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BON SECOURS HEALTH SYSTEM

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Title: BON SECOURS HEALTH SYSTEM


1
BON SECOURS HEALTH SYSTEM
  • Building a System-Wide Foundation for Palliative
    Care
  • Bon Secours Journey
  • Maria Gatto, MA, APRN, BC-PCM, NP, HNP
  • Director Palliative Care, Bon Secours Health
    System
  • Supportive Care Coalition
  • March 14th, 2007

2
The Vision
  • To provide integrative
  • comprehensive holistic palliative
  • care services across
  • the continuum
  • BSHSI Statement on Quality, 2004

3
The Tragic Reality
4
Objectives
  • Understand the process of a system wide
    palliative care needs assessment across the
    continuum of care
  • Identify the elements of a system-wide palliative
    care foundational support plan across the
    continuum of care
  • Identify the palliative care patient and measure
    the outcomes across the continuum of care

5


Bon Secours Health System Mission Statement The
Mission of Bon Secours Health System is to bring
compassion to health care and to be good help to
those in need, especially those who are poor and
dying. As a System of caregivers, we commit
ourselves to help bring people and communities to
health and wholeness as part of the healing
ministry of Jesus Christ and the Catholic
Church.
6
Bon Secours Health System
  • 20 Acute Care Hospitals
  • 1 Psychiatric Hospital
  • 6 Nursing Care Facilities
  • 6 Assisted Living Facilities
  • 2 Retirement Communities
  • 6 Home Care and Hospice Providers

A 2.7 billion not-for-profit Catholic health
system, Bon Secours owns, manages, or joint
ventures
NY
M I
PA
MD
KY
VA
SC
Bon Secours more than 18,000 caregivers help
people in 11 communities in 8 states
FL
7
Beginning the story of our journey
8
Objective
  • I. Understand the process of a system wide
    palliative
  • care needs assessment across the continuum of
    care
  • Palliative Care History within Bon Secours
  • Identification of Current Status
  • System Wide Palliative Care Assessment
  • System Wide Palliative Care Process Results
  • Key Findings
  • Next Steps

9
Timeline of our journey.
  • 1992 Sisters of Bon Secours Statement on Care
    of the Dying
  • 1999-2004 Care of the Dying Quality Plan
  • Included element to develop Palliative Care Teams
    by 2002
  • Care provision a local initiative only, often
    Mission driven
  • 2004 Expansion of Palliative Care to Quality /
    Care Management
  • Identification of BSHSI Palliative Care
    Demonstration Project Task Group
  • Representatives from the HSO, Local System Care
    Providers
  • Local System Leaders commitment for development
    of Palliative Care Service and establishment of a
    virtual center of excellence
  • Charity, Greenville, Richmond, Hampton Roads
  • 2005 Palliative care
  • Director of Palliative Care Services hired
  • Mission, Pastoral, and Local System Palliative
    Care Leaders included in planning
  • Demonstration Project Task Group determined needs
    assessment process to identify palliative care
    baseline status system wide
  • System wide assessment completed

10

THE ASSESSMENT Chapter One
11
Palliative Care Baseline Process Assessment
  • Goal Establish baseline process measurement of
    palliative care services
  • system wide across the continuum of
    care
  • Evaluation Tool
  • 12 Elements from BSHSI Palliative Care Quality
    and
  • Business Plan
  • Baseline Process Rating /Color Code System
  • 3Present/Green
  • 2Partially Present/Yellow
  • 1Not Present/Red
  • 28 Health Care Sites Assessed Across the
    Continuum
  • 14 Hospitals
  • 7 Nursing Homes
  • 5 Assisted Living Facilities
  • 2 Home Health Care Agencies

12
Palliative Care Overall Process Scores
13

KEY FINDINGS
14
Successes Realized
  • Baltimore Acute Care Dr. Neal Reynolds,
    Intensivist, established Palliative Care in the
    ICU, standing orders, redefined code status
    from DNR, Do Not Resuscitate, to AND, Allow
    Natural Death, a compassionate communication
    technique for palliative/hospice discussions
  • Charity Education and Integration Grant
    funding All staff at St Anthony Community
    Hospital receives ELNEC, Palliative Care
    Education, Joie Ogrodnick, Patient Relations.
    Good Samaritan Hospital established integrative
    volunteer holistic nursing service team, Kathleen
    Lynam, VP Patient Services
  • New York Grant Funding for Shervier Nursing Care
    Center Palliative Care Education for the Care of
    Dementia Patients, Paulette Sansone, PhD, LMSW
  • Hampton Roads Continuum of Care Liaison role's
    of hospice nurses provides continuity of
    palliative care through all care settings, Robin
    Boothe, Director of Hospice/Home Care
  • Florida Long Term Care Maria Manor Nursing and
    Rehabilitation Center Angels Passing By
    Program, unique end-of-life program, 24 hour
    compassion at the bedside, Martha Smith, ADON

15
Top Foundational Issues Realized
  • LACK OF PALLIATIVE CARE TEAMS
  • INADEQUATE EDUCATION, CERTIFICATION PROGRAM
    DEVELOPMENT
  • INCONSISTENT PALLIATIVE CARE POLICIES
    STANDARDS
  • NO ESTABLISHED PALLIATIVE CARE METRICS OR
  • MEASUREMENT SYSTEM
  • LACK OF INTEGRATION OF PALLIATIVE CARE SERVICES
    ACROSS THE CONTINUUM OF CARE

16
PHASE-IN PROCESS Chapter Two
17
Objective
  • II. Identify the elements of a system-wide
    palliative care foundational support plan across
    the continuum of care

18
NEXT STEP Phase 1 Accountability
  • Building the Foundation Through
  • Engagement
  • Leadership
  • Team Building
  • Education
  • Policy and Procedure
  • Outcomes
  • Integration
  • IT/Electronic Support

19
Building the Foundation Through
  • Engagement
  • Presentation of results system wide to corporate
    and local system leadership
  • Executive Management Team Presentation
  • Board Quality Presentation
  • Mission Leadership Presentation
  • Local System Leadership Presentation
  • Palliative Care System Wide Presentation
  • Leadership
  • Create unified interdisciplinary leadership body
  • Development and Establishment of Palliative Care
    Charter and Advisory Council
  • Team Building
  • Financial Planning Expectation
  • Required Budget Items for FTEs

20
Building the Foundation Through
  • Education
  • Set standard for Team Professional Licensure,
    Training, Education
  • EPEC, ELNEC, Board Certification, CAPC/PCLC, ACE
    Project, On-Line Web Based Educational Programs,
    Wellspring
  • Policy and Procedure
  • Develop system wide policy to meet national
    compliance standard
  • Policy Task Force Team
  • Identify National Standards JCAHO and CAPC
    Crosswalk
  • Create Minimal Standard Set inclusive of BSHSI
    perspective
  • Local and Corporate Review and Approval Process
  • Outcomes
  • Identify and establish standard outcomes
    measurement, data collection, reporting, and
    improvement process
  • Palliative Care Dashboard
  • Mortality Review BSHSI Definition of Mortality,
    Zero Preventable Deaths Palliative Care
    Bundle

21
Building the Foundation Through
  • Outcomes (continued)
  • Integrative Holistic Palliative Care Assessment
  • Initial, Daily, Final Quality Outcome Assessment
  • Supportive Care Coalition National Data
    Collection and Benchmarking System for Spiritual
    Palliative Care Assessment
  • Palliative Care Patient Trigger
  • National Palliative Care Pilot NHPCO Quality
    Partner Initiative
  • Integration
  • Connecting palliative care across the continuum
  • Integration with Outcomes Management SOFTMED
  • Development of Identification and Reporting
    Processes for palliative care residents through
    EQUIP / MDS Softwear
  • IT Support
  • Knowledge share through intranet
  • IRIS Palliative Care Collaborative Page

22
QUALITY OUTCOME MEASUREMENT Chapter Three
23
Objective
  • III. Identify the palliative care patient and
    measure the
  • outcomes across the continuum of care

24
Palliative Care Dashboard
BSHSIs FY07 Strategic Quality Plan
Key Strategies
Goal
Outcomes
25
Palliative Care Dashboard Indicator
Determination and Reference Base
  • Benchmarking indicators limited due to
  • New specialty
  • Research data limited - none
  • CAPC The Center to Advance Palliative Care
  • National initiative supported by The Robert Wood
    Johnson Foundation, named national leader, Mount
    Sinai School of Medicine, (NY)
  • Only national organization to establish accepted
    benchmark
  • Estimated number of potential palliative care
    patients based on an estimated 5 of annual
    discharges
  • Assumed potential of palliative care patients
    based on experience of palliative care program
    increasing over time
  • BSHSIs First Year Trial 1.0
  • System Wide Goal Met
  • 1,970 Total Number of Palliative Care Consults as
    of January 2007



  • http//www.capc.org/ http//www.capc.org/about-c
    apc/faqs
  • http//www.capc.org/impact_calculator_basic/
  • http//www.capc.org/impact_calculator_detailed/

26
Mortality Review
  • IHI Analysis of Mortality information reveal 3
    common themes
  • Failure to plan (diagnosis, treatment appropriate
    care and end of life)
  • Failure to communicate (between caregivers and
    covering physicians/consultants) inadequate
    documentation
  • Failure to rescue/recognize (change in condition
    not recognized)
  • Overarching aim of SPQ, Strategic Quality Plan
  • Zero Preventable Deaths by 2009
  • Goal achieved by
  • Incorporating the IHI Mortality Reduction
    Strategy
  • Further define Preventable Deaths by examining
    3 categories of death
  • Anticipated
  • Unanticipated
  • No Failure

27
Mortality Review
  • First Mortality Study 14 Hospitals reporting
    N687
  • Local System Mortality Results Report Related to
    Palliative Care
  • Lack of pc identification, intervention, end of
    life discussions
  • Inappropriate transfer to ICU (perception of ICU
    focus group)
  • Lack of end of life discussions with
    patient/family
  • Outcomes
  • System wide trend identified Lack of palliative
    care service
  • Action to implement palliative care teams
  • Development of new bundle tool to add to
    Mortality Review Process Palliative Care Screen
    and Bundle Tool
  • Second Mortality Review 96 Palliative Care
    Screen and Bundles
  • 93 out of the 96 palliative care screens met
    potential of palliative care consult Average
    score 7.6 (gt 4 consider palliative care consult)
  • No Palliative Care appropriate patients had
    completed bundle criteria
  • Day 1 Decision maker established Advanced
    directives addressed
  • Day 3 Pain managed optimally, Social support,
    Spiritual support
  • Day 5 Family goal planning meeting completed

28
DNR Status Before Day of Death
60 patients were placed on DNR status one day
before death another 47 on the day of death
29
Days Between Advance Directive Death
Advance Directives most commonly occurred on
1.5-2.0 days before death
30
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31
Identify Palliative Care Patient
  • Known Supportive Processes
  • Establishing palliative care services,
    collaborative relationships, trust
  • Increased staff education
  • Daily Huddles
  • Attending Care Management Rounds
  • Known Barriers
  • Culture change difficult
  • Lack of education Hospital staff, community,
    patients/family
  • Limited staff, time, resources
  • New service development
  • Poor communication Departmental silos,
    fragmented care
  • Lack of identification on admission,
    re-admission, and late referrals

32
Challenge Create New Electronic Processes
  • Created Project Team HSO/Local Clinical,
    Operational, IT Systems
  • Created process map of multiple interfaces
  • Identified integration with Process Redesign
    Project led by Barbara
  • Oot-Giromini, Director Outcomes Management,
    HSO, joined project team
  • SOFTMED- electronic medical record system used to
    improve care management processes by redesigning
    process information flow to increase efficiency
    connecting patient to all levels of care.
    Identified appropriateness to integrate
    palliative care identification / referral process
  • Manual screening tool identified CAPC Screening
    Tool
  • Determine which part of process tool utilized,
    and create alert screen when criteria met,
    (pilot in care management successful)
  • Created electronic referral between care
    management and palliative care coordinator,
    worklists, and electronic progress note template
    for palliative care coordinator
  • In development automatic alert to identify
    patients on readmissions, screening tool, and
    bundle review, initial, daily and final
    assessment screens
  • Pilot site determined Hampton Roads

33
ALERT to care managers to contact Attending to
discuss need of palliative care referral and
discuss with palliative care team when screen
tool is a score of 4, and/or alert flag D, Y,
N Key D Declined, Y Yes, had consult on
previous admission, met criteria N No, met
criteria, no previous palliative care consult
34
CAPC Screening Tool Pilot To be integrated in
nursing admission, or relevant history screen to
be done by care managers
35
Palliative Care Referral Screen
36
Palliative Care Worklist
37
Palliative Care Bundle Bundle screen is for the
palliative care coordinator to complete for all
patients part of the palliative care service
38
Palliative Care Initial Assessment
39
Palliative Care Assessment Initial Assessment
40
Palliative Care Assessment Initial Assessment
41
Palliative Care Assessment Daily Rounding
42
Palliative Care Assessment Daily Rounding
43
Palliative Care Assessment Daily Rounding
44
Palliative Care Assessment Daily Rounding
45
Palliative Care Assessment Final
46
Palliative Care Assessment Final
47
Palliative Care Assessment Final
48
Palliative Care Outcome Sample Reports
49
Palliative Care Outcome Sample Reports
50
Palliative Care Outcome Sample Reports
51
Palliative Care Outcome Sample Reports
52
Palliative Care Outcome Sample Reports
53
Palliative Care Outcome Sample Reports
54
Palliative Care Outcome Sample Reports
55
Integrative Spiritual-Palliative Care Assessment
  • Need Identified Interdisciplinary Palliative
    Care System Wide Leadership, Mission Leader
    Guidance
  • Project Team Created
  • Goals Objectives Determined
  • Short Term Goal To Identify Spiritual Palliative
    Care, SPC, outcomes measurement process
  • Long Term Goal To identify overall reportable
    dashboard metric
  • Objectives
  • Identify SPC assessment tools
  • Identify SPC data collection process
  • Identify SPC reporting process
  • Identify Bereavement assessment tool
  • Identify Bereavement data collection process
  • Identify Bereavement reporting process
  • Tools/Data Collection/Reporting Process
    Identified Supportive Care Coalition City of
    Hope Quality of Life Assessment and Benchmarking
    Program
  • Next Steps Pilot Planning

56
National Palliative Care Pilot
  • National Hospice and Palliative Care Organization
    Quality Partner Initiative
  • BSHSI accepted as the only National Palliative
    Care Pilot to work in partnership with the NHPCO
    the Centers of Medicare and Medicaid to assist
    in a study for the determination of future
    Hospice Care CMS measures
  • Quality Partners 10 Components of Focus
  • Patient Family Centered Care
  • Ethical Behavior Consumer Rights
  • Clinical Excellence Safety
  • Inclusion Access
  • Organizational Excellence
  • Workforce Excellence Safety
  • Standards
  • 7 out of 15 BSHSI Hospitals part of National
    Initiative

57
National Palliative Care Pilot
  • Charity System St. Anthony Community Hospital,
    Good Samaritan Hospital, Community
  • Hospital
  • Component Patient and Family Centered Care
  • Focus Pain and Symptom Management
  • Goal Reduce patients/residents discomfort by 50
    within 48 hours of admission to the Palliative
    Care Service
  • Kentucky System Our Lady of Bellefonte Hospital
  • Component Ethical Behavior and Consumer Rights
  • Focus Advanced Directives
  • Goal Documentation that Advanced Directive are
    addressed 48 hours of admission to Palliative
    Care Service for 90 of patients
  • Richmond System Memorial Regional Medical
    Center, St. Marys Hospital, Richmond
  • Community
    Hospital, St. Francis Medical Center
  • Component Patient and Family Centered Care
  • Focus Goals of Care
  • Goal Develop, document, and communicate, those
    Goals of Care that address the Palliative Care
    Bundle for 75 of patients

58
What this journey is all about Final Chapter
59
(No Transcript)
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