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Improving End-of-Life Care:Eating the ElephantOne Bite at a Time
July 19, 2018
WELCOME AND REMINDERS
▪ Welcome!
▪ Q & As at end of presentations
▪ Use chat for questions and comments
▪ Slides and recording will be available on the GPQIN website in 7-10 days
▪ http://greatplainsqin.org
Sally May, RN, BSN, CH-GCNSenior Quality Improvement Specialist
Quality Health Associates of North Dakota
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OBJECTIVES
▪ Evaluate the current status of end-of-life care within their organization and across their community.
▪ Outline strategies for engaging patients and families in conversations about end-of-life care.
▪ Identify resources for improving end-of-life care.
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CEU FOR NURSES: 1.5 CONTACT HOURS
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For individual attendees:▪ You will be redirected to the required evaluation when you
close out of this webinar
▪ Certificate will be emailed in 3-5 business days to individuals completing the evaluation
For multiple attendees: ▪ An email with a link to the required evaluation and
instructions to forward the email to fellow attendees will be sent to all individuals who logged into this webinar
▪ Certificate will be emailed in 3-5 business days to individuals completing the evaluation [email address is required]
OBJECTIVE 1: Evaluate current status of end-of-life care within their organization and across their community
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OBJECTIVE 2: Outline strategies for engaging patients and families in conversations about end-of-life care.
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END-OF-LIFE: THE ALLERGY ANALOGY
Imagine that an 80-year-old woman with a known medication allergy comes to your clinic or facility for care but . . .
NOW
Imagine that same 80-year-old woman with severe COPD with frequent encounters with your health system and has no health care directive . . .McCutcheon Adams K, Kabcenell A, Little K, Sokol-Hessner L. “Conversation Ready”: A Framework for Improving End-of-Life Care. IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2015. (Available at ihi.org)
END-OF-LIFE: AMERICAN ATTITUDES
▪ 52% of adults said that they would want treatment stopped so they could die if they had an incurable disease and suffering great deal of pain
▪ 35% would fight for life no matter what
▪ 37% of adults said that had given considerable thought
▪ 27% of adults said that they had not given much or no thought about medical treatment at the end of their lives
Is it enough to “check the box”?
Huff Post. American Attitudes Towards Death: 12 Facts From New Pew Research Center Survey. https://www.huffingtonpost.com/2013/11/21/death-america-pew-research_n_4312321.html. [National sample: Phone interview of 1,994 adults 18 years or older, living in all 50 states.] Accessed July 12, 2018
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ADVANCE DIRECTIVES: THE CONFUSION
▪ The document• Durable power of attorney for health care• Living will• Advance directive • Health care directive
▪ The healthcare proxy• Healthcare power of attorney• Power of attorney for healthcare• Surrogate• Health care agent • “any title”
▪ POLST – MOLST – NETO (Nebraska Emergency Treatment Orders)
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FRAMEWORK FOR IMPROVING
END-OF-LIFE CARE: ENGAGE
Engage with patients and families to understand what matters most to them at the end of life.
McCutcheon Adams K, Kabcenell A, Little K, Sokol-Hessner L. “Conversation Ready”: A Framework for Improving End-of-Life Care. IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2015. (Available at ihi.org)
Advance Care Planning – Group Visits
VA Community Based Outpatient Clinic
Grand Forks, NDFargo VA
Health Care System
ACP-GV at: Grand Forks CBOP
Contact:
Jacqueline Ann Adams-Hove
Advance Care Planning
Coordinator
Fargo VA HCS
701-239-3700 ext. 4166
Implementation Accomplishments
• Advance care planning group visits (ACP-GV)
– Increased visibility within the facility and catchment
area by holding an open ACP-GV every day at the same time and same location.
– Made available to community-based outpatient clinics
(CBOC) using video/conferencing
• Focus areas – increase attendance and participation by utilizing Tele health
• Marketing and outreach
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Marketing and Outreach
DATE DOCUMENT T YPE/STATUS 15
Attend an ACP- GV and get a tote bag:
Do you have a plan? Start a conversation today!
Complete an advance directive and get a coffee mug:
I completed my Advance directive at My VA
with contact information.
Implementation Goals
• Meet the sustainment goals by offering a consistent time and location each day for the Advance Care Planning Group Visit.
• In FY18 we hope to increase awareness of Advance Directives by increasing the number of conversations being held in all areas of our facility.
• We emphasize there is no right or wrong – it is all about personal goals, preferences and values.
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Framework for Improving End-of-Life Care
Steward information about each patient’s end-of-life care wishes as reliably as we do allergy information.
McCutcheon Adams K, Kabcenell A, Little K, Sokol-Hessner L. “Conversation Ready”: A Framework for Improving End-of-Life Care. IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2015. (Available at ihi.org)
Dawn Hummel, RN, CDON/LTC, C-NE –
Senior Executive of Resident Care,
Skilled Operations
at Bethany Retirement Living
I have been with Bethany Retirement Living for 15
years and value the opportunity I have to enrich the
lives of our residents.
Advanced Care Planning
www.bethanynd.org
Contact InformationPhone: 701.478.8908
Email: [email protected]
Advanced Care Planning
www.bethanynd.org
Advanced Care Planning
www.bethanynd.org
Framework for Improving End-of-Life Care
Respect people’s wishes for care at the end-of-life by partnering to develop a patient-centered plan of care.
McCutcheon Adams K, Kabcenell A, Little K, Sokol-Hessner L. “Conversation Ready”: A Framework for Improving End-of-Life Care. IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2015. (Available at ihi.org)
Vibra Hospital
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Bonnie Vangerud RN, MSN CCRN-K Chief Clinical Officer P: [email protected]
Julie Loebrick RN, BSN, PCCNClinical Supervisor and Educator P: [email protected]
5225 23rd Ave. South – 7th FloorFargo, ND 58104
Framework for Improving End-of-Life Care
Exemplify the work in our own lives so that we fully understand the benefits and challenges, i.e. “walk the talk”.
McCutcheon Adams K, Kabcenell A, Little K, Sokol-Hessner L. “Conversation Ready”: A Framework for Improving End-of-Life Care. IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2015. (Available at ihi.org)
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Contact Information
▪ (P)701-757-2100 ext.2312
▪ (e)[email protected]
▪ (F)701-757-0305
▪ http://valleychc.org
Personal Story: Life and Death Used to Seem Very Simple to Me
https://greatplainsqin.org/blog/life-and-death-used-to-seem-very-simple-to-me/
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Kayla Hochstetler MSW, LCSW
Framework for Improving End-of-Life Care
Connect in a manner that is culturally and individually respectful.
McCutcheon Adams K, Kabcenell A, Little K, Sokol-Hessner L. “Conversation Ready”: A Framework for Improving End-of-Life Care. IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2015. (Available at ihi.org)
WakankiEwastepikteCARE FOR OUR ELDERS
MARY ISAACSON, PHD, RN, CHPN®
Contact InformationPhone: 605.367.8308Email: [email protected]
The JourneyEvidence from previous work
-“We need to have these discussions.”
-“It needs to be real simple, a brochure or something.”
The Team
The Hurdles
Isaacson. M.J. (2017). Wakanki ewastepikte: An advance directive education project with American Indian elders. Journal of Hospice and Palliative Nursing, 19(6), 580-587. doi: 10.1097/NJH.0000000000000392.https://openprairie.sdstate.edu/con_pubs/58/
Conclusion
“I will always have Tunkashila with me.
That’s all I need. When I die, I don’t want nobody fighting or nothing, you
know, because everything is already
taken care of.”
FRAMEWORK FOR IMPROVING END-OF-LIFE
CARE: FIVE CONVERSATION READY PRINCIPLES
Getting started
▪ % of individuals with an advance directive
▪ Understand current process
▪ Set an aim
▪ Identify a subpopulation
McCutcheon Adams K, Kabcenell A, Little K, Sokol-Hessner L. “Conversation Ready”: A Framework for Improving End-of-Life Care. IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2015. (Available at ihi.org)
OBJECTIVE 3: Identify resources for improving end-of-life care.
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How to Get Involved
CEU FOR NURSES: 1.5 CONTACT HOURS
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For individual attendees:▪ You will be redirected to the required evaluation when you
close out of this webinar
▪ Certificate will be emailed in 3-5 business days to individuals completing the evaluation
For multiple attendees: ▪ An email with a link to the required evaluation and
instructions to forward the email to fellow attendees will be sent to all individuals who logged into this webinar
▪ Certificate will be emailed in 3-5 business days to individuals completing the evaluation [email address is required]
Care Coordination State LeadContact Information
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Beth Nech, MAProject [email protected]
Kansas Foundation for Medical Care800 SW Jackson St, Ste 700Topeka, KS 66612
P: 785.271.4120
Paula Sitzman, RN, BSNQuality Improvement [email protected]
Tammy Baumann RN, [email protected] of Nebraska1200 Libra Drive, Suite 102Lincoln, Nebraska 68512P: 402.476.1399, Ext. 512
Sally May, RN, BSN, CH-GCNSenior Quality Improvement Specialist [email protected]
Jayme Steig, , PharmD, RPhQuality Improvement [email protected] Health Associates of North Dakota3520 North BroadwayMinot, ND 58703P: 701.989.6220
Linda Penisten, RN, OTR/LProgram [email protected] Dakota Foundation for Medical Care2600 West 49th Street, Suite 300Sioux Falls, SD 57105P: 605-444-4124
This material was prepared by the Great Plains Quality Innovation Network, the Medicare Quality Improvement Organization for Kansas, Nebraska, North
Dakota and South Dakota, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human
Services. The contents presented do not necessarily reflect CMS policy. 11S0W-GPQIN-ND-C3-204/0718
