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“Empowering the Healthcare Professional to Support End of Life Discussions with Patients and Families”
Ann Marie Day, MBAAmanda Gagnon, BSN, RN
Who We Are…Healthcentric Advisors
• Nationally recognized, non-profit firm serving as
o Prime contractor for the Centers for Medicaid And Medicare’s Quality Improvement Organization for the 6 New England states.
o Goal: Improve the quality and efficiency of healthcare for all Medicare Beneficiaries
o Provide technical support, research, analytic and project management support to providers, health systems and community coalitions
o Serve as health care quality improvement consults
Who we serve…
Beneficiaries Quality Leaders
Families Infection Preventionists
PhysiciansNurses Social Workers
Pharmacists
Why is Palliative Care Important?
Ensures Patients Wishes
Improves Care for Patients
Decrease Cost to
Healthcare System
The Palliative Care Story
Patient history - 68 yo male with end stage COPD, diagnosed
30 years prior
O2 dependent with only 20% lung function
Coronary artery disease, cancer survivor and a history of
heart attack 15 years prior
In last 3 years he had 5 hospitalizations 3 of which required
intubation and ventilation and lengthy rehab stays to return
him to “baseline.”
Baseline activity consistent with very minimal mobility
Go Wish Activity
Situation: Patient arrives at Emergency Department in
respiratory distress. Had loss of consciousness but alert
and oriented upon EMS transfer. Patient states he wanted
to be intubate only. Doctor said “why would we bother to
intubate you if we can’t do CPR.” Patient decides to be full
code and is admitted to the hospital’s ICU. Patient unable
to tolerate bipap, intubated for 3rd time in as many years and
transferred to larger hospital.
Patient successfully extubated 3 days later but codes in the
ICU on day 5. Full code status remained in effect (was not
readdressed at any point). Patient resuscitated after 20
minutes of CPR - therapeutic hypothermia was offered as a
treatment option. Family declines. Patient was medicated 2
days later for a terminal wean from the ventilator and died
peacefully 53 minutes later. Both daughters were by his
side and playing the Eagle’s “Peaceful Easy Feeling.”
The End of the Story
What Sen. McCain’s death can teach us about end of life care?
http://thehill.com/opinion/healthcare/403878-what-sen-mccains-death-can-teach-us-about-end-of-life-care
“There’s no room for facts when our minds are occupied by fear.”
• Build trusting and respectful relationships
• Learn about the patient as a person
• Talk about “what matters most” to the patient
• Establish a surrogate decision maker
• Promote patient-family conversations
• Normalize the conversation
• Ensure a good understanding of diagnosis, prognosis, and treatment options
• Anticipate emergencies and make a plan when appropriate
Tips for having the talk
The Conversation Project
Go Wish Game
QIO – My Care, My Choice, My Voice
Resources
Key Take AwaysStart the Conversation
• Ask the Questions• Don’t wait until it is already too late
Document the Patient’s Wishes • Make sure patients complete their advanced directives, durable power of attorney for
healthcare • Have copies in the patient’s chart • Encourage patients to have copies share with family, friends, keep on the fridge for
Emergency Services to easily find
Revisit the Conversation• Decisions may change as the condition changes or progresses• The more you talk about end of life care and wishes the more normalized it becomes
I Didn’t Want That
I Didn't Want That - Dying Matters Video
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Ann Marie Day, MBA Program Administrator
Amanda Gagnon, BSN, RNSenior Program Coordinator