Advance Care Planning 2012 Update

Patti Betlach

Dawne Sipe

Park Nicollet Health Services

Timeline

Sept 2006 Ethics/Palliative Care

June 2007 Grant Obtained

Feb 2008 Guidance Council led by CMO

- EOL Care and ACP

March 2008 Site visit by Bud and Linda

October 2008 Respecting Choices Training

Jan-May 2009 3 Pilot Studies

Jan 2010 Organizational ACP Charter

Jan 2011 Pilots/POLST

April 2011 Program Manager Hired!

2011 Targets/Results

Train 100 new facilitators – trained 106

Increase facilitations to 150/Qtr by 4th Qtr – 204 tracked

Greater than 85% of facilitations result in an advancement - 95% by year end

100% HCD’s retrievable/scanned – 97%

50% patients who die at PNMH will have retrievable ACD – 52.2%YTD 2011

Track number of HDC’s scanned – 3415 YTD

Track number of POLST scanned – 1169 YTD

ACP session held for 1:1 facilitations in St Louis Park project – 34 individuals assisted

2012 Goals/Targets

Increase the number of HCD and POLST forms scanned per month by 100%

Increase the % of patients who die at PNMH who have a retrievable HCD from 52.2% to 57.4%

Continue to train ACP and POLST facilitators

Educate and communicate internally Communication campaign Online learning module Assess workflows and processes for ACP Train, maintain, and support facilitators

2012 Goals/Targets

Implement plans to grow capacity in strategic Primary Care and Specialty Care areas

Develop processes for Outpatient Care Managers to assist with Advance Care Planning

Provide opportunities for staff to complete HCD’s

Maximize Epic opportunities for documentation

Hire additional facilitators

Provide community outreach and education

% Deceased Inpatients with Health Care Directive

# of Health Care Directives

# of POLST Forms

Value of Advance Care Planning for PNHS

Managing our ACO Population Internal Medicine Pilot – Health Care Home Multiple approaches including group classes, 1:1 facilitator

assistance at clinic or home, telephonic assistance, ACP signs in exam rooms, letters to patients from their physician about advance care planning and offerings

Develop a model that can be replicated in other ambulatory settings

Partner with Palliative Medicine for advanced symptom support for complex patients

Value of Advance Care Planning for PNHS

Preventing Avoidable Readmissions

Coordinating Effective Care Transitions

Improving the Patient Experience – ACP is a tool for patient centered care

It needs to be embedded into our culture of care

Cancer Center Pilot

Palliative Care SW with dedicated hours for ACP work

Initiated July 2011

What we’ve learned:-advantage of facilitator on-site with convenient accessibility

-advantage of facilitator who can move from inpatient to clinic

-building trust with CC staff critical to referrals

-facilitator as part of PC team provides credibility

-oncologists uncomfortable with triggers for referral

-challenge to build relationship with nurses due to high rotation

-resistance from patients to complete satisfaction survey

Cancer Center ACP 2012 Data

Jan Feb Mar Apr May TOTAL

Contacts 22 29 30 42 59 182

Facilitated Conversations 11 14 10 14 20 69

Completed Documents 10 7 8 13 9 47

Amendments 1 1 2

Referrals to Hospice 1 2 1 1 5

New Pilots and Projects

Prairie Center Clinic-Individualized staff education, use of signage

-Develop workflow with one clinician

-Use of group classes for clinic patients and community

Creekside Clinic-Measure effectiveness of signage

-Trial of scripting for residents and nurses

-Use of template for ACP visit summary

Pulmonary & Nephrology Departments-Use of expanded education for nurses

-Trial a workflow that allows maximum flexibility

Community Outreach

NHDD – 5 locations including PN staff initiative to complete HCD

Successful Aging Initiative of St Louis Park – active ACP committee

Ongoing presentations in faith communities, local health fairs, and Caregiver Conference

Continued scheduled facilitator times at Lenox Community Center

Education for nurses and social workers at local LTC and AL facilities

Challenges

Delay of education and pilots due to Epic transition

Currently no access for centralized intranet page

Continued over-reliance on volunteers, only one staff with dedicated ACP time

Lack of intake personnel to receive ACP referrals

EMR not yet accommodating our needs for ACP documentation and to rapidly identify care plans

Locating older AD’s prior to EMR transition

Successes

Ability for clinicians to place order for ACP via Epic

Revision of Inpatient Nurse Admission Navigator, including consult order to ACP facilitator

Access to Problem List for facilitators

Growing awareness from staff with request for assistance

Creation of ACP webpage

Steady growth of referrals

New PM and Community Care department protocol to offer ACP to all hospice, home care, and palliative care patients

Development of online learning module initiated

Future Priorities

Our VISION is that Advance Care Planning at PNHS will be widely recognized as an essential element of a comprehensive, person-centered care plan.

Our MISSION is to embed the principles and practices of Advance Care Planning into the culture at PNHS and the community we serve.

Our focus will be:

System-wide education and training

Effective, widespread ACP implementation

Optimize use of EMR