3One Conversation Can Make All the Difference Consider the facts90% 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 discussionSource: 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 wishesSource: Survey of Californians by the California HealthCare Foundation (2012)70% of people say they prefer to die at home70% die in a hospital, nursing home, or long-term-care facilitySource: 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 care7% report having had an end-of-life conversation with their doctorOne Conversation Can Make All the Difference
4Imagine a world where early advance care planning is normal. Where people routinely identify a health care agentAnd 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.
5Are 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 doctorHow 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?
6Core PrinciplesEngage with our patients and families to understand what matters most to them at the end of lifeSteward this information as reliably as we do allergy informationRespect people’s wishes for care at the end of life by partnering to develop shared goals of careExemplify this work in our own lives so that we understand the benefits and challengesConnect in a manner that is culturally and individually respectful of each patient
8St. Luke’s Home Engagement with the Conversation Ready Project
9First step was to evaluate how we are currently discussing advance care planning and end of life wishes with our residents and new admissions.
10Prior to Conversation Ready Few conversation regarding advance care planning took place until 14 days from admission and it was social worker onlyMOLST forms were not completed at time of admission, completed by day 14The environment surrounding the meeting was not conduciveLack of staff education
11Since introduction of the Conversation Ready Project All staff were educated on Palliative care-weekly webinars were conductedMedical staff, nursing and social work meet with familyMOLST forms are started on admission and conversation regarding wishes and goals of their health care continue without stay
12Re-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
15Where do we go from here Data collection E-MOLST Continue with education for all staff membersNationally certify C.N.A., LPN’s and RN’s
16Emphasis to staffNot to lose sight that we abide by the wishes of our residents for what they want in medically, spiritually and culturally.
17Steward this information as reliably as we do allergy information
18Stewardship Issues Identified Advance Directives were completed but not available in the current chart.Redundant processes lead to conflicting informationElectronic storage of information was not easily accessible by the clinicians caring for the patient.
19Lack 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 %
20Redundant 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.
21Electronic 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.