Setting Your Sail Safe

Bereavement Care Initiative

Khin Zaw, MD, Phillip Binnie, D Min, Raegan Radenheimer, Psy D

Hospice and Palliative Care Program, Miami VA Healthcare System

Setting Your Sail Safe Why we did this?• Pre-intervention (FY08Q4 – FY09Q3)

• Bereaved Family Survey– Emotional support after the veteran’s death 45%

(n = 68)

• Chart Review Items– Bereavement support contact 23% (n = 161)

Setting Your Sail Safe Inpatient Death By Locations

Metrics FY05 FY06 FY07 FY08 FY09 FY10

Total inpatient deaths 182 191 177 151 158 160

Percent in ICU 39% 41% 26% 33% 32% 37%

Percent in acute + other 25% 22% 32% 25% 25% 17%

All acute care locations 64% 63% 58% 58% 57% 54%

Percent in NHCU 11% 9% 8% 5% 3% 2%

Percent in hospice (TS96) 25% 28% 34% 37% 40% 44%

All extended care locations 36% 37% 42% 42% 43% 46%

Setting Your Sail Safe Teaming and Strategizing

• Target – all inpatient deaths

• Team forming – chaplain, psychology, PCCT coordinator, and decedent affairs

• Strategy – consistency, backup, record keeping, communication

• How we did it?

Setting Your Sail Safe Goals of Bereavement Initiative

Enhance our Bereavement Support (i.e. condolence/bereavement calls & mailing)

Establish a structured Bereavement Clinical Services (i.e. improving delivery of direct clinical care, anticipatory grief care)

Setting Your Sail Safe Bereavement Care Interventions

• Telephone support:– Condolence calls– Bereavement calls

• Mailings– Condolence card and bereavement packages

• Clinical encounters– Anticipatory grief assessment– Individual and group counseling

Setting Your Sail Safe Telephone Support

• Condolence calls: 2-14 days after death (Chaplain service)– In-hospital (88%) and hospice (92%) completion

• Bereavement calls: 1 month after death and follow up calls as necessary (Psychology service)– In-hospital (83%) and hospice (85%) completion

Setting Your Sail Safe Mailings

• Condolence cards: Individualized cards signed by PCCT and mailed out

• Bereavement packages: Comprised of condolence letter, psychoeducation, and

resources Inpatient Hospice –Mailing completed at the 1st, 3rd, 6th,

9th, & 12th month anniversary of death Non-hospice patient/family out of state – 1 month

mailing

Setting Your Sail Safe Clinical EncountersAnticipatory grief assessment: Chaplain and

Psychology services collaborated to meet with family members of all veterans admitted for inpatient hospice services.

Template was created and utilized to document these encounters in CPRS.

Grief and spiritual counseling is offered to all family members before and after death of veterans

Setting Your Sail Safe Interventions by Chaplaincy

• From Faith-based to “unit-based” coverage

• Assigned each chaplain to clinical areas

• Focus attention to “unit of care”

• Improve communication with medical staff regarding the prognosis

Setting Your Sail Safe Face-to-face Encounters

Number of admission

Family contact

% family member contacted

Anticipatory grief therapy

Bereavement therapy

FY 09 Q4 31 11 35% 7 2

FY 10 Q1-3 66 44 * 81% 17 4

* 4 Veterans did not provide consent, 2 Veterans had no family

Setting Your Sail Safe Future Plans

• Collaborative efforts by chaplain & psychology services to implement the following group therapy:– Bereavement Support Group: Closed group

providing psychoeducation and support to bereaved family members

– Anticipatory Grief Support Group: Open group for emotional support and processing

• HPC database recording and reporting

Setting Your Sail SafeHPC database - recording

Setting Your Sail SafeHPC database - recording

Setting Your Sail SafeHPC database - worksheet

Setting Your Sail Safe

Thank you!