1. 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

2. 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)

3. Setting Your Sail Safe Inpatient Death By Locations MetricsFY05FY06FY07FY08FY09FY10 Total inpatient deaths182191177151158160 Percent in ICU39%41%26%33%32%37% Percent in acute + other25%22%32%25% 17% All acute care locations64%63%58% 57%54% Percent in NHCU11%9%8%5%3%2% Percent in hospice (TS96)25%28%34%37%40%44% All extended care locations36%37%42% 43%46%

4. 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?

5. 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)

6. 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

7. 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

8. 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

9. Setting Your Sail Safe Clinical Encounters  Anticipatory 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

10. 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

11. Setting Your Sail Safe Face-to-face Encounters Number of admission Family contact % family member contacted Anticipatory grief therapy Bereavement therapy FY 09 Q4 311135%72 FY 10 Q1-3 6644* 81%174 * 4 Veterans did not provide consent, 2 Veterans had no family

12. 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

13. Setting Your Sail Safe HPC database - recording

14. Setting Your Sail Safe HPC database - recording

15. Setting Your Sail Safe HPC database - worksheet

16. Setting Your Sail Safe Thank you!