AMDA Foundation: Quality Improvement Awards

1
AMDA Foundation Quality Improvement Awards

• Anurita Mendhiratta, M.D., F.A.C.P.
• Annie Durkin, C.R.N.P., A.C.H.P.N.

2
Faculty Disclosures

• Dr. Mendhiratta
• Medical Director, Evercare Hospice and Palliative
  Care

3
Learning Objectives

• By the end of the session, participants will be
  able to
• Understand the barriers to providing palliative
  care in Long-Term Care
• Describe a model for a palliative care program in
  Long-Term Care
• Understand the process for building a
  facility-based palliative care program
• Describe the benefits of a palliative care
  program in Long-Term Care

4
Facility Demographics

• Potomac Valley Nursing and Wellness Center
• Rockville, Maryland
• 175 Beds
• Private Owner

5
Potomac Valley Palliative Care Program

• Problem
• Lack of accessible palliative care providers in
  LTC
• Fragmented care
• Lack of palliative care training in LTC staff
• Objectives
• --Create a facility-based palliative care
  program
• --Use facility resources at no extra charge to
  residents
• --Follow National Consensus Project guidelines
  where possible
• --Increase staff knowledge/performance in
  palliative/EOL care
• --Provide palliative/EOL education to residents
  and families

6
Project Timeline

• Educational Phase 9/2005 to 5/2006
• --EOL Seminar, ELNEC training and certification
• palliative care certification, staff
  in-service
• Planning Phase Summer 2006
• --Weekly team meetings, program forms
  created, resident selection, informal process
• Program Launched September 2006
• Outcome Measures Assessed 9/2008

7
QI Planning Implementation

• Leadership
• NP as program director, MD as medical director
• Weekly meetings first year, then bi-weekly
• Team Work
• MD, NP, DON, Department Champions from Social
  Services, Behavioral Health, Dietary, Pastoral
  Care, Activities
• 2- 8 hours/week per team member for first six
  months
• Communication
• Facility Newsletter, Letters to Providers,
  In-Service
• House Report, Chart Documentation, In-Service

8
Potomac Valley Palliative Care Program

• How was the program conducted?
• Resident identified and family contacted
• Primary physician/NP notified
• Palliative care assessment by NP and team
  members
• Care conference with resident/family
• Recommendations made to Primary
• Continued follow up by all team members
• Issues encountered how they were overcome
• Negative connotations and lack of knowledge
  related to palliative care

9
Tools Used to Affect Change

• Tools used
• PAINAD scale
• Hard Choices for Loving People (Hank Dunn)
• Tools created
• NP Initial Assessment
• EXCEL Spreadsheet
• Palliative Care Plan

10
Facility Expenses

• Start-up expenses (6 months) 3100
• Medical Director stipend
• NP 16 hours/week
• Continuing education in palliative care
• No extra costs incurred for other team members

11
Outcomes

• Resident Outcomes
• --Resident/Family direct the goals of care
• --Family Satisfaction
• Regulatory Outcomes Pain Management
• Improved Quality of Service
• --Improved interdisciplinary approach to EOL
  care
• Enhanced Staff Performance in EOL care
• Improved Organization Management Structure
  Systems Integrated care
• Financial Outcomes Additional facility service
  without hiring additional staff

12
Closing Thoughts

• What is the feasibility that this project could
  be implemented at other facilities?
• Highly feasible using existing LTC staff
• Lessons Learned Quality EOL care is an essential
  service that should be available at all LTC
  facilities
• Helpful Tips/Insights Education is the key to
  creating change
• Any Questions?