pullman regional hospital - washington state hospital ...pullman regional staff and identified...

Pullman Regional Hospital

Jeannie Eylar, MSN, RN, CNO

Joy Drake, Board of Commissioners

Pullman

Regional

HospitalAdvance Care Planning

Experience

Rural Hospital Leadership Conference

June 28, 2016

Hospital dataIndicator Total 2014

ALOS 2.96

# of Inpatients# of Observation

1326700

# of Inpatient 1 day LOS

235

# of Inpatient with LOS 2-3 days

843

# of Inpatients with LOS 4-10 days

230

# of Inpatients with LOS > 10 days

18

# deaths 27

Indicator Total 2015

ALOS 2.73

# of Inpatients# of Observation

1392654

# of Inpatient 1 day LOS

218

# of Inpatient with LOS 2-3 days

859

# of Inpatients with LOS 4-10 days

319

# of Inpatients with LOS > 10 days

13

# deaths 39 (40)

06-28-2016 Rural Leadership Conference


Chart review

2013 – 32 Deaths 2015 – 39 Deaths

26* %

*1 newborn

18/26 POLST 69%

5/26 AdvanceDirective

19%

8/26 Health Care Agent

31%

33* %

*6 children <2

*2 yr old with Cancer POLST

20/33 POLST 61%

10/33 Advance

Directive

30%


27%

*32 %

17/32 POLST 53%

9/32 AdvanceDirective

28%


25%

2014 – 27 Deaths




Experience Nurses and social workers

experiencing moral distress trying to identify the patients wishes for care

Family members struggling to make decisions and experiencing complicated grief reactions

Physicians struggling to talk with their patients about end of life preferences

Patients struggling to talk to their family and physician about what is important to them



Something needed to change Collectively there was a

strong sense that how, when and where conversations about end of life care needed to change

Meeting a patient for the first time when they are in the ICU on a ventilator is not the time to start a conversation about patient preference for treatment

How do we know what the patients’ wishes are? How do we ensure known wishes are honored? How can we move this conversation upstream?

Quality of Life Team formed 2008



Community Collaboration & Steering

Committee – Summer 2013

Invited 45 people to attend a presentation on how Gundersen Health System has created a model of standardized advance care planning that satisfies patients’ wishes, eases family concerns, and lowers end-of-life care costs.

Explore ways and benefits of engaging the broader community in advance care planning and training.



Engage the broader community in advance care planning and training

Join with primary care and the community for a unified approach and ACP process

Seek critical support from local faith, business, and social service agencies Countywide

selection/invitation

Nurses (hospital based and primary care), social workers, hospice volunteers, physician, volunteer chaplains, church leaders, EMT, mental health, SNF Administrator, Case Managers, Librarian, primary care practice manager, hospital board members

Train community volunteers and professionals to have initial ACP conversations with friends, family, and neighbors (circles of influence)

October 2014



Atul Gawade book

Being Mortal

Released October

2014

PBS special

available for

viewing -www.honoringchoicespnw.org/



http://www.honoringchoicespnw.org/

Who, When, and What for advance care

conversations

Use a phased approach to ACP that

engages patients at the right times in their

illness and wellness

Redefine physician and clinical team roles

in advance care conversations

Teach and measure the skills for effective,

compassionate conversations with patients

and their families



Use systems design and continuous quality

improvement to standardize advance care

planning

Develop communication (common

language), structure, and leadership

support for consistent, standardized

advance care planning

Use quality improvement to drive results

and measure success

Effectively use the EHR platform to prompt

ACP at the point of care



Honoring Choices

Pacific Northwest

Implementation

Plan Pullman Regional

Hospital partnered with Pullman Family Medicine

Physician Champion

Shared IT support

Physician Invite and referral generated to ACP Facilitator

Utilize clinical staff and volunteers

Docuware accessible to Pullman Regional staff and identified clinical staff with Pullman Family Medicine



Advance care

planning is a

process of

communication

that helps you

understand, reflect

upon and discuss

your goals, values

and beliefs for

future health care

decisions.

Who will speak

for you?



pullman regional hospital - washington state hospital ...pullman regional staff and identified...

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