1. Becoming Conversation Ready
Kevin Mathews MD, FAAFP
Director, Palliative Medicine Service
Jeanne Tracy RN, BSN
Director of Nursing/Quality Improvement
St Luke’s Home.
Evelyn Kropp, RN, BPS, CPHQ
Palliative Medicine Navigator

3. One Conversation Can Make All the Difference
Consider the facts
90% of the people think it’s important to talk about their loved ones’
and their own wishes for end-of-life care.
30% of people have had the discussion
Source: National Survey by The Conversation Project 2013.
60% of people say that making sure their family is not burdened by tough decisions is “extremely important”
56% have not communicated their end-of-life wishes
Source: Survey of Californians by the California HealthCare Foundation (2012)
70% of people say they prefer to die at home
70% die in a hospital, nursing home, or long-term-care facility
Source: Centers for Disease Control (2005)
80% of people say that if seriously ill, they would want to talk to their doctor about end-of-life care
7% report having had an end-of-life conversation with their doctor
One Conversation Can Make All the Difference

4. Imagine a world where early advance care planning is normal.
Where people routinely identify a health care agent
And provide guidance to their agent, family and healthcare providers regarding their wishes if faced with a catastrophic Illness.
According to the new IOM report,”Dying In America” that should be a primary goal of the health system in the US.

5. Are We Ready?
80% of people say that if seriously ill, they would want to talk to their doctor about end-of-life care, 7% report having had the conversation with their doctor
How often do we ask ourselves-why are we doing this?
How often do we say-”That will never be me!”
Are we ready for a patient population eager to discuss end of life care?

6. Core Principles
Engage with our patients and families to understand what matters most to them at the end of life
Steward this information as reliably as we do allergy information
Respect people’s wishes for care at the end of life by partnering to develop shared goals of care
Exemplify this work in our own lives so that we understand the benefits and challenges
Connect in a manner that is culturally and individually respectful of each patient

8. St. Luke’s Home Engagement with the Conversation Ready Project

9. First step was to evaluate how we are currently discussing advance care planning and end of life wishes with our residents and new admissions.

10. Prior to Conversation Ready
Few conversation regarding advance care planning took place until 14 days from admission and it was social worker only
MOLST forms were not completed at time of admission, completed by day 14
The environment surrounding the meeting was not conducive
Lack of staff education

11. Since introduction of the Conversation Ready Project
All staff were educated on Palliative care-weekly webinars were conducted
Medical staff, nursing and social work meet with family
MOLST forms are started on admission and conversation regarding wishes and goals of their health care continue without stay

12. Re-development of our palliative care program
Residents on the palliative care program are on our 24 hour report sheet and the IDCP team discuss the plan of care daily

13. Environment for the conversation prior

14. Our new meeting room

15. Where do we go from here Data collection E-MOLST
Continue with education for all staff members
Nationally certify C.N.A., LPN’s and RN’s

16. Emphasis to staff
Not to lose sight that we abide by the wishes of our residents for what they want in medically, spiritually and culturally.

17. Steward this information as reliably as we do allergy information

18. Stewardship Issues Identified
Advance Directives were completed but not available in the current chart.
Redundant processes lead to conflicting information
Electronic storage of information was not easily accessible by the clinicians caring for the patient.

19. Lack of forms in the chart
Unit Secretaries were given access to the scanned records and taught how to go in and print previous copies. This increased the rate of having an actual HCP form in the chart from 9 to 28 %

20. Redundant processes lead to conflicting information
Patients were asked at registration and on the unit for information regarding their Advance Directives.
20% of the time there was a disagreement between what the patient was saying and what reality was.
Inpatients will only be asked by a nurse.

21. Electronic storage of information was not easily accessible by the clinicians caring for the patient
Stored in a obscure section of the EMR.
Now is stored in the Adult Patient Profile and the information is readily accessible in the electronic kardex and other “snapshot” views.
ADT system could only store 1 relationship- ie HCP or daughter, but not both. Clinical information stores both.

23. Past Conversations

24. Current Conversations

25. Future Conversation

26. Who Controls OUR Conversation?