Challenges health systems face in accessing AD documents, providing training, and communicating with patients and families
Vidant Health Footprint 2
Vidant Health Framework Vidant Health End of Life Care Advance Care Health Care Systems Planning Ready, Able and Reliably Act Upon Patient Plan for Future Preferences Health Care Decisions Best Practice End of Life Care Every adult with an Advance Directive Be honest to enable informed choices Know what matters to our patients Honor and act upon their preferences 3
Vidant Health 2019 Work Plan Integrate & Community Team Member Experience ACP Systems Analytics Transform Advocacy ACP Outreach Education Care • ACP events in • Secure and • Increase • EHR ACP • Drill down • We’re • State & faith, launch team Navigator & capability of Listening National community, provider member Visits – Advance innovations leadership & worksites, curriculum participation Refine, drive Directive collaboration • Increase ACP hospitals, in HELLO uptake, audit Metric : TCC Board, • ACP in in service clinics documentati NCHA, Essentials for • Explore No • Team lines on & NCPCC, • 3 Campaigns: Excellence One Dies Member ACP • Support reimburseme NCIOM Conversation Module Alone and Measure via Palliative nt Palliative Sabbath, Death Doula CIN • Increase Care Care Task NHCDD, Programs • MyChart team • Establish EOL development Force, Dying to revisions members • Monitor Scorecard for regional Premier, Know trained in experience • Document hospitals and Respecting • Marketing ELNEC & surveys, indexing outpatient Choices enhancemen Respecting complaints & workflow • Develop EOL Advisory ts: web Choices grievances audit strategies for • Legislative content, for • Serve as • Complete population Agenda videos, event opportunitie regional EOL/ACP health referral s and training Policy Review • Collaborative workflow & celebrations center and s to improve marketing faculty transitions and portability of MOST/DNR 4
Community engagement Advance Care Planning Outreach Past 3 Years: 850 Events- 15,537 Participation- 1000 AD Scanned in Community FY 2018: 347 Events 10,578 Participation 281 AD Scanned in Community $300K Community Benefit Where Engaging they Community Consumers in live, & Senior Worksites Churches Centers Advance Care work, Planning & pray Completion of Where Advance they Wellness Practices Hospitals Centers Directives receive care 5
Desired state 1. MD/Provider Introduces ACP Completed AD’s are 6. When ready, made part of EHR 2. patients are Multidisciplinary provided team member assistance in continues completing their discussion AD documents Patient & Provided Toolkit Family 5. Patient 3. Patient provided time to provided and/or think through referred to their choices and appropriate get all questions resources answered 4. Patient experiences Given list of FREE events multiple “touch points” to support their Asked about ACP at F/U engagement visits 6
www.VidantHealth.com/AdvanceCare 7
Challenges related to accessing AD documents
Epic re-design Increase Use of EPIC Tools for ACP Header, ACP Navigator, AD Documents, ACP Note Header: Quick Check Code Status • • Quick Check if Advance Directive on File • Hyperlink to ACP Navigator ACP Navigator: • View Code Status History View Advance Directives - Current & History • View ACP Notes across Inpatient & Ambulatory • Add ACP Note - ANYONE! • • Provider, Case Manager, SW, RN, Chaplain. • If you have an ACP Conversation – Document It! 9
10
Not the time to check the EHR
What if… Designation of AD on file Current organ donor designation 12
Challenges related to ACP training
“The Irish b e lie v e de ath is ine v itab le , the English that de ath is im m ine nt, the Am e ric ans that de ath is o ptio nal” 14
Whose job is it? 15
16
The Evaluation of Physicians’ Com m unication Skills From Multiple Perspectives
Trainings For MD’s/Providers… In-person, turn-key products for MD’s/Providers are all very good (Vital Talk, Respecting Choices, SICP), but… • Expensive • Require broad system buy-in/investment/support • Long-term dedication (creating opportunities to use/teach skills, ongoing mentoring/coaching for skill refinement over the long haul) • Who do you train? (early adopters; moveable middle; axe carrying resisters..?) • Is training sufficient for integration? No! 18
System trainings/resources Team Member Advanced Training in EOL & ACP 15 Events & 118 Vidant Team Members Participated in 2018 Learn Center for Dates & Details 19
Nurses and other staff 20
Community members Beautiful weather is the death knell for ACP educational events! 21
Keeping it fresh… NHDD • Dying to Know: • Bringing Death to Life Conversation • Sabbath Writing Your Own Obituary- Class at Chowan University 22
Challenges around ACP communication with patients and families Yo You may no not co cont ntro rol l life' e's circu cumstances, nces, but g getting ng to be t the auth thor or of of you our l life means getti tting to to con ontr trol ol what y t you ou do o with th th them. -A. . Gawan ande de
Requires deep listening 24
Thank You “Sometimes we can offer a cure, sometimes only a salve, sometimes not even that. But whatever we can offer, our interventions, and the risks and sacrifices they entail, are justified only if they serve the larger aims of a person's life. When we forget that, the suffering we inflict can be barbaric. When we remember it the good we do can be breathtaking.” Atul Guwande 25
Recommend
More recommend
