national expert in palliative education.
Teaching methods include case presentations, discussion, feedback, and experiential learning. Class size is limited to four to eight in order to allow for maximum participation. In the fall of 2013, four pilot sessions were held for a total of 20, self-selected participants. A dedicated training for nine senior clinical leaders is scheduled for February 2014. They will be asked to provide feedback, evaluating how this training facilitates alignment with overall system goals. Based on observation and feedback from the pilot sessions, the curriculum was adjusted to better address common attitudinal barriers in the practicing clinician. In March 2014 regular training sessions will begin. Outcome data on changes in knowledge, perceived competency, and level of concern will be collected.
Objectives:
1. List three key attitudinal barriers to practice change in the practicing clinician.
2. Identify three components of an effective generalist-level curriculum.
3. Consider the system-level changes needed to support education and promote change.
Acceptability of Palliative Care in the Dialysis Unit
Geisinger Medical Center
Danville, PA 17822
Rebecca Puher, DO
Palliative Medicine Fellow
Geisinger Medical Center
100 North Academy Ave.
Danville, PA 17822
570-271-6211
Capturing PCA in the MSICU
Greenwich Hospital
Greenwich, CT 06830
Donna E. Coletti, MD
Medical Director of Palliative Care Services
Greenwich Hospital
5 Perryridge Road
Greenwich, CT 06830
203-863-4622
A Palliative care appropriateness initiative was begun in July 2013 in the MSICU in order to both identify eligible patients and foster education in palliative care to residents, medical students, and hospital staff. This tool has demonstrated more awareness and referrals to the PC service than other units that do not have such a tool.
Additionally, a retrospective, randomized control trial was performed for those with and without a palliative care consultation through the hospital. The results of which emphasize the severe level of illness of these patients as well as the need for early intervention in order to facilitate enhanced implementation of advance directives and subsequent hospice referrals as well as 30d ED visits.
Objectives:
1. Understand the potential cause and effect relationship of screening tools and house staff education.
2. Appreciate the serious level of illness that most current palliative care patients presently require in order to receive a consultation and the need to have earlier identification of these patients in order to reduce hospital costs.
3. Understand the nature of cause and effect on length of stay as it relates to palliative care intervention.
Intregrating Spiritual Care across the Health Care System—Home, Hospital, Hospice
Grey Bruce Health Services/Grey Bruce Healthcare Chaplaincy
Owen Sound, Ontario, Canada N4K 6M9
Angela E. Schmidt
Doctor of Ministry in Spirituality and Psychotherapy
Healthcare Chaplaincy Coordinator
Grey Bruce Health Services/Grey Bruce Healthcare Chaplaincy
1800 8th Street East, Spiritual Care Dept.
Owen Sound, Ontario, Canada N4K 6M9
519-376-2121-2861
The Hospital-Community Collaborative (HCC) Model ensures patient access to professional spiritual care providers at end of life and ensures continuity of care by following the patient from home to hospital to hospice.
We discuss here a system for the provision of quality spiritual care to patients who have a terminal illness developed through the creation of a partnership between health care providers and a community organization. The community organization wanted to ensure that all palliative patients, whether they were at home, in the hospital, or entering the hospice, had access to spiritual care. The health care team members wanted to be able to refer to professional spiritual care providers who would support the patient according to the patient's spiritual perspective or connect the patient with a specific faith representative. The Grey Bruce Healthcare Chaplaincy was formed and created a partnership relationship with four hospital corporations, the community home care service, and the local hospice. This model is called the Hospital-Community Collaborative (HCC) Model. The hospital chaplains with palliative care expertise are accessed by the home care system to come to a patient's home to provide care as well as to the residential hospice. The model ensures quality spiritual care to patients, has an effective referral system, links community ministers with the hospital chaplains, and promotes spiritual care education to staff and community. The result has been the development of a strong relationship among the health care team members (hospital, home care, hospice), the chaplains, and the local faith leaders, and has increased the number of people who would like spiritual care but are not associated with an organized faith group.
Objectives:
1. Participants will be able to identify the importance of access to quality spiritual care at the end of life.
2. Participants will be able to note the strengths of a Hospital-Community Collaborative and what is necessary to replicate this model in their community.
3. Continuity of spiritual care at end of life is essential. Learners will discuss how they can promote this concept in their home communities.
This model is truly an interprofessional and interagency model that builds bridges across the health care system with a goal of quality spiritual care. We link our hospital palliative care rounds to the community palliative care physicians as well as to the hospice and home care system. It is a wonderful example of integration and collaboration with the patient's best interest at the heart. Our area has 11 rural hospitals with one large regional hospital; this model is more effective in smaller urban centers as well as rural centers.
Psychosocial Distress: An Outpatient Palliative Social Work Intervention
Hendrick Medical Center
Abilene, TX 79601
Alexandra Reed, LBSW
Katherine Lewis, LMSW
Palliative Care Social Workers
Hendrick Medical Center
1900 Pine Street
Abilene, TX 79601
325-670-7690
This abstract will explore barriers to facilitating goals of care communication, describe research-based interventions related to communication best practices, and explain the outcomes measured to reflect patient-directed care.
Review of literature pertaining to advance care planning (ACP) reflected the need for availability of medical professionals to address goals of care to obtain results of greater patient-directed care. Hendrick Hospice Care in collaboration with Pathways at Hendrick: Supportive Care and Palliative Medicine partnered to provide Pathways at Home—a community-based program focused on ACP. Pathways at Home is facilitated by a palliative social worker primarily conducting sessions in the patient's home or physician office. The Pathways at Home program generated goals of addressing total pain while working alongside the patient's physician, increasing advance directive (AD) completion and establishing core measures for assessment of communication practices. Program core measures include: NCCN Distress Thermometer scores, hospice length-of-stay, and AD completion rates. The NCCN Distress Thermometer reinforces comprehensive assessment and directs a plan of care based on the self-identified needs of the patient and/or family. The outcomes reflect a decrease in psychosocial distress with AD completion and with the increased support through the Pathways program. Our understanding of patient and health care provider barriers to ACP reinforced community need and assisted in identification of best practices. Hospital administration's support of the program stems from a focus on patient-directed care and potential cost savings.
Objectives:
1. Identify medical provider and patient barriers to effective communication in ACP.
2. Categorize communication best practices that generate increased patient-directed care.
3. Demonstrate ability to identify measurable outcomes associated with ACP, including utilization of the NCCN Distress Thermometer in practice.
The Social Hospice: A Model of Advocacy in End-of-Life Care
Hillcrest Medical Center
Tulsa, OK 74104
Jennifer Clark, MD
Chief Quality Officer and Palliative Care Medical Director
Hillcrest Medical Center
1120 S. Utica Ave.
Tulsa, OK 74104
918-579-3871
Kelley Scott, RN, CHPN
Founder and Executive Director
Clarehouse, Tulsa, OK
This abstract introduces the social hospice concept and explores the key tenets to this innovative approach to community-based end-of-life care.
Dying is a universal experience. In the United States, it has unfortunately transformed from a family experience to a medical event. Patients and families have repeatedly expressed wishes to be at home to die, only the U.S. health care system has funneled the dying into the cycle of repeated hospitalization and institutionalization at end of life. However, for those able to articulate their wishes clearly, hospice has provided the avenue and services needed to die at home. Unfortunately, dying at home is not always possible for those without a safe environment or adequate caregivers and resources. The social hospice model serves as a compassionate option for patients and families facing such difficulties. Combined with traditional hospice care, the social hospice provides hands-on caregiving in free-standing home environments developed to care for those in the last month of life. Uniquely, these programs and facilities are sustained by various community advocacy efforts and are, therefore, outside the current health care regulatory environment. Early research has shown a significantly positive effect on caregiver well-being and bereavement. This session will introduce the social hospice concept and explore the key tenets of this innovative approach to community-based end-of-life care.
Objectives:
1. Develop an awareness of the social hospice movement.
2. Articulate the key components of the social hospice model.
3. Understand the benefits of the social hospice.
Pediatric Palliative Care in an Urban Academic Medical Center: “It Takes a Village”
Holtz Children's Hospital/University of Miami–Jackson Memorial Hospital
Miami, FL 33136
G. Patricia Cantwell, MD
Division Chief, Pediatric Critical Care Medicine; Chief, Pediatric Palliative Care Medicine
Holtz Children's Hospital/University of Miami–Jackson Memorial Hospital
Division of Pediatric Critical Care; Holtz Children's, Room 6006
1611 N.W. 12th Avenue
Miami, FL 33136
305-585-6051
Provide highlights of our pediatric palliative care team with our strategy to overcome the stigma that palliative care is a service that most subspecialists “are not ready for yet.”
• Overview team composition: pediatric palliative care.
• Discuss process of receiving consults.
• Review the successful weekly interdisciplinary team meetings using existing hospital staff.
• Provide insight about our successes.
• Discuss challenges to growing program (no dedicated FTEs, for example) and threats to success.
• Focus upon future planning to improve education at all levels of the medical team.
Objectives:
1. Outline our innovative utilization of Child Life as the nucleus for our team.
2. Provide strategies for successful integration of palliative care into the mainstream of skeptical subspecialties.
3. Review our experience of partnering with community resources to improve comprehensive quality care.
• Our experience can provide those without targeted resources with optimism that palliative care can be successfully implemented.
• Our medical center is a tertiary care facility with many subspecialists being resistant to the concept of palliative care, that is, viewed as a threat.
• We have the history of finding innovative alliances to provide our patient population with mini quality experiences while undergoing in-hospital care.
The Story of a PC in a Community, by a Community, for a Community
Hospice and Palliative Care Chautauqua County
Lakewood, NY 14712
Shauna Anderson
Hospice and Palliative Care Chautauqua County
20 W. Fairmount Ave.
Lakewood, NY 14712
716-338-0033
Thomas Putnam, MD (General/Family Practice, Hospice and Palliative Care)
Medical Director
The evolution of a palliative care (PC) program that involves the PCP wherever the person currently resides at the time of the visit(s) by a multidisciplinary team from community agencies, facilities, and the associated hospice.
A high percentage of late hospice referrals with short lengths of stay and many symptoms poorly managed at the time of assessment prompted our community to development a PC program. A goal of the program is early referrals to appropriate programs that enhance the awareness of choice and adequate symptom management. PCLC training was completed in March 2012 but needed adaptation as current models were all hospital-based programs. Another goal for our program was to become a training site in 2015 for community-based programs of the future. A community advisory and implementation committee provides guidance on our rural community's needs and focus. The pilot program began July 2012 and ran until December 31, 2012. Admission to the PC program following PCP approval and PC MD visit for symptom management related to a life-limiting illness with follow-up as indicated with physician, RN, MSW, and chaplain care team. Initial resistance was from PCPs, which was overcome with the realization that they remained in charge of person's care. Creative financial model with insurers began January 1, 2013. Opportunities for physician and community education have increased awareness. Outcomes measured include number of ER visits/hospitalizations/advance directives completed. Training additional staff and educating physicians will contribute toward continued growth.
Objectives:
1. List three key factors in establishing a PC program delivered within the community.
2. Identify pitfalls and advantages of establishing a PC program in a small rural community.
3. Describe the financial and quality-of-life benefits of a PC program.
We have a growing number of champions in our community who promote the PC program to physicians and other people. Our medical director has been instrumental in the development of this program and has become board certified in hospice and PC.
Home-based Palliative Care Community Partners
Hospice Care of America
Rockford, IL 61114
Marty Johnson, RN
CEO/Founder
Hospice Care of America
3815 N. Mulford
Rockford, IL 61114
815-316-2700
Home-based Palliative Care Community Partners (PCCP) developed from the interdisciplinary hospice model and is focused on identifying individuals' goals of care and reducing barriers to successfully managing health care from home—through advanced symptom management, community-based care coordination, tele-health monitoring, on-call crisis nursing visits, and facilitation of shared decision making.
Capturing the proven success of hospice in caring for critically ill persons at home—maintaining optimal wellness, improving quality of life, and decreasing costs—PCCP moves the hospice philosophy and paradigm of home-based care upstream from a 6-month prognosis to any individual with a serious illness who would like to have their health care managed from the comfort, privacy, and dignity of home. Through scheduled and on-call home visits, along with tele-health monitoring, PCCP's interdisciplinary team focuses on meeting those patients' complex needs by: arranging for caregiving or medical equipment, relieving uncontrolled or recurring physical symptoms, and addressing emotional/spiritual needs. To achieve these objectives, PCCP partners with other community organizations to provide: 1) home medical equipment to keep individuals safe and comfortable at home; 2) adequate and competent caregivers to assure medication regimens are followed and personal care needs are met; 3) collaborations with pharmacists, therapists, meal delivery organizations, transportation providers, volunteers, veterans groups, etc.; 4) hospice services; 5) home health; 6) health department services; and 7) other community-based services. PCCP facilitates communication, medication reconciliation, and shared decision making between inpatient palliative care team, hospitalists, discharge planners, specialists and the primary care physician, clinic, or patient-centered medical home.
Objectives:
1. Describe the strengths of a community-based hospice-model palliative care program.
2. Identify community-based service providers that could complement their own palliative care program.
3. Analyze the benefits of RN care management, tele-health monitoring, and on-call crisis responding.
Providing Palliative Care through a Community Hospice
Hospice of Holland
Holland, MI 49423
Tod Wyn, MD
Associate Medical Director
Hospice of Holland
270 Hoover Blvd.
Holland, MI 49423
616-396-2972
This abstract will discuss the approach taken by a small, independent, nonprofit hospice to provide outpatient palliative care services in a community setting.
This small, independent hospice determined that patients in the community were being underserved with regards to palliative care. To correct this, our hospice developed an outpatient palliative care program that included an interdisciplinary team consisting of physicians, nurses, and social worker as well as a coordinator. We determined that services needed to be provided through several different venues: office, home, and facility (ALF/SNF). Evaluation data we are tracking include enrollment, goal of consult, clinical outcome, and conversion into hospice. Discussion will include a description of the process for consult and follow-up, generation of referrals and community education, allocation of resources, patient demographics, and financial challenges.
Objectives:
1. Identify the core components of an outpatient palliative care program.
2. Describe the process used to deliver outpatient palliative care.
3. Examine the challenges of staffing and financing such a program.
Development and Validation of a Prognostic Tool for Palliative Children and Young Adults with Cancer
Institute of Health Research, University of Bedfordshire
Luton, Bedfordshire, UK
Meralita Silvere, PhD
Institute of Health Research, University of Bedfordshire
69 May Street
Luton, Bedfordshire, UK LU1 3QX
44-742-960-0935
The tool helps in predicting the remaining life span of the patient, which contributes to advance care planning and better quality of life in the remaining period.
Palliative patients are in need to know and understand the remaining life span (Lunney et al., 2003). Prognostication is essential for palliative patients and clinicians, as it helps in advance care planning, preparing toward impending death and a comfortable ending (Lynn et al., 2000). Manworren and Hynan (2003) note that there is a need for the development of a specific prognostic tool for children as they are nonverbal and intolerant to pain. Low quality of life is measured among children dying with cancer (Speyer et al., 2009). It was believed that children and young people are exempted from pain, grief, or loss, but research depicts that they too experience these the same as adults but lack language to express, maturity to understand, and experience to demonstrate controlled emotions and feelings. The interpretation of their perception is different when compared with adults. This is where the importance of development of a prognostic tool arises, reasoning out the usage of the adults tools for the children. There is always a question in the hearts and minds of palliative patients such as children, parents, families, and the health team of “How long will they live?” or “How long can I live?” The prognostic tool will answer the question.
Objectives:
1. To develop a prognostic tool to measure the life expectancy of the palliative children and young adults with cancer.
2. To evaluate the prognostic tool among palliative children and young adults suffering with cancer.
3. To systematically analyze the evidenced-based practice of the prognostic factors among palliative children and young adults.
Patient Support Team: A Palliative Approach to Outpatient Cancer Care
John T. Vucurevich Regional Cancer Care Institute
Rapid City, SD 57701
Mary Ann Fredrickson, CSW-PIP
Patient Support Team Social Worker
John T. Vucurevich Regional Cancer Care Institute
353 Fairmont Boulevard
Rapid City, SD 57701
605-755-2365
The Integration of a Palliative Care Program and Life Care Planning Program with the End-stage Renal Disease Population
Kaiser Permanente
San Jose, CA 95119
Ava Lee, MD, MPH
Hospice and Palliative Care Medical Director
Kaiser Permanente
270 Hospital Parkway
San Jose, CA 95119
408-972-6306
Jane Coppola, RN, MHAL
Manager of Palliative and Transitional Care
This abstract will describe the integration of a formal life care planning program into a health system with an existing palliative care program.
Kaiser Permanente is an integrated health system. In 2002, Kaiser Permanente San Jose established an Inpatient Palliative Care (PC) Program and in 2007 an Outpatient PC Program. The teams are multidisciplinary and provide primary and secondary PC. In 2012, due to the identified need for more patients to document health care wishes, a Life Care Planning (LCP) Program was instituted. The goal of the LCP Program is to deliver a systematic, population-wide approach to help adult patients and their agents engage in advance care planning, and prepare agents to make health care decisions consistent with these preferences. A team of experts, including executives, physicians, and nurses was involved in the planning and implementation of the LCP Program. During the implementation process a pilot was initiated that focused on 200 end-stage renal disease (ESRD) patients. The ESRD population was chosen due to high disease burden, and the need for values-driven care planning. Challenges faced included: identifying appropriate ESRD patients, reluctance of patients to participate, confusion about differences between LCP and PC, limited resources and space, and access for homebound patients. The program expanded to include heart failure patients. Future growth in the program will focus on the frail elderly with limited life expectancy.
Objectives:
1. Identify the evidence-based outcomes associated with an organized, systematic approach to LCP.
2. Describe three potential barriers to integrating LCP into a system with an existing PC program.
3. List strategies for engaging primary care physicians and specialists in referring patients to PC or LCP.
The Sooner the Better: Early Intervention of Palliative Medicine Improves Outcomes among Patients with Stage IV Malignancy in the MICU
Lenox Hill Hospital
New York, NY 10075
Shanna Levine, MD
Internal Medicine PGY3
Lenox Hill Hospital
100 East 77th Street
New York, NY 10075
954-415-5769
Palliative care has been shown to improve quality of life and prolong median survival in patients with advanced cancer. Intensive care unit (ICU) use in the last month of life increased from 24.3% to 29.2% over the last study decade. Our objective was to evaluate and quantify outcomes, including survival of patients with active stage IV malignancy admitted to an urban university affiliated hospital MICU who had a palliative medicine consult.
A retrospective chart review of patients from April 2013 to April 2014 admitted to the MICU with active stage IV malignancy identified via a validated proactive case finding trigger tool was conducted. Data collected included pain and symptom relief, clarification of goals of care, length of stay, and disposition (hospice, rehabilitation facility, home, and death).
Nearly 40% of patients with active stage IV malignancy admitted to the MICU died during their hospital stay. We believe this study illuminates the futility of ICU care in this patient population. Consultation from the palliative medicine team using a proactive trigger tool can be beneficial to allow for better symptom control, clarification of goals, and psychosocial counseling.
Evaluation of Practitioner Use of Music Therapy in an Inpatient Consult Service
Lenox Hill Hospital NSLIJ Health System
New York, NY 10075
Bridget Earle, MD
Palliative Medicine Attending
Lenox Hill Hospital NSLIJ Health System
100 East 77th Street
New York, NY 10075
212-434-4174
Meghan Hinman, MA, LCAT
Lenox Hill is an urban community hospital with a thriving music therapy (MT) program integrated in the palliative medicine consult service. Limited data exist examining the trends in referral to MT despite a body of literature about the benefits from the MT community. Our objective was to examine the trends in MT referrals among our physicians and nurse practitioners in order to provide better quality of care. We conducted a retrospective data review of patients referred to MT. Data collected included referring practitioner, date of palliative care (PC) consult, and date of initial MT visit. We also surveyed the practitioners about reasons for MT referral.
Preliminary results point to more frequent utilization of MT service by physicians than nurse practitioners, but only one-third of the total PC patients also received MT. Despite feelings of support and commitment to the benefits of MT from PC clinicians, our data suggest that MT is underutilized within the PC consultation service. Given this data, our intention is to implement checklists and regular education to allow for better recruitment of patients who can benefit from a MT visit. Data are ongoing.
Initiating Music Therapy in a Palliative Medicine Team
Lenox Hill Hospital NSLIJ Health System
New York, NY 10075
Bridget Earle, MD
Palliative Medicine Attending
Lenox Hill Hospital NSLIJ Health System
100 East 77th Street
New York, NY 10075
212-434-4174
Meghan Hinman, MA, LCAT
Music has an impact on patients, and on humans in general, that is difficult to convey with only words, but integrating a music therapist into your medical team can bring a plethora of exciting discourse about patient and family needs and how they can be addressed by the team. The work of the music therapist can contribute to positive outcomes in goals-of-care discussions and discharge planning, in addition to easing the anxiety of patients and family members, and sometimes easing other clinicians' anxieties by providing a comforting service when there is nothing left to say. This poster will present the Lenox Hill Hospital Palliative Medicine Program's process in initiating a music therapy component to the team services.
Poster will describe the decision-making process in deciding to initiate a music therapy program. Other important information includes sources of funding for such a program, identification of qualities necessary for appropriate music therapy candidates, strategies for orienting the music therapist to the team, and strategies and potential challenges for orienting hospital staff to the presence and clinical expertise of music therapists.
Introducing the MOLST into Practice
Manchester VA Medical Center
Manchester, NH 03104
Ritamarie Moscola, MD
Medical Director GEC
Manchester VA Medical Center
718 Smyth Road
Manchester, NH 03104
603-624-4366
Members of the PCCT, Ethics Team, and Nurse Informatics Team worked together to develop an approach to discussing and documenting end-of-life choices. We discussed possible options for care. We created templates for documenting the discussion and order sets to enter into the medical record. The Palliative Care Team piloted these notes and orders. We made adjustments to the templates. We wrote a policy for the medical center. We presented the information to providers in other specialty care groups. The need for documentation insures that we have the conversations. This has improved communication between the Palliative Care Team, patients, and families. It has also improved communication between the Palliative Care Team and other provider teams.
Objectives:
1. The learner will be able to define MOLST.
2. The learner will be able to discuss MOLST with patients and families.
3. The learner will be able to introduce MOLST into his/her practice.
Preventing Burnout
Manchester VA Medical Center
Manchester, NH 03104
Ritamarie Moscola, MD
Medical Director GEC
Manchester VA Medical Center
718 Smyth Road
Manchester, NH 03104
603-624-4366
Consuelo Alvarez, MD
Section Chief of Geriatric Medicine
Elliot Health Systems
There is discussion of “burnout” experienced by health care providers. There is much discussion about the need for us to “heal.” The objective of this abstract is that clinicians in different disciplines will learn to recognize burnout and ways to prevent it. This presentation is best experienced as a “hands-on” workshop in which clinicians come together to create works of art that are healing.
Objectives:
1. Recognize that self-care is a core competency for all clinicians.
2. Recognize work-related stress and burnout.
3. Identify ways to decrease burnout.
Embedding Standardized Primary Palliative Care into Primary Care
Mayo Clinic
Rochester, MN
Cory Ingram, MD, MS, FAAHPM
Senior Associate Consultant Palliative Medicine, Assistant Professor of Family and Palliative Medicine, Medical Director of Palliative Medicine MCHS, Director of Palliative Medicine Office of Population Health Management
Mayo Clinic
200 1st St. S.W.
Rochester, MN
507-284-2661
The Office of Population Health Management at Mayo Clinic identified 10 programs to transform community primary care to ensure delivery of our primary value, the needs of the patient come first. Palliative medicine is one of the 10 programs, and our goal is to embed the basic practices and principles of palliative care in a uniform structured way within the day-to-day practice of primary care as defined by the new Mayo Model of Community Care (MMOCC).
These basic practices and principles are represented within the following three categories:
1. Advance care planning conversations. 2. Basic pain and symptom management. 3. Basic management of depression and anxiety and screening for spiritual well-being.
Our initial approach is hallmarked by developing relationships with the individual practices and forming a network, COPAL (COmmunity PALliative Care). Our COPAL network development has achieved the following:
1. Dyad partnerships between primary care and specialty palliative care across enterprise sites. 2. Introductory dialogue with enterprise primary care practices. 3. A cooperative peer observership between primary and palliative care. 4. COPAL retreat with common ground development and consensus on population definitions. 5. Interventions, documentation, and measurements. Engagement of key stakeholders for data, quality, and EMR development.
From Passion to Plan to Position: How a Hospitalist's Passion for Palliative Care Medicine Led to Establishing an Inpatient Program with 24/7 Coverage
Mercy General Hospital
Sacramento, CA
Faryal Michaud, DO
Director of Inpatient Palliative Care Program
Mercy General Hospital
4001 J Street
Sacramento, CA
916-453-4966
The aim is to show how to make a case for palliative care within a hospitalist group and get buy-in from a medical group to establish a hospital-based service.
We started by having two RNs running our palliative care service. Within one year, we have developed our program into a full-service line that works in a 24/7 setting with 3 palliative care physicians, as well as a designated social worker and 0.5 FTE chaplaincy. We have established our inpatient service across all service lines and now serve with cardiothoracic surgery for outpatient screening for LVAD and are looking into developing an outpatient service through our outpatient cancer center. We have an ongoing education series that benefits attending physicians, nursing, and residents as well as ancillary staff.
Objectives:
1. Growing your own: How to use hospitalist service as a resource for palliative care providers.
2. Making the case: How by involvement in different departments within the hospital setting, you can make a case for a service.
3. How to convince a medical group that otherwise does not benefit from cost saving from a business standpoint to allow a physician FTE to join an inpatient palliative care service.
Bringing Palliative Care to the Outskirts of Town
Mercy Regional Medical Center Centura Health
Durango, CO 81301
Daniel Keuning, NP, RN, MSN, FNP, ACHPN
Palliative Care Nurse Practitioner
Mercy Regional Medical Center Centura Health
1 Mercado, Suite 270
Durango, CO 81301
970-731-9190
Moving palliative care from the acute care setting with continuity of care to skilled nursing facilities, assisting living facilities, and homes in rural southwest Colorado.
This abstract is a 3-year history of program development from the acute care hospital-based setting to the outpatient world of palliative care: the opportunities and challenges of staffing all these settings using nurse practitioners; how to integrate the programs with skilled home care services and successful transitions to hospice; program development pitfalls, strategies, and outcomes in a 3-year retrospective overview; working with physicians and providers to maximize the impact of palliative care to appropriate patient populations.
Objectives:
1. How to set out a plan to move palliative care out of the acute setting into a rural home and facility-based program.
2. Demonstrate success areas and pitfalls of expanding service areas.
3. Demonstrate the impact on rehospitalizations, increase in hospice days, home care collaboration, and positive physician relationships.
Integrating Intensive Hospice and Palliative Care Interprofessional Education into Community-focused Family Medicine Residency Training
Mesilla Valley Hospice
Las Cruces, NM 88005
Traci White, PharmD, PhC
Pharmacist Clinician
Mesilla Valley Hospice
299 E. Montana Avenue
Las Cruces, NM 88005
575-405-3442
Kathy Olson, RN
Through the 4-week comprehensive “Hospice Academy” curriculum, medical residents from the Southern New Mexico Family Medicine Residency Program (SNMFMRP) train with the various disciplines of the hospice team including the nurse case manager, social worker, pharmacist clinician, chaplain, nurse practitioner, admissions coordinator, billing specialist, bereavement specialist, and volunteer. Mesilla Valley Hospice is a community nonprofit hospice serving rural Dona Ana County and has the only free-standing 16-bed inpatient facility in the state of New Mexico. The mission of the SNMFMRP is to provide high-quality and comprehensive medical education to produce board-certified family physicians. The end-of-life immersion experience exposes medical residents to effective interpersonal communication skills through a team-based patient and family-centered approach with an emphasis on having difficult conversations with the terminally ill patient. The pharmacist clinician, who has prescriptive authority as an advanced practice pharmacist under protocol, serves as the primary mentor for palliative pharmacologic pain and symptom management. The residents take part in the interdisciplinary team meetings and receive didactic education on-site as well as through the University of New Mexico's Project ECHO (Extension for Community Healthcare Outcomes) palliative care clinic. The CAPC Learner Assessment Tool will be utilized for pre- and post-test learning assessments.
Palliative Pyrotechnics to Avoid Burnout and Fuel Passion
Moffitt Cancer Center
Tampa, FL 33612
Diane Portman, MD FAAHPM
Chair, Department of Supportive Care Medicine
Moffitt Cancer Center
12902 Magnolia Drive
Tampa, FL 33612
941-321-4681
Palliative clinicians experience stress in response to work conditions and patient loss or suffering. Unprocessed emotions may lead to clinician moral distress, compassion fatigue, and burnout. Support of staff well-being may maintain work enthusiasm, improve staff retention, and promote clinician effectiveness. Advanced certification in palliative care by the Joint Commission also requires a staff wellness and resilience plan.
We describe the development and implementation of a wellness plan to reduce burden, support self-care, and nurture job engagement. Initial steps included literature review, guidance from another institution with an established wellness plan, and examination of internal resources. The plan consisted of changes to existing work processes and establishment of voluntary provider self-care activities (PSCA). Work processes were modified by including psychiatry at weekly interdisciplinary team meetings to offer insight into challenging cases and by giving clinicians 2 weekdays off monthly. PSCA consisted of facilitated debriefing sessions to share feelings, mindfulness training, and bi-weekly chair massage. Changes to work processes were well-received. Challenges to PSCA implementation include erratic clinician attendance due to competing obligations, variable comfort with sharing, and service location distance from inpatient units. Future goals include solicitation of feedback about the program and identification of options to enhance PSCA participation.
Communication: Using Palliative Care-trained Qualified Competent Medical Interpreters
Natividad Medical Center
Salinas, CA 93912-1611
Mark R. Kite, BSN FCN
Palliative Care Team Leader
Natividad Medical Center
1441 Constitution Boulevard
Post Office Box 81611
Salinas, CA 93912-1611
831-772-7583
This abstract will discuss the importance and necessity of using palliative care-trained qualified competent medical interpreters when speaking/communicating with non-English-speaking palliative care patients and/or their families.
California's Salinas Valley has a diverse multicultural population. The top five language groups spoken at Natividad Medical Center are English, Spanish, Mixteco, Vietnamese, and Triqui. Other language groups represented in the Salinas Valley include Zapoteco, various Filipino and Chinese dialects, Korean, and Middle Eastern dialects extending into India and Pakistan. In the 20 months since Natividad Medical Center's palliative care service began it has become very apparent that each cultural group has very different beliefs about the meaning of pain, speaking of end of life, spirituality, or even the words “palliative care.” Natividad Medical Center has three Mexican indigenousness Indian interpreters (Mixteco, Triqui and Zapoteco). Brought together by the Natividad Medical Foundation, these interpreters and the palliative care team discussed various aspects of their understanding of palliative care and the different components of palliative care. Through these discussions an educational video series consisting of five topics was made for educating staff and the outside medical community. The lessons learned from the recording of these videos are extremely valuable. For instance: there is no concept of “palliative care” in the Mixteco, Triqui, and Zapoteco language or culture. Effective communication is paramount in providing effective palliative care.
Objectives:
1. State two reasons why only palliative care-trained qualified interpreters should be used as interpreters.
2. Describe potential barriers to providing palliative care-trained qualified interpreters.
3. Identify when the use of palliative care-trained qualified interpreters is necessary/required.
Using a Hospital-based Champion Program to Train Nurses and Social Workers How to Provide Expert Palliative Care at the Bedside
New York Presbyterian Hospital, Cornell Campus
New York, NY 10065
Elizabeth E. Schack, NP, LCSW
Palliative Care Nurse Practitioner
New York Presbyterian Hospital, Cornell Campus
525 East 68th Street, Baker 14
New York, NY 10065
212-746-1729
Tara Benziger
Anna Sheldon
Dory Hottensen
This abstract will discuss an on-the-job training model designed to teach social workers and nurses how to provide expert palliative care at the bedside, including learner assessments and evaluations, curricula, and program outcomes.
Despite our strong interest in and commitment to interdisciplinary palliative care education, no formal curriculum existed at our institution that would ensure that nurses and social workers throughout the hospital are adequately trained and supported in delivering quality palliative care to seriously ill patients and their families. The goal of our hospital-based palliative care champion program for unit nurses and social workers is to create a sustainable, comprehensive, and measurable on-the-job training model designed to teach each participant how to provide expert palliative care at the bedside.
During year one, 10 hospital social workers and 14 hospital nurses completed rigorous training that included interdisciplinary and discipline-specific seminars on palliative care principles, one-on-one training at the bedside, clinical supervision, and co-teaching responsibilities. The year-one outcomes for both programs demonstrate increased knowledge, improved skills, and increased confidence and professional development activity. Challenges regarding seminar attendance, clinical supervision, and culture change will be discussed. Despite some challenges, the outcomes bode well for year two, when each of the new champions will train another set of champions, resulting in the beginning of a self-sufficient educational program advancing palliative care in our institution.
Objectives:
1. List the key components of a palliative care on-the-job training model for nurses and social workers.
2. Identify three challenges in program development, initiation, and completion.
3. List two techniques for obtaining nurse and social work buy-in.
Preparing for The Joint Commission Advanced Certification for Palliative Care
North Shore University Hospital
Manhasset, NY 11030
Isabella Park, DO
North Shore University Hospital
300 Community Drive
Manhasset, NY 11030
516-562-8884
This abstract will discuss the institutional benefits and process for The Joint Commission Advanced Certification for Palliative Care.
The Palliative Medicine Program at North Shore University Hospital (NSUH), part of the North Shore-LIJ Health System, began in 2003. This program initially started with 300 inpatient palliative medicine consultations per year, with an annual consultation volume exceeding 2000 new patients per year in 2013. The program also established an accredited Hospice and Palliative Medicine Fellowship in 2007 coinciding with the opening of new 10-bed Palliative Care Unit. The next logical step for continued growth was to seek Joint Commission (JC) Advanced Certification for Palliative Care. The process for certification was beneficial to the institution and team because of the focus on rigorous performance metrics that are reported monthly. The accreditation process fostered dialogue around palliative care metrics and quality within our organization from frontline staff to senior leaders in the C-suite. Our program selected four performance metrics to monitor related to pain management, documentation of goals of care, intensive care unit length of stay for terminally ill patients, and use of advance directives. In 2012, NSUH was the sixth hospital in the nation to receive certification, thereby inspiring three additional hospitals in our own health system to apply for JC Advanced Certification for Palliative Care this year.
Objectives:
1. To discuss the preparation process for JC Advanced Certification for Palliative Care.
2. To identify valuable metrics for certification.
3. Describe three benefits to receiving JC Advanced Certification for Palliative Care.
Toward Validating the Bedside Capacity Assessment Tool
North Shore-LIJ Health System
New Hyde Park, NY 11040
Maria T. Carney, MD
Chief of Geriatric and Palliative Care
North Shore-LIJ Health System
270-05 76th Avenue, Research Building, 2nd Floor
New Hyde Park, NY 11040
718-470-7270
Brian E. Emmert, Jr.
Claudia Elera, MA
Brian M. Keefe, MD
When patients approach the end of their lives, the construct of patient autonomy, or the right for a patient to accept/refuse a medical treatment, becomes a pressing issue. This autonomy rests upon a patient's capacity to make a decision. As palliative care becomes more prominent, practicality demands that quality decision-making capacity assessments be made rapidly and at a patient's bedside by the patient's physician. Thus, a validated decision-making capacity assessment tool must be developed to assist physicians in making accurate capacity determinations. This present study progresses toward validating the Bedside Capacity Assessment Tool (BCAT), a tool developed to help physicians make timely and more accurate capacity judgments. Thirty geriatric medicine fellows, palliative medicine fellows, and internal medicine residents used the BCAT to assess the decision-making capacity of 10 hypothetical patients. Their conclusions were compared with those of experts and their percent correct was calculated. Assessments of capacity had a 76.1% agreement, with a range of 50% to 100%. This tool demonstrates a strong correlation and promise of being effective and user-friendly. The large range indicates that further refinement and testing of this tool is necessary. However, potential exists for this tool to improve capacity assessment skills in physicians.
Early Palliative Integration in Oncology: Palliative Care Upstreamed
NYU Langone Medical Center
The Perlmutter Cancer Center
New York, NY 10016
Gary Shelton, DNP, MSN, AOCNP, ANP-BC
The Perlmutter Cancer Center at
NYU Langone Medical Center
160 East 34th Street
New York, NY 10016
212-731-5395
Tanveer Mir, MD
Abraham Chachoua, MD
The Perlmutter Cancer Center at NYU Langone Medical Center, with ties to the larger university, enhances collaborations on all NYU campuses across scientific disciplines, offering an integrated palliative and oncological care approach to cancer patients and their families. The Palliative Care Service was established at the Perlmutter Cancer Center in 2012. This team comprises a senior palliative physician, a senior nurse practitioner, and a social worker and is an integral part of the Cancer Center. The team evaluates and manages cancer patients and their families at the ambulatory cancer center and collaborates with the other cancer disease management groups, the broader supportive oncology team. During hospitalization of oncology patients at the NYU Langone Medical Center, the Cancer Center palliative team collaborates with the inpatient palliative team. It is a way of providing early palliative interventions to potentially reduce hospitalizations and ICU utilization.
Patients thrive in many ways when they receive supportive services, based on the 2010 Harvard study published in The New England Journal of Medicine that found that palliative care could extend survival time. Yet the model for these sorts of interventions in cancer care has long been an effort to merely make services available for those who ask for them, as well as for those experiencing a serious crisis. The 15-month experience of this Cancer-Center based palliative team focuses on the following:
1. Assessing patients physical symptoms and managing them. 2. Early integration of palliative and supportive services in cancer care. 3. Psycho-social issues. 4. Obtaining and documenting advance directives in the EHR. 5. Team building and education. 6. Short-term symptom management at the infusion center. 7. Distress screening using a tablet at the second visit.
We believe the interventions of this integrated multidisciplinary palliative team address complex symptoms and enhances quality of life for cancer patients and their families. Expanding integrated palliative team services beyond the Cancer Center to other cancer center satellites and possibly heart failure and other chronic illnesses is our vision for the future.
Objectives:
1. Understand benefits of early integration of palliative care in cancer.
2. Educate different teams in understanding disease-specific models of ambulatory palliative care.
3. Develop an understanding of the broad scope of palliative care and not limit it to end of life.
Advancing Advanced Heart Failure: Palliative Care and Mechanical Circulatory Support
Ochsner
New Orleans, LA 70448
Deborah Bourgeois, MN, APRN, ACNS-BC.CNS
Manager Palliative Care
Ochsner
1514 Jefferson Highway
New Orleans, LA 70448
504-842-4491
Heart failure is a major contributor to morbidity and mortality worldwide. Expenditure for cardiovascular disease in the United States is likely to triple over the next 2 decades increasing costs from $272.5 billion to $818.1 billion. Prevention strategies and advanced therapies have improved life expectancy and morbidity; however, economic costs associated with advanced therapies have contributed to increased financial and societal burden. Accessibility to advanced therapies, such as transplant and mechanical circulatory support (MCS) is limited, due to availability of organs for transplant and device-associated costs. Ethical issues including patient autonomy and equitable distribution of resources play a role in discussions of heart failure therapy. Health care reform is moving the fee-for-service financing model to a bundled payment system in which use of expensive technologies reduces hospitals' operating margins. Health care systems are creating innovative strategies to efficiently allocate resources for chronic disease management.
Because implantation of MCS is expensive, patient selection is a key consideration prior to surgery; adding palliative care consultation to the selection process prior to implantation can facilitate alignment of patient's goals, values, and preferences. This provides a more involved and structured approach to advance directive discussions that may be beneficial to clinicians, patients, and families.
Objectives:
1. Describe the importance of palliative care in advanced cardiac disease.
2. Discuss innovative solutions to meet regulatory and certification requirements for ventricular assist devices.
3. List one reason for palliative care involvement in care of the patient with MCS.
Application of Lean Thinking to Improve Home-based Palliative Care Program
Optum
Minneapolis, MN 55440-9472
Betsy Chang Ha, RN, MS, MBB
VP of Clinical Program Management
Optum
PO Box 9472
Minneapolis, MN 55440-9472
949-241-2847
Dr. James Mittelberger
CMO
Optum Hospice and Palliative Care
Innovative practical approach and application of the Lean methodology to create efficient and effective standard work in the home-based palliative care core processes.
This abstract will include an overview of the three critical core processes of a home-based palliative care program, including a brief overview of Lean Thinking with the focus on how to identify wastes in the care delivery system and methods to create efficient continuous flow. The presenters will share practical experience of applying the Lean methodology, such as Value Stream Mapping, 5S, and Visual Control to create standard work in the home-based palliative care program core processes. The presenters will facilitate a meaningful Q&A session based on lessons learned from a local program improvement experience.
Objectives:
1. List three critical processes of a home-based palliative care program.
2. Identify eight types of wastes in the health care delivery system.
3. Apply one Lean methodology to eliminate a minimum of one waste in its home-based palliative care process.
Palliative Care across the Care Continuum
Providence Seaside Hospital
Seaside, OR 97138
Allison Whisenhunt, LCSW
Social Work Supervisor
Providence Seaside Hospital
725 S. Wahanna Rd.
Seaside, OR 97138
503-717-7439
Form Follows Function: Why an RN-Led ICU Regional Model of Palliative Care Works!
Saint Joseph Mercy Hospital Chelsea
Chelsea, MI 48118-1399
Jan Sexton, RN, BSN
Palliative Care Site Lead
Saint Joseph Mercy Hospital Chelsea
775 S. Main Street
Chelsea, MI 48118-1399
734-593-5450
This poster will demonstrate how small hospitals can evaluate system function, overcome challenges, and implement a novel, comprehensive, hospital-wide palliative care (PC) program with sustainable positive outcomes. Determined to provide PC services, Saint Joseph Mercy Chelsea (SJMC), a 113-bed hospital, evaluated low patient volumes, budgetary concerns, physician accessibility, and personnel limitations as major constraints. Unable to support a traditional model, an innovative model emerged known as the Hybrid RN-Led ICU Regional Model. Led by an intensive care registered nurse (RN), a team of three nurses coordinate completion of an Initial RN Palliative Care Assessment, consults an off-site board certified palliative care physician, initiates a team-based care protocol, coordinates interdisciplinary rounds, and monitors the patient's plan of care and program outcomes. Each RN also holds a full-time staff position in addition to their dedication to the PC program. Well-developed processes and clear communication among all team members and hospital staff have become essential to the success of this model. Since the program's introduction in February 2014, consults have doubled the metric expectation of two per month, patients and families articulate positive feedback, and the RN team has grown to five. This model has proficiently exceeded hospital expectations and met patient needs.
Impact of Inpatient Palliative Care Consultation on Length of Stay and Readmissions
Saint Louis University School of Medicine
Saint Louis, MO 63104
On Ying Liu, BS, MD Candidate
Saint Louis University School of Medicine
1402 S. Grand Blvd.
Saint Louis, MO 63104
314-977-8462
This study examines the impact of an inpatient palliative consultation team on outcomes of interest to supporters of palliative service delivery in an urban teaching hospital setting. We compare 30-day readmissions, 6-month readmissions, and 30-day ER visits among patients of various discharge dispositions following palliative care consultation, from May 2009 to October 2012. Consulted patients were discharged to home or a facility with or without hospice, or expired in the hospital. We also tracked the diagnosis-related group (DRG) assigned to consulted patients upon readmissions or ER visits.
Of 1133 total consultations given during this period, 26.7% of the consulted patients expired in the hospital. Readmitted at least once within 30 days were 9.1%. Of these, 12.6% were discharged to home or a facility with hospice, and 87.4% were discharged to home or a facility without hospice following consultation. Similar rates were found for 6-month readmissions and ER visits. The most common DRGs assigned to patients readmitted within 30 days were diseases and disorders of the respiratory system (19.8%), digestive system (12.9%), kidney and urinary tract (11.9%), and infectious and parasitic diseases (11.9%). Additionally, palliative care consultation did not have a significant impact on hospital length of stay over time.
We conclude that among these seriously ill patients in an urban “safety net” hospital, discharge with hospice care is associated with a lower rate of readmission than similar patients discharged without hospice care.
Objectives:
1. Palliative care consultation plays a role in influencing and educating patients about options of discharge, for example, with or without hospice.
2. Consulted patients who elected discharge with hospice are less likely to have 30-day and 6-month readmissions, and ER visits.
3. Palliative care consultation does not significantly affect length of hospital stay.
Is Outpatient Palliative Care Feasible in the Safety Net?
San Francisco General Hospital and Trauma Center
San Francisco, CA 94110
Heather A. Harris, MD
Associate Medical Director, Supportive and Palliative Care Program
San Francisco General Hospital and Trauma Center
1001 Potrero Avenue, Box 0862
San Francisco, CA 94110
415-206-3786
Oncology patients cared for in safety net systems often present late in the course of illness, raising concerns about the proportion of patients who could be referred to an outpatient palliative care (OP PC) clinic. To examine the need, feasibility, and expected benefits of OP PC, we performed a retrospective cohort study using cancer registry and claims data to evaluate utilization patterns and cost of care in the final 6 months of life for oncology patients within our institution. Among the 403 decedents we found heavy, late utilization of inpatient (IP) services. Whereas late presentation was common, 133 patients (33%) had multiple health system encounters 180 to 191 days prior to death, thus early enough to be referred to an OP PC clinic. Prior research suggests that utilization of IP services in the final month of life is 40% lower among patients who receive early OP PC. Using this estimate, we determined providing OP PC to only 50 patients annually would avoid 38 hospitalizations, with resulting avoided direct costs of $846,450. Annual staffing costs for an OP PC team (20% FTE) were estimated at $88,290. This feasibility study reveals OP PC in the safety net can provide substantial return on investment.
Increasing Palliative Care Utilization through the Use of a Consult Nurse
Sanford Medical Center–Fargo
Fargo, ND 58122
Tom O'Keefe, MSN, RN
Director of Nursing Service
Sanford Medical Center–Fargo
720 4th St. North
Fargo, ND 58122
701-234-5938
From 2011 to 2013 Sanford Medical Center has increased the number of “lives touched” by our palliative care team by more than 90% in total and by more than 200% in the intensive care units (ICUs) by the use of a palliative care consult nurse to assist our palliative care physicians. The consult nurse has been instrumental in advancing the cause of palliative care in our ICU, ED, and general medical surgical units. The nurse's skill in conducting goals-of-care discussion has been invaluable to the physicians who are very time limited. This role has increased the number of admissions to our inpatient palliative care unit by 15%.
The PC Swirl: A Creative Strategy to Fulfill the Need for Social Work Support in Palliative Care
Santa Monica UCLA Medical Center
Santa Monica, CA 90404
Jeannette Meyer, MSN, RN, CCRN, CCNS, PCCN, ACHPN
Clinical Nurse Specialist for Palliative Care
Santa Monica UCLA Medical Center
1328 16th Street, 2nd Floor Suite
Santa Monica, CA 90404
424-259-8161
The PC-Swirl participated in weekly interdisciplinary rounds, which were titled “Swirl Rounds” and were a weekly discussion of all patients. Attendees included the palliative care physician, clinical nurse specialist, palliative care fellow, administrative assistant, and palliative chaplain as well as the PC Swirl. Individual cases were discussed and the PC Swirl was able to provide interventions directly or through interactions with other case managers and social workers.
The Palliative team identified the patients who had received PC Swirl intervention in two acuity-based categories: P-1 (PC Swirl participates in rounds and gives opinions) and P-2 (PC Swirl does direct interventions with the patient/significant others/staff).
As an additional responsibility, the PC Swirl has taken an active role in the Quality of Life Resource and Support Team, assisting in Bereavement Packet development, dissemination of the Compassion Palm Program for dying patients, circulating and mailing bereavement cards, and direct supervision of the Celebration of Life Program.
The PC Swirl also has provided support to the palliative care staff members who are involved with challenging and often painful patient and family situations.
Objectives:
1. Recognize the value of the social worker role in palliative care.
2. Describe creative strategies for obtaining social work support when financial resources are limited.
3. Discuss ways to measure the productivity of the social worker role in palliative care.
For programs that do not have the financial resource to obtain a full-time palliative social worker, a dedicated and enthusiastic intermittent social worker who is willing to contribute time to the palliative care cause is of infinite value.
“Caring with Heart.” In Their Own Words: The Meaning of Caring for Seriously Ill Patients
School of Nursing, Alexandria University, Egypt–School of Nursing, University of Maryland
Baltimore, MD 21201
Mary Gergis, PhD, MSc, BSc
Assistant Professor, School of Nursing, Alexandria University, Egypt; Post Doctoral Fellow, School of Nursing, University of Maryland
School of Nursing, Alexandria University, Egypt–School of Nursing, University of Maryland
655 W. Lombard Street, Suite 404 G
Baltimore, MD 21201
443-374-7320
Implications:
• Caring and caring behaviors should be integrated into palliative care education and practices as one of the essential palliative care core competencies.
• Research is needed to design innovative educational strategies that promote clinicians' caring behaviors.
Want To Graduate Clinicians Who Care? A Caring Behavior Scale For Health Care Students
School of Nursing, Alexandria University, Egypt–School of Nursing, University of Maryland
Baltimore, MD 21201
Mary Gergis, PhD, MSc, BSc
Assistant Professor, School of Nursing, Alexandria University, Egypt; Post Doctoral Fellow, School of Nursing, University of Maryland
School of Nursing, Alexandria University, Egypt–School of Nursing, University of Maryland
655 W. Lombard Street, Suite 404 G
Baltimore, MD 21201
443-374-7320
Implications:
• Further research is needed to accumulate evidence for the validity and reliability of the scale.
• Incorporating the scale into undergraduate health care education and ongoing behavioral training of health care professionals could help promote the perception of patients and their families of the quality of clinicians' caring behaviors.
Communication in Intensive Care Units: What Do Nurses Say to Their Seriously Ill Patients?
School of Nursing, Alexandria University, Egypt–School of Nursing, University of Maryland
Baltimore, MD 21201
Mary Gergis, PhD, MSc, BSc
Assistant Professor, School of Nursing, Alexandria University, Egypt; Post Doctoral Fellow, School of Nursing, University of Maryland
School of Nursing, Alexandria University, Egypt–School of Nursing, University of Maryland
655 W. Lombard Street, Suite 404 G
Baltimore, MD 21201
443-374-7320
Mission Impossible? A Standardized Consult Note within the EMR That Serves to Collect Data, Improve Outcomes, and Protect Provider Time
Sentara
Virginia Beach, VA 23456
Sarah Zaglifa, LCSW, ACHP-SW, OSW-C
Palliative Care Social Worker
Sentara
2025 Glenn Mitchell Dr.
Virginia Beach, VA 23456
757-507-4111
Many electronic medical records (EMRs) have been created for hospital medicine, but few are tailored to the specific needs of palliative care. The goal of this project was to create a standardized documentation template that combines the functionalities of clinical documentation with a data repository for quality improvement and national reporting within an EMR (EPIC).
Beginning in September 2013, an interdisciplinary workgroup convened monthly to create a standardized template for clinical documentation, billing, and quality metric needs. National guidelines and standardized tools (ESAS) were reviewed and incorporated. The development process was consensus driven. Focus was on efficiency in clinical care, prevention of duplicate data entry, and adaptability as quality metrics change over time.
Currently, the template is in the pilot phase. Initial outcomes include: 18 clinicians across seven hospitals using the documentation tool, and an average time to complete. The template generates discrete data elements, including ESAS, which allows data access for CAPC registry and quality improvement studies.
A multifunctional, EMR template has been created to serve palliative care medicine providers across a network of hospitals to maximize efficiency and clinical relevance in the documentation process. The potential impact on time, billing, and quality of care requires further study.
Evolution of Palliative Care Team with Physician Addition
Shawnee Mission Medical Center
Shawnee Mission, KS 66204
Cindy Kuklenski, RN
Palliative Care/Pain Management Nurse
Shawnee Mission Medical Center
9100 W. 74th Street
Shawnee Mission, KS 66204
913-676-2224
In 2007, a multidisciplinary palliative care team was established at Shawnee Mission Medical Center, a 500-bed community hospital. The model for the initial team was a nurse and pharmacist, specializing in pain and palliative care, rounding on patients when consulted. Patient cases were then discussed weekly with the social worker and chaplain. The team would manage symptoms and assist in plan development. A barrier was identified, however, in the lack of a physician to assimilate information from all consultants, deliver a comprehensive clinical picture for patients and families, and provide prognosis.
Funding for two part-time board-certified palliative care physicians was obtained, and they joined the existing team in 2013. This model became more efficient and cohesive, providing an integrated, comprehensive clinical picture to facilitate care planning based on patient/family wishes.
This poster will compare: referrals, access to services, length of stay, and transition to next level of care for 12 months pre- and post-physician acquisition.
This poster will also demonstrate the necessary modifications that occurred in the roles and responsibilities of the various disciplines within the team, in order to optimize the team's performance and productivity and sustain the growing service.
A Glimpse of Life before Passing Away
Sheba Medical Centre
Ramat Gan, Israel 52621
Michaela Bercovitch, MD
Head of Oncological Hospice “Beit Friedman”
Sheba Medical Centre
Ramat Gan, Israel 52621
009-723-530-3290
Near the end of life the patient–family–caregiver group dynamic plays an important role in the decision-making process and needs to be managed in a structured manner that has meaning for the patient, family, physician, and other caregivers.
The patient's role in the palliative care decision-making process is a critical topic. The care plans must be aimed to meet his changing needs and take into consideration his decisions, while respecting the rights, privacy, and confidentiality of our patients and families. This can be achieved only in an open communication climate that encourages the free expression of his concerns about the treatment or family matters.
Objectives:
1. The learner will learn the importance of open communication between patient, his family, and members of the team, and between team members.
2. How to coordinate the decision-making process taking in consideration the wishes of the patient and his family.
3. What can be achieved when caregiver group dynamics play the central role in the decision-making process.
Integrating Palliative Care into a Medical Oncology Practice
Spartanburg Regional Healthcare System
Spartanburg, SC 29302
Linda Harris, MPH, BSN, RN
Director Hospice and Palliative Care Programs
Spartanburg Regional Healthcare System
120 Heywood Ave., Suite 300
Spartanburg, SC 29302
864-560-3909
Brian Bell, MD
Palliative care was successfully integrated into Gibbs Cancer Center and Research Institute of Spartanburg Regional Healthcare System through the design of an innovative outpatient clinic. This Supportive Care Clinic mirrors the look and feel of the Gibbs Cancer Center, and is staffed by two nurse practitioners from the medical oncology practice. Involving two APRNs from the practice has been key to building a trusting relationship between the medical oncologists and the Supportive Care Clinic. The APRNs have been receptive to palliative care principles and philosophy, and the hope is that they will spread this information. The Supportive Care Clinic was awarded the 2013 ACCC (Association of Community Cancer Centers) Innovator Award.
Community Partners Working Together to Optimize Hospice Use
Stratis Health
Bloomington, MN 55425
Janelle Shearer, RN, MA, CPHQ
Program Manager
Stratis Health
2901 Metro Drive, Suite 400
Bloomington, MN 55425
952-853-8553
Although coverage for hospice services is available through Medicare and many private insurers, consumers significantly underuse hospice. According to Medicare data, Minnesota nationally ranks in the 3rd quartile (between the 25th and 49th percentile), which is below the national average. The Minnesota average length of stay in hospice was 56 days, compared with the national average of 70 days. The national median length of stay was 18.7 days in 2012. Many Minnesota hospice programs report that approximately 35% of hospice deaths occur within 7 days of admission.
Stratis Health, Minnesota's Quality Improvement Organization received funding for one year from the Centers for Medicare and Medicaid Services to develop and implement a special innovation project to optimize the use of hospice in three rural Minnesota communities.
A summary of the project and a review of the patient and provider resources that were developed will be the focus of this poster presentation. Practical strategies for identifying patients with serious illness who would benefit from a conversation about expectations and goals of care will be offered. Additional tips for conducting these important conversations will also be a focus of this session. All resource materials are available to physicians and the public at large.
Integrating Spirituality in Palliative Care Team Practice
Supportive Care Coalition
Hillsboro, OR 97124
Tina Picchi, MA, BCC
Executive Director
Supportive Care Coalition
18530 N.W. Cornell Rd., Suite 101
Hillsboro, OR 97124
503-216-5375
We will present the outcomes of a 9-month pilot to embed spirituality in palliative care practice within five geographically diverse Catholic hospitals, all members of the Supportive Care Coalition. Our project maximized the roles of chaplains and social workers in supporting nursing staff and physicians to provide whole person care, particularly during goals-of-care conversations. This project emphasized change management strategies to encourage new behaviors of intentional presence and listening to strengthen clinicians' awareness of the spiritual needs of their patients. Through team debriefing, interdisciplinary palliative care team members learned from one another how to better attend to the spiritual and existential suffering of patients and families. A key strategy for success was engaging mission and spiritual care leaders as sponsors for each of the clinical teams. These administrative champions monitored the projects locally and provided valuable feedback that allowed the project to adopt new strategies for learning and transforming the practice.
Compassionate Communication: A Collaborative Approach
Swedish Medical Center
Seattle, WA 98122
Janice Connolly, MD
Medical Director, Palliative Care
Swedish Medical Center
747 Broadway
Seattle, WA 98122
206-386-3170
Interprofessional One-day Training in Compassionate Communication:
Goals:
1. Develop a toolkit for compassionate communication that promotes wellness during serious illness; develop consensus with patient, loved ones, and care team members on goals of care; consideration of cultural context.
2. Raise awareness of the importance of being “conversation ready.”
3. Engage in interprofessional communication to leverage the skills of the palliative care team in order to achieve patients' goals of care.
4. Emphasize importance of self-care for caregivers.
5. Create a participatory and collaborative learning environment.
1. Members worked together to develop goals, learning objectives, activities, and logistics that would support conference goals.
2. Faculty planning meeting: learning objectives, collaboration, cohesive curriculum.
Educational methods:
1. Interactive didactic lectures.
2. Q&A during and following lectures.
3. One-hour plus simulation of family conference/discussion.
4. One-hour plus palliative care case presentation/discussion.
5. Reflection.
Adult Palliative Care Team Collaborating with Multiple Specialties Including Pediatric Palliative Care
Texas Health Harris Fort Worth Palliative Care Consult Team
Fort Worth, TX 76104
Alvin J. Mathe, DO, FACP
Assistant Professor UNTHSC
Texas Health Harris Fort Worth Palliative Care Consult Team
1301 Pennsylvania Avenue
Fort Worth, TX 76104
817-845-6919
A case presentation-based discussion of the adult palliative care consult team collaborating with maternal fetal medicine, pulmonary, infectious disease, and pediatric palliative care consult team (Wee Care) on the same patient. The patient was a 25-year-old pregnant female with cystic fibrosis and severe chest pain related to multidrug-resistant pulmonary infections. Adult palliative care helped manage her pain, constipation, and anxiety while she was on the palliative care unit, antepartum unit, labor and delivery, and ultimately, post partum unit. We worked with multiple consultants including Wee Care while the patient was on the various specialty units to manage symptoms of mother and infant pre- and postpartum. Issues regarding the use of opiates in the pregnant female and neonatal abstinence syndrome will be highlighted.
Beyond SPIKES: Key Principles to Enhance Communication
Texas Tech University Health Science Center Hospice and Palliative Medicine Fellowship
Lubbock, TX 79430
Tommie Farrell, MD
Program Director
Texas Tech University Health Science Center Hospice and Palliative Medicine Fellowship
3601 4th Street
Lubbock, TX 79430
806-743-2757
• Emotional Alignment: aligning team goals with the goals of the patient/family. This includes eliciting the goals of the patient, clarifying the basis of these goals, and showing alignment. • Transparency: sharing the ambiguity inherent in care. This includes presenting all options of care, and the variability that exists with all options. • Clarity: clarifying misconceptions and ensuring that goals and treatment plans match. This includes asking for expectations of treatment, giving accurate expected outcomes, and using language that is clear.
It's Called Collaboration: A Hospice/Hospital Joint Venture to Provide a Comprehensive Palliative Program of Excellence
The Steward Center for Palliative Care
Savannah, GA 31416
Laura N. Wiggins, MSN, APRN, BC-ANP, ACHPN
Director
The Steward Center for Palliative Care
PO Box 14549
Savannah, GA 31416
912-354-8014
The poster presentation will explain the approach, methods used, and success of how a hospice organization has partnered with a community-based health care system to provide a comprehensive palliative care program and has made a difference in the quality of life for seriously ill patients and their caregivers as well as impacting the financial sustainability of community health care providers.
Changing Culture within Your Institution to Build a More Sustainable Model of Palliative Care
Thomas Jefferson University Hospital
Philadelphia, PA 19107
Beth Wagner, MSN, CRNP, ACHPN
Nurse Practitioner Palliative Care Team
Thomas Jefferson University Hospital
11th and Walnut Street
Philadelphia, PA 19107
215-503-6339
Our palliative care program was challenged trying to meet an increased demand for palliative care services with a limited number of palliative care team members. Improving the availability and integration of palliative care services throughout the hospital requires engagement and support from multiple medical specialties and hospital administration. This session will outline specific strategies our team implemented to create a structure that integrates palliative care into various medical specialties without having to increase palliative care team staffing. We developed a palliative care taskforce that includes specialties across the hospital (oncology, neurology, cardiology, ICU, nursing, administration, social work, pastoral care, etc). The taskforce has the goal of engaging departments throughout the hospital to better integrate palliative care in their own program. Monthly meetings are held with agendas that include development of hospital-wide educational initiatives and specific department projects, quality improvement initiatives, and research endeavors. Examples of outcomes from this taskforce include the development of an annual Palliative Care Symposium, educational seminars within the department of oncology, survey of palliative care needs of physicians, policy and procedure development, family meeting documentation form, institution of grief rounds, educational initiatives within each department, successful completion of The Joint Commission certification in palliative care.
Objectives:
1. Develop a strategic plan that facilitates a change in hospital culture for better integration of palliative care services.
2. Identify strategies to better engage various medical specialties and hospital administration into the delivery model of palliative care.
3. Develop specific outcome metrics that demonstrate improved integration of palliative care throughout your hospital.
Measuring Patient and Family Satisfaction of Palliative Care Services
Thomas Jefferson University Hospital
Philadelphia, PA 19107
Beth Wagner, MSN, CRNP, ACHPN
Nurse Practitioner Palliative Care Team
Thomas Jefferson University Hospital
11th and Walnut Street
Philadelphia, PA 19107
215-503-6339
Clinical practice guidelines suggest that patients and families participate in the evaluation of palliative care services. In addition, programs seeking Joint Commission certification must select at least one patient satisfaction outcome measure as part of the performance improvement standards. This is often accomplished through use of patient/family satisfaction surveys. However, challenges in the measurement of patient/family satisfaction include low participation rates and ways to delineate satisfaction for palliative care services during hospitalization from the services of other providers. This session will address various methods used to measure patient/family satisfaction. We will also review a unique family satisfaction survey our palliative care program developed to assess the overall palliative care team's communication with the family after participating in a family meeting. A satisfaction tool was developed by our palliative care program. The use of the tool was approved by our institutional review board. Following a family meeting, the family is asked if they would be willing to participate in a family satisfaction survey. If they agree, they are contacted by a trained interviewer who completes the survey with the family via telephone call. This survey is also used as one of our performance improvement measures reported to The Joint Commission.
Objectives:
1. List benefits and challenges in the measurement of patient and family satisfaction.
2. Identify at least one measurement of patient/family satisfaction that can be implemented by their palliative care program.
3. Describe an innovative approach to measure family satisfaction by survey following family meetings.
Our hospital is a large academic medical center that has a well-established palliative care program that includes an inpatient consult team and an outpatient palliative care clinic; it is Joint Commission certified in palliative care.
Breathing Easier: Supportive and Palliative Care in COPD IPU
University of Alabama at Birmingham (UAB)
Birmingham, AL 35294
Rodney Tucker, MD
Director, UAB Center for Palliative and Supportive Care
University of Alabama at Birmingham (UAB)
1720 2nd Avenue S, CH19-219V
Birmingham, AL 35294
205-975-8197
With the advent of new payment and care delivery models such as integrated practice units (IPUs) and bundled payments, the incorporation of palliative and supportive care into the delivery model is considered a potentially key component for success.
Integration of palliative and supportive care (PSC) referrals coupled with home care and hospice coordination serve as parts of the overall delivery of COPD care for a patient population that has significant needs for enhanced care, especially as the disease progresses. With an emphasis on managing the population of patients with the diagnosis of COPD or asthma, our institution has developed and is now assuming financial risk for a portion of this population. Involvement and incorporation of PSC teams both inpatient and outpatient is a part of the model and is seeing early success in both increased referral rates to PSC, enhanced provider satisfaction, as well as better coordination of patients' care team as the disease progresses.
A broad interdisciplinary team developed the COPD IPU and bundled payment model and included experts in palliative and supportive care at the start of the process. Initial results of this project and the impact will be reviewed and available by the end of the current fiscal year.
Objectives:
1. Be introduced to the concept of disease-specific IPUs and bundled payment models.
2. Be able to describe the components of an IPU that incorporates palliative and supportive care.
3. Review the initial results of a risk pool of patients with a specific disease (COPD) enrolled in an IPU with bundled payment reimbursement.
This project is truly interdisciplinary and incorporates palliative and supportive care clinical team members working with pulmonary specialists and includes nurses and nurse practitioners at the core of the delivery model. In addition, the model incorporates home care partnership and utilizes palliative and supportive care services both in the inpatient and ambulatory settings.
PPS is Predictor of 3-Month Mortality in Hospital Patients Admitted through ED
UCONN Health
Farmington, CT 06107
Joanne Gould Kuntz, MD
Clinical Director of Palliative Care
University of Connecticut School of Medicine
263 Farmington Ave.
Farmington, CT 06107
860-679-2072
This is a prospective cohort study of 123 patients, assessing the utility of the Palliative Performance Scale (PPS) to predict 3-month mortality in patients admitted to the tertiary care hospital through the ED. PPS score was evaluated initially in the ED, and at 3 months with ongoing data collection at 6 and 12 months as well.
Standardized Approach to Family Meetings in the ICU
UCSF Fresno
Fresno, CA 93701
James Simmons, DO
Hospice and Palliative Medicine Fellow
UCSF Fresno
155 N. Fresno Street
Fresno, CA 93701
209-603-9108
The intensive care unit (ICU) is a hectic and traumatic environment for patients and their families. In many internal medicine training programs, there is no formalized education provided to the house staff on how to conduct these family meetings. Our study asked residents about their comfort in conducting ICU family meetings before and after an educational intervention. Family satisfaction was measured by phone survey. Seven residents received education and direct feedback from a palliative care specialist; seven were controls. Resident change in comfort level was analyzed using a Wilcoxon rank sum test. Family satisfaction between the intervention and control group was compared using a chi-squared test. There were no significant differences in pre/post comfort level for the resident participants. Spiritual needs were the least comfortable area for residents to address. Eighty-five family meetings were included with 46 family contacts completing the phone survey. Families in the intervention group reported increased satisfaction in understanding medical information presented to them compared with the control group (p = 0.03). In conclusion, palliative care integration is an important and emerging part of ICU care. Addressing spiritual needs is an area for resident education improvement. Our intervention resulted in better communication between families and physicians.
Using Ethics Case Presentations to Increase Awareness of Process and Outcomes
University Medical Center at Austin
Austin, TX 78701
Karen McCarthy, MSN, RN, ANP, ACHPN
Palliative Care Advanced Practice Nurse
University Medical Center at Austin
601 East 15th Street, Suite 406
Austin, TX 78701
512-324-7000 ext 71857
Selected cases are discussed that have been identified by bedside nurses, faculty, residents, or members of the palliative care team that have increased moral distress or raised ethical concerns surrounding autonomy, nonmaleficence, and beneficence. The cases have been presented in an open format with a panel from the palliative care team including physicians, chaplains, APRNs, psychologist, and various invited guests. Alternative approaches are discussed with those in the audience as well as governing principles and processes that applied to each case. Internal and external resources are also covered for future reference in order to provide stakeholders with the tools to handle these instances in the future. Comments are reviewed to assist in selection of future cases as well as to keep current with perceived audience wants and needs. Free CNE and CME are provided for those who attend.
Objectives:
1. Discuss the barriers encountered at the initiation of the project, including identification of the ethical, legal, or cultural dilemma in the case presented.
2. Discuss governing principles and processes specific to the dilemma presented, including an alternate approach to the dilemma presented as well as resources to access for future dilemmas.
3. Provide examples of the format, the use of panelists, and how to grow this type of program in the future.
This is still in progress, supported mostly by residents, case managers, and social workers. There are a few bedside RNs who attend when able and at times the faculty for the residency program attend. The goal is to expand the program or increase accessibility to the information by providing media-based webinars for interested parties to watch in their leisure time.
Palliative Care Not Just for Academic Centers
University Cancer and Blood Center
Athens, GA 30606
Karen Williams, APN-BC, ACHP
Living Well Division Director
University Cancer and Blood Center
3320 Old Jefferson Road
Athens, GA 30606
706-353-2990
This abstract will describe the establishment of a community-based multidisciplinary palliative care department embedded within a community-based hematology/oncology practice with three distinct audiences: cancer survivors, outpatient palliative care patients, (both oncology and nononcology), and inpatient palliative care patients.
Athens, Georgia, is a community with a population of 115,000. Its medical professionals serve a rural population of around 500,000 surrounding Athens. Prior to the spring of 2013 there was limited palliative care available to these patients. University Cancer and Blood Center saw this need and we established a community-based palliative care program: UCBC Living Well. There are three major components within this program: a Survivorship Clinic, an Outpatient Clinic, and an Inpatient Service within a 350-bed hospital. Each division functions with a multidisciplinary team to address and alleviate suffering of patients, as well as optimize coordination of community resources. Barriers we have encountered include perception that palliative care is synonymous with end-of-life care and availability of experienced practitioners. Evaluation data we are tracking include use of a Distress Assessment Tool over time, physician satisfaction, and tracking of quality measures within the hospital. Our future plans include a cachexia clinic for community patients, continued education of and networking with nononcology physicians, and pursuit of JAACO palliative care certification for a hospital program.
Objectives:
1. Describe challenges to community-based palliative care.
2. List five quality measures necessary to demonstrate effectiveness of a palliative care program.
3. Identify appropriate and successful marketing strategies for a program within a multispecialty medical environment.
Our inpatient program is a unique partnership between an inpatient facility and a private oncology practice that allows not only for inpatient palliative care service, but also facilitates an outpatient follow-up component.
From Bereavement to Family Support to Palliative Care
University Hospital
Newark, NJ 07101
Susanne Walther, APRN
Director Palliative Care
University Hospital
150 Bergen Street, G 345
Newark, NJ 07101
973-972-0147
Initial need was identified by both CNO and trauma surgeons for enriched bereavement services initially provided by CPE chaplaincy program for patients and families in a Level 1 trauma center, also serving as a safety net community hospital. Bereavement services were expanded with the addition of a full-time APRN with expertise in communication that evolved to a Family Support Team. The Family Support Team reached out to provide hospital-wide support for breaking bad news, goals-of-care discussions, and family meetings. The Family Support Team continued to grow, and initially with grant funding, added two masters-prepared counselors certified in thanatology. As the communication expertise and supportive services the team provided was further embraced, including a unique open model for referrals (rather than a consultation model), the result was a palliative care team with two board-certified APRNs and two counselors. The current team, which renamed itself Palliative Care/Family Support, enlists volunteer chaplains for the spiritual dimension and works hand in hand with all other specialty services including hospitalists, residents, PAs, and APRNs. Additionally, they work closely with social workers and case managers, who are assigned to each floor and are acquainted with each patient. This model has integrated palliative care into the fabric of care that all patients are eligible to receive regardless of age, diagnosis, or prognosis.
Objectives:
1. Examined evolution of unique palliative care delivery team model.
2. Identified collaboration possibilities for hospital-wide team partnership.
3. Demonstrated effective alternative referral paradigm in safety net hospital.
Innovative Strategy to Improve Patient Care at End of Life
University of Iowa Hospitals and Clinics
Iowa City, IA 52242
Deb Bohlken, MSN, RN, OCN
Advanced Practice Nurse (APN)
University of Iowa Hospitals and Clinics
200 Hawkins Drive
Iowa City, IA 52242
319-356-7827
End-of-life care is often fragmented and inconsistent, leading to poor quality of care. Educational opportunities for nurses related to improving end-of-life care are limited. The Palliative Care Team at University of Iowa Hospitals and Clinics (UIHC) recognized this deficit and committed to support improvements. In April 2013, the Palliative Care Program provided scholarships for 100 nurses to complete the online End-of-Life Nursing Education Consortium (ELNEC) Program. The content includes eight modules: nursing care at end of life, pain management, symptom management, ethical/legal issues, cultural considerations, communication, loss/grief/bereavement, and care at the time of death. Before the course, nurses completed an attitudinal survey and a knowledge-based test. After completing the ELNEC curriculum, nurses repeated the survey/test. After completion of the course, the percentage of “STRONGLY AGREE/AGREE” answers to the statement “I have a clear understanding of the philosophy and principles of palliative care that can be integrated across settings to affect quality care at end of life” rose from 35.13% to 94.64%. Since the initiation of the ELNEC Program, the HCAHPS adult inpatient scores for “Was your pain well controlled?” have shown a 13.4% increase in the percentage of “always” scores, raising the UIHC ranking for this question to the 71st percentile nationally.
General Inpatient Hospice in Acute Care: Who Is Using It?
University of Iowa Hospitals and Clinics
Iowa City, IA 52242
Marcia Wenberg, MSW
Social Work Specialist I
University of Iowa Hospitals and Clinics
200 Hawkins Drive
Iowa City, IA 52242
319-356-1616
Early Palliative Care Intervention with HSCT Patients
University of Michigan Health System
Ann Arbor, MI 48109
Patricia Lyndale, PhD
Chaplain
University of Michigan Health System
1500 E. Medical Center Drive, SPC506
Spiritual Care Department, 2A220
Ann Arbor, MI 48109
734-763-0138
The purpose of this project is to formally initiate palliative care prior to admission for hematopoietic stem cell transplant (HSCT) patients/families to improve knowledge of and access to palliative care. A practice gap existed between our practice for HSCT patients regarding palliative care and the recommended evidenced-based guidelines from the National Comprehensive Cancer Network (NCCN). The characteristics from NCCN that qualify patients for palliative care are indicative of many patients who are hospitalized for transplant.
The palliative care team facilitated two meetings for the patients: one outpatient meeting prior to admission with a focus on information and one inpatient approximately 8 days post stem cell transplant with a focus of individualizing a plan of care for the patient. A patient questionnaire was completed and an exit interview with the palliative care team was held.
A total of 25 patients completed the study. Eighty-four percent of the patients reported an increase in knowledge about palliative care. Ninety-two percent of the patients felt they had the information needed to access palliative care.
Increased knowledge of palliative care, and an improved ability to access palliative care was concluded. However, the most effective timing still has yet to be determined for HSCT patients.
“Transitional” Palliative Care in Advanced Ovarian Cancer
University of South Florida
Tampa, FL 33612
Betty J. Lackey, DO
Hospice and Palliative Medicine Fellow
University of South Florida
12901 Bruce B. Downs Blvd. MDC 19
Tampa, FL 33612
813-974-2460
We will use a case presentation to discuss the opportunities and challenges of integrating palliative care services into a patient population with advance GYN cancer.
Patients with advanced ovarian cancer are often young and receive aggressive care until very close to death. To serve these patients better, and those who care for them, we must be present to identify transitional events, initiate timely discussions of goals, and help alter the trajectory of care. We will discuss our efforts to formally integrate palliative care services into a busy GYN oncology service.
Objectives:
1. To discuss integration of palliative care services into the GYN oncology population.
2. To discuss facilitating “transitions of care” in a population with a prolonged terminal phase of illness, frequent health care encounters, and limited advance care planning.
3. To discuss the opportunities for earlier integration of palliative care services for these patients.
Drug Diversion: What Does Palliative Care Need to Know?
University of South Florida
Tampa, FL 33612
Christopher Hritz, MD
Palliative Care Fellow
University of South Florida
12901 Bruce B. Downs Blvd. MDC 19
Tampa, FL 33612
813-974-2460
Howard Tuch, MD
State regulations concerning prescription drug abuse and opioid prescribing are growing challenges for clinicians who manage severe, chronic pain. Nearly all states have implemented or are planning prescription drug monitoring programs (PDMPs) to monitor prescribing practices and help identify and prevent abuse. These programs may have an unintended effect of limiting access to needed drugs. In some state programs, patients with cancer-related pain, as well as patients in the hospice setting may be excluded from oversight. Palliative care clinicians also care for patients with chronic, nonmalignant pain. As the palliative care field expands, it is likely that patients will present earlier in their disease, and at much higher functional levels. This population will most certainly include a segment at high risk for aberrant drug use and or diversion. Understanding current prescription drug monitoring programs will be vital to safe and effective prescribing habits. This session will present an overview of various state regulatory efforts in this area, and discuss what the palliative care service “needs to know” when prescribing opioids in this age of growing regulatory oversight and understanding of the dangers of prescription drug abuse.
Objectives:
1. List common and unique state-specific traits of PDMPs throughout the United States.
2. Examine how PDMPs can help prevent diversion of opioids, as well as limit access for patients in need.
3. Explore the implications of PDMPs for hospice and palliative providers as we move “upstream” in the care of serious illness.
Developing a Service Line Approach to Palliative and Hospice Care
Vidant Medical Center/Vidant Home Health and Hospice
Greenville, NC 28734
Pamela Cowin, MSN, RN
Director of Operations
Vidant Medical Center/Vidant Home Health and Hospice
1005 WH Smith Boulevard
Greenville, NC 28734
252-229-1318
Janet Moye PhD, RN
Manager Palliative Care Services
This abstract will discuss the efforts of a large tertiary hospital in a 10-hospital system to redesign existing services into an integrated comprehensive service line approach to inpatient palliative care, inpatient hospice care, and inpatient consultation utilizing a dedicated team of palliative-hospice expert nurse practitioners and MDs.
The nurse practitioner-led palliative consult team at our 900-bed hospital has been well-established for several years. The palliative care unit is an acute care 18-bed unit in the main hospital and has undergone several transitions over the years and has been not well understood or utilized due to multiple factors. The 8-bed inpatient hospice house was built 4 years ago and had experienced an inconsistent census. The executive leadership of the health care organization sponsored a rapid cycle change work group to assess and make recommendations centered around utilization and throughput—and to better live the mission of “providing the right care, right place, right time, right cost,” After the team submitted recommendations, executive leadership endorsed a plan to redesign the three services under one umbrella. As a result, a new leadership structure was developed to fiscally and medically manage all aspects of inpatient consultation and hospice and palliative care. The nurse practitioner and MD team was expanded and roles now encompass patient consultation across the hospital and care management of patients admitted to the palliative care unit and inpatient hospice house. Extensive education continues to be provided at all levels of the organization to explain the new services and to facilitate patients and families getting the “right care, right place, right time.” Metrics being tracked will be shared with participants and early successes and findings, lessons learned, and next steps will be discussed.
Objectives:
1. Describe a comprehensive service line approach to palliative and hospice care.
2. List metrics and results used to manage program growth, outcomes (clinical and financial), and trends.
3. Describe at least three major lessons learned in developing and implementing a program redesign and paradigm shift.
The State of Inpatient Palliative Care Units: A National Survey
Virginia Commonwealth University Health System
Richmond, VA 23298
Clareen Wiencek, RN, PhD, CNP, ACHPN
Nurse Manager, Thomas Palliative Care Unit
Virginia Commonwealth University Health System
North Hospital, 1300 East Marshall St.
PO Box 985934
Richmond, VA 23298
804-628-1295
We discuss the methodology and results from a national web-based survey of nonfederal hospitals that reported a palliative care unit or palliative care program in AHA's survey and correlated with CAPC's annual registry.
The state of inpatient palliative care units as essential components of comprehensive palliative care programs has not been reported in the literature. This extensive survey was designed, pilot tested, and distributed using RedCap survey methods. Two databases, the AHA survey and CAPC's annual survey of palliative care programs, were cross-walked to develop a list of nonfederal hospitals that reported a palliative care unit or a program. Unit features will be described such as average daily census, number of beds, mortality rates, staffing ratios, administrative structures, type of patient population, and whether fixed or swing beds. Implications for business plans and sustainability will be presented.
Objectives:
1. Discuss national trends in regulatory compliance and health care reform that impact palliative care units.
2. Describe the characteristics of inpatient palliative care units in nonfederal hospitals.
3. Analyze the current state of inpatient palliative care units to determine if necessary structures are in place to support palliative care delivery.
How Advanced Illness Management in Collaboration with the IHI Conversation Project can Improve Patient Outcomes and Increase Patient Access to Palliative Care across the Continuum
VNA Care New England
Warwick, RI 02886
Therese Rochon, MS, MA, FNP, ACHPN
Director of the Advanced Illness Management Program
VNA Care New England
51 Health Lane
Warwick, RI 02886
401-465-5605
Kate Lally, MD, Director of Palliative Care for Care New England Health System
Kelly Baxter, APRN, Palliative Care Consultant for Care New England
Ruth Scott, RN, Director of Clinical Operations for VNA Care New England
This abstract will describe how a patient-centered advanced illness management (AIM) program and the IHI Conversation Project honors patients' wishes for end-of-life care, and improves patient palliative care across the care continuum.
Care New England Health System is leveraging the resources of palliative care advanced practice nurses (APRNs) and the IHI Conversation Project to develop an advanced illness management program (AIM). The goals of this program are to improve patient outcomes, increase quality end-of-life care, and provide continuity of palliative care services. Home health patients who are referred by the hospital palliative care team or identified by admission data as being at high risk for rehospitalization or eligible for hospice are referred to AIM for case conferencing. An RN trained in goals-of-care conversations attends the conference along with a homecare case manager and the director of AIM to discuss goals, symptom management, and disease trajectory. Home visits with an APRN for symptom management or an RN for ongoing goals-of-care conversations are scheduled. In addition, if an identified patient no longer has a skilled need and is planned for discharge, the APRN offers ongoing assessment with scheduled visits, PCP communication, and telephone support. Through the development of this program, we have demonstrated improved symptom management, increased documentation of patient wishes, and improved palliative care across the continuum.
Objectives:
1. Describe how the combination of an advanced illness management program and the IHI Conversation Project can improve palliative care across the continuum.
2. Describe how a home health agency can become conversation ready in order to improve documentation of patient wishes and goals of care.
3. Identify measures that can improve quality of care at end of life.
This program is an innovative way to provide homecare palliative care aligning with other strategic programs within the health system.
National Capital Region Pain Management Initiative
Walter Reed National Military Medical Center
Bethesda, MD 20889
Valencia Clay, MD
Palliative Care Physician
Walter Reed National Military Medical Center
4954 North Palmer Road
American Bldg. 19, 3rd fl., Room 3606
Bethesda, MD 20889
301-319-8126
The Joint Task Force CapMed Pain Management Initiative (PMI) at Walter Reed National Military Medical Center (WRNMMC) is a uniquely mandated regional military initiative that, in addition to integrative and alternative medicine, includes a palliative care (PC) program. Begun in May of 2014, the PC program will fully integrate into patient care at WRNMMC, and will serve as a prototype for future PC programs in the military health system.
Initial PC services include inpatient and outpatient pain, symptom management; goals-of-care and end-of-life (EOL) care discussions; representatives in support groups and committees; liaisons to community hospices; PC education to patients, family, and staff.
Future plans include a PC outpatient clinic; integration into the Murtha Cancer Center's interdisciplinary structure.
Developing novel approaches to unique circumstances at WRNMMC:
• Longer hospital length of stay (LOS). • No military hospices. • Patients' geographic distance from support system. • TriCare's simultaneous coverage of curative treatment and hospice.
PMI goals:
• Improve access to and quality of services for all beneficiaries, particularly Wounded Warriors. • Improve staff pain/symptom management competency. • Improve afterhours pain emergency response time. • Increase patient/family education and satisfaction. • Reduce hospital costs, reliance on medications, and opioid abuse/ misuse. • Improve chronic pain and PTSD treatment.
Measurable outcomes:
• Pain scores. • Code status. • Hospice referrals. • Readmissions. • Patient/family satisfaction.
Clinical and Cost Outcomes for Triggered PC Consults in the ICU: A Multihospital Study
Wayne State University School of Medicine
Detroit, MI 48326
Robert Zalenski, MD
Professor of Emergency Medicine
Wayne State University School of Medicine
6071 West Outer Drive
Lourdes, 4th Floor
Detroit, MI 48326
248-930-9808
Examine validity and impact of an intensive care unit (ICU) trigger-screen for palliative care (PC) consultation for clinical and cost outcomes across seven hospitals in three regions of the United States.
In this abstract, we will review outcomes of a study of a seven-item PC trigger-screen used at two university-affiliated and five community teaching hospitals in three cities to screen MICU patients upon admission for PC needs. PC consultation was ordered on a subset of high-risk patients, defined as the group with one or more positive screen items. Using a propensity model and a regression analysis, high-risk patients with and without PC consultation were compared for DNR conversions, hospice referrals, readmissions within 30 days, length of stay (LOS), and total direct costs.
A total of 1923 patients were admitted to MICUs during the period, of which 58.9% were screened; 38% of all patients screened were positive for PC needs. Patients who were high risk by screen and received a PC consult had much higher rates of DNR, hospice referral, and lower readmissions at 30 days. Median daily costs decreased significantly soon after the start of PC consultation, regardless of the time of consult. On multivariate regression and propensity analysis, early consultation, begun at 4 or fewer days from admission, was associated with a reduction of 2.5 days (95% CI: −3.7, −1.1) LOS and $2706 less (95% CI: −4518, −464) per admission compared with patients who did not get a PC consult. The results will be put in the context of other analyses of ICU trials of PC.
Objectives:
1. Examine the predictive value of an ICU trigger tool for PC consultation, ICU and hospital LOS, ICU-related hospital mortality, and hospice referral.
2. Understand the impact of ICU PC consultation on change in code status, hospice referral, and reduction in 30-day hospital readmission.
3. Understand how early PC consultation shortened hospital LOS and led to a reduction of $2706 in costs per case when the consult was initiated by ICU day 4 or sooner.
Interdisciplinary Collaborative Practice Intervention to Improve Pain Control for All Patients at Community Cancer Center
Yuma Regional Medical Center
Yuma, AZ 85364
Jeanne Elnadry, MD
Director of Supportive Care
Yuma Regional Medical Center
2851 S. Avenue A, Suite 2503
Yuma, AZ 85364
928-336-7159
In rural Yuma, Arizona, there are too few palliative care specialists to meet the needs of the population. To address this need, a palliative care specialist collaborated with the entire clinical staff of the community cancer center, including physicians, nurses, social worker, pharmacist, and medical assistants, to initiate a new distress screening tool and develop an interdisciplinary collaborative practice model for pain management. Hospice data showed that nearly all patients referred by the cancer center who had moderate to severe pain could have pain control within 48 hours, with a pain score of 0–3. Patients undergoing outpatient cancer treatment should be able to have similar results, but were not. Data from 274 cancer clinic patients showed that 30% of patients had concerns about pain, 30% about advance care planning and communication, and 32% about anxiety, depression, and coping. After all clinic staff reviewed the data, a pain assessment protocol was developed for nurses and medical assistants, and nurses were taught an algorithm to collaborate with physicians for pain medication orders driven by the assessment findings.
Follow-up data collection to assess the effect of the collaborative practice model intervention is planned for August 2014.