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Never AlonePerinatal Palliative Care Program

Eileen Ludden, BSN, RNC –OB C-EFMDirector Labor and Delivery

Nancy Wood, BSN, RNC-OB, C-EFM , CDEDirector High Risk Perinatal Center

Holy Cross HospitalSilver Spring, Maryland, 20910

Mission

To be the most trusted healthcare provider in the area

To serve patients and their families who elect to carry a pregnancy to delivery in which a poor outcome is expected

Prenatal Diagnosis

Exists when a pregnant woman is determined to have a life-threatening or serious illness or when her unborn fetus is anticipated to be born with a life-limiting birth defect that will likely result in a neonatal death.

Birth Defects

In the U.S. up to 20,000 infants are born annually with conditions that are considered incompatible with life beyond the first year

In the State of Maryland 1 in 6 births result in a birth defect

What is Palliative Care?

Model of care that is holistic and extensive specifically for a patient who is not expected to “get better”

Planned intervention by trained interdisciplinary staff members who support the family and deliver care in an empathetic and sensitive manner

Goal is to prevent and relieve physical pain and suffering of the patient and to improve the conditions of living and dying

Focus is on the family as a unit, on preserving the dignity of life and helping to memorialize whatever brief time they may have together

A team approach to alleviate physical, psychological, social, emotional, and spiritual suffering

Potential vs. Actual Referrals

Of the forty patients in FY10 who were potential referrals to this program, zero referrals were received

Problem Statement

Patients with a prenatal diagnosis, medical staff, nursing staff and the community were not aware of the Perinatal Palliative Care Program

Goal

To educate the medical and nursing staff and community about the existence of the Never Alone Perinatal Palliative Care Program

Why does this matter?

With advanced planning, patient’s wishes for their delivery and the care of their baby are addressed

Decreases stress on the patient, family, and staff

Staff is better able to support the family when there is a plan of care

Process Metrics & Baseline Measures

Number of referrals Pre & post implementation knowledge

surveys Zero referrals in Fiscal Year 2010 A pre-implementation survey of the medical

and nursing staff indicated only 33% had any knowledge of the existing Perinatal Palliative Care Program

Pre-Implementation KnowledgeSurvey – December 2010

Are you aware of the Perinatal Palliative Care Program?

33%

67% Yes

No

Identified Problems

Knowledge deficit No single phone number to call to

enter patient into program No intake sheet to get information

regarding patient’s diagnosis No marketing of the program

Action Plan

After survey results were reviewed, education opportunities were provided

OB/GYN Dept. Meeting Staff Meetings Fact sheet for physician offices Brochure for patients and physician offices Community Outreach-Isaiah’s Promise and

Archdiocese of Washington, DC

Summary of Improvement

Identity of the program occurred through name recognition

Education-staff meetings & department meetings Development & Implementation

Patient brochure Fact sheet for the physicians Intake Information Sheet A sample birth plan

Re-educate on the Perinatal Alerts Binder Community Outreach-Isaiah’s Promise, Archdiocese of

Washington, DC

Post Implementation Survey

Are you aware of the Never Alone Perinatal Palliative Care Program?

82%18% Yes

No

The Never Alone Program is not about Finances

Revenue to HCH for a routine Mother Baby stay of 2-3 days averages $5,000 for the mother and $1,000 for the baby Revenue for a NICU 5 day stay averages $8,800 “Revenue” or potential benefit to the patient who has the support of the Never Alone program is PRICELESS!!!

Families will partner with us for their future health care needs and may refer others to us because of the care and support that they received

Challenges

Large number of physician groups and multidisciplinary staff to educate about program

Communication of patient’s plan of care to their physician, neonatology and nursing departments

Program Identity

Change Management

Marketing-competing agendas with other areas of the hospital and the new hospital

Develop relationships with other departments and the community

It is not easy!!! Make sure you communicate effectively

Lessons Learned

Communication is vital to the success of any program

Increased knowledge base in regards to the development of a brochure

Importance of “branding” and name recognition

Be prepared for the plan of care to change

Miles EmmanuelApril 23, 2011- April 24, 2011

But Jesus called them to him, saying,“Let the children come to me, and do not

hinder them, for to such belongs the kingdom of

God.” –Luke 18:16