1. Organizational Strategic Plan Project Holistic End of Life Care and Palliative Respite Care Unit NURS 440 - Group 3 Marisa Gariglio, Dawn Platt, Tammy Radionoff, Nicole Rosebrock, Joella Show, and Alicia Williamson

2. Assessment of External and Internal Environment ● Internal Assessment ●Internal factors to consider include staffing, staff education, cost, equipment needed to run the unit, and approval by the hospital board. Since this service would be provided in the acute care setting, we would have to consider hospital policies and procedure. A study done by Bradley et al. (2001) found that most nurses in the acute care setting working with patients at end of life felt they had little to no training. ● External Assessment ●MidMichigan Medical Center has outpatient hospice services available, but there are no inpatient hospice or palliative care unit services available within a 10 mile radius. A need exists for inpatient palliative care services in the Midland area. With the introduction of the Holistic End of Life Care and Palliative Respite Care Unit (PRCU), care in an inpatient setting can be provided to community members in need.

3. Holistic End of Life Care and Palliative Respite Care Unit ●Comfort and Compassion ○Open 24-Hours per Day & 7 Days per Week ○6 large private rooms ○Patient and Family Centered Education ○Pastoral care available ■All Religious and Cultural Needs will be cared for. ●Choice ○Patients wishes respected. ○All life shortening diagnoses accepted ●Efficiency ○Rapid assessment of patient specific needs ○Rapid palliative relief of pain symptoms ●Excellence ○Staffed by nurses specially trained in palliative care ●Quality Care and Safety ○Excellent reviews

4. Cost Savings Partnership with Medical - Oncology Unit o Shares Manager, Secretary, Social Worker, Case Manager, etc. o Shares Registered Nurses - Specially Trained in Palliative Care o Shares Patient Care Technicians o Shares Supplies o Shares Unit  Quiet and Newly Renovated Area on Shared Unit

5. Mission Statement To provide compassionate and holistic palliative care to a patient and their family during his/her life’s end.

6. Philosophy The philosophy of the Holistic End of Life and Palliative Respite Care Unit (PRCU) is based on the importance of including one’s family in the end of life process and in providing rapid assessment and care to the dying, rather than cause them undue suffering.

7. We believe: ●In educating the patient and their family regarding comfort measures and patient care. ●It is of utmost importance that the patient and family understand the end of life process. ●That no person should ever die alone, regardless of what service they qualify for. ●In patient-centered care that meets the physical, psychological, and spiritual needs of the patient and his or her family. ●It is important to be culturally competent in order to meet religious and cultural needs of our patients and their families. ●Each patient has the right to make decisions regarding issues affecting the quality of life during his or her end of life experience, including pain control and subsequent level of awareness. ●Physician assisted suicide is not an acceptable choice. ●In access to an interdisciplinary team of individuals which include, but are not limited to registered nurses, advanced practitioners, patient care technicians, and respiratory therapists. ●In confidentiality. ●In maintaining evidence-based practice throughout the palliative care team. ●Carefully managing resources on the PRCU. (Alberta Health Services, 2009)

8. Organizational Goals Identify the patient’s concerns, regrets, and wishes (use the Five Wishes Form) concerning who and what should be involved in his or her care (Aging with Dignity, 2011). Formulate a plan of care that mimics the patient’s wishes including any involvement with family and friends. Verify with the patient and family that the patient is not experiencing pain, anxiety, or shortness of breath. ●Offer spiritual and social support and provide such support within one hour of request. Help the patient and family know what to expect during a patient’s last days/hours of life. Provide a list of qualifying diagnoses and symptoms that would qualify patients for holistic end-of-life and palliative respite care to the entire hospital.

9. Organizational Objectives To open a Holistic End-of-Life Care and Palliative Respite Care unit (PRCU) at Mid-Michigan Medical Center in Midland, Michigan by January, 2014. To establish protocols for end-of-life and palliative care by a committee of doctors, nurses, legal expert, social worker, spiritual advisor, and other experts at least one month before the palliative care unit opens. To establish an end-of-life support group for patients and/or families within six months. To meet The Joint Commission Palliative Care Unit certification requirements by January 2015.

10. Organizational Chart

11. Positions Needed 4 Full Time Registered Nurses Trained in Palliative Care 2 for Day Shift 2 for Night Shift 2 Patient Care Technicians 1 for Day Shift 1 for Night Shift

12. Job Description - RN Palliative Care Registered Nurse The nurse employed to be a member of the holistic end of life and palliative respite care team will have successfully completed specialized training for end of life care and will be at the BSN graduate level within 2 years of hire. He or she will provide comprehensive, compassionate, and holistic end of life care. Provision of physical, psychological, spiritual and social support to the patient and the patient’s family ensuring comfort, understanding, and peace. The palliative care nurse will rapidly assess patients newly admitted to the unit (within one hour of admission) and obtain orders and initiate protocols within two hours of admission.

13. Job Description - PCT Patient Care Technician The patient-care-technician (PCT) is a member who is a state certified nursing assistant and who has specialized end-of-life care training. He or she will provide direct and holistic care to any patient admitted to the PRCU. This care will be provided in an expeditious manner with compassion and understanding. The PCT performs daily self-care tasks for the patient when he or she is no longer able to do them. These tasks include daily bathing, dressing, toileting, eating, and other duties as needed. The PCT will report to the nurse regarding any difficulties the patient is having or appears to be in pain.

14. Job Advertisement Seeking: Palliative Care Registered Nurse Palliative Care Registered Nurse · Night shift and day shift positions available · 36 hours per pay period and every other weekend · One year RN experience, BSN preferred and encouraged. · Palliative care experience and certification required. The nurse employed to be a member of the holistic end of life and palliative respite care team will have successfully completed specialized training for end of life care; must be friendly, confident, calm, and have great organizational skills; have excellent communication skills and be willing to work as part of a local and community-wide health care team. A collegial attitude with lifelong learning is a must. The palliative care nurse is required to take part in a monthly bereavement support group. He or she will agree to follow all policies and procedures as well as the mission and philosophy of MidMichigan Medical Center. This nurse will be required to keep up to date on the American Nursing Association’s Scope and Standards of Practice. If you are interested in this amazing position, please see Human Resources 4000 Wellness Drive Midland, Michigan 48670 Phone (989) 839-3230

15. Advertising Midland Daily News o Recruitment ads from print appear on monster.com at a rate of $65 for 7 days or $90 for 30 days (Midland Daily News, 2013). We could run a 17 line ad with graphics listed for one Sunday in the Midland Daily News and for 30 days on monster.com for a package deal of $139 dollars (J. Bromley, personal communication, November 11, 2013). MidMichigan.org Job Opportunities - Free Listing on MidMichigan Health Website

16. Budget Proposal Potential revenue= Based on 6 patient census, average pay per patient $225/ 365 days/year = $492,750 Estimated cost for 1 year: $632,378 Estimated revenue for 1 year: $492,750 Deficit = $139,628 The PRCU institutes cost saving measures such as cross training existing staff and utilizing staff members who are current employees. Fundraisers and donations from area businesses including Dow Chemical will help to soften the deficit.

17. Budget Proposal (cont.) Project RoleSalary%FTEFringe %Total fringe benefits Salary/Benefits RN$50,000100%16%$8,000$58,000 RN$50,000100%16%$8,000$58,000 RN$50,000100%16%$8,000$58,000 RN$50,000100%16%$8,000$58,000 PCT$27,000100%30%$8,000$35,000 PCT$27,000100%30%$8,000$35,000 Training cost $35/employee X 6 =$210 Advertising cost $1668/year Cost per patient per day $150 = $328,500 annual Total Cost $632,378.00

18. Reimbursement Government o Medicaid o Medicare  “Medicare beneficiaries make up 80% of those who die in the United States” (Raphael, Ahrens & Fowler, 2001. p. 1). Private Insurance o Private healthcare insurance covers about thirty percent of the population and is the second largest source of healthcare financing (Kiil, 2012) (Yoder-Wise, 2011). o The MidMichigan Health Website has a List of Accepted Private Insurances Donation o Dow Chemical Fundraisers

19. References Aging with Dignity. (2011). Five wishes. Retrieved from http://www.agingwithdignity.org/forms/5wishes.pdf Alberta Health Services (AHS). (2009). Regional palliative care program vision, mission, philosophy and goals. Retrieve from http://www.palliative.org/newpc/_pdfs/_pdf_general/1A%202%20%20Mission%20Vision%20Philosophy%20%20Goals.pdf Bradley et al. (2001).Nurses’ use of palliative care practices in the acute care setting. Journal of Professional Nursing, 17(1), 14-22. Kiil, A. (2012). What characterizes the privately insured in universal health care systems? A review of the empirical evidence. Health Policy and Eudcation,106, 60-75. Retrieved from: http://0-www.sciencedirect.com.libcat.ferris.edu/science/article/pii/S0168851012000656 Midland Daily News. (2013). Classifieds. Retrieved from http://www.ourmidland.com/contact/marketing/advertising/classifieds/ MidMichigan Health (MMH). (2013). Job opportunities: Nursing and health care jobs in Michigan. Retrieved from http://www.midmichigan.org/careers/JobOpportunities/ Raphael, C., Ahrens, J., & Fowler, N. (2001). Financing end of life care in the USA. Journal of the Royal Society of Medicine 94 pp. 458-461 Yoder-Wise, P. S. (2011). Leading and managing in nursing (5th ed., pp. 146, 614). St. Louis, MO: Elsevier.