the pcqn qi collaborative · the pcqn qi collaborative spiritual screening project & next steps...

The PCQN QI Collaborative Spiritual Screening Project

& Next Steps

Kara Bischoff PCQN Fall Conference

Agenda

• Review of the PCQN QI Collaborative • Summary of the spiritual screening project • Team report out:

1. ZSFG 2. CHOMP 3. Providence Little Company of Mary 4. Hoag

• Next steps

Components of the QI Collaborative

Interactive didactic sessions to teach QI methods

Monthly calls to review data, learn from best

performers, discuss stumbling blocks Ongoing support

Why Spiritual Screening?

• Pain ACP Spiritual care • Alignment with MWM / national QI trends • Interest among PCQN members • Wide range of clinical practice • PCQN data shows room for improvement

0%

10%

20%

30%

40%

50%

60%

70%

2013 2014 2015 2016

Percent of Patients with Spiritual Needs

May 2016 Strategy Exchange

Themes: • Coping/meaning • Beliefs and practices • Interest in further care from chaplain

May 2016 Strategy Exchange

May 2016 Strategy Exchange

May 2016 Strategy Exchange “Positive screen”: Patient comments about…

• Grief/loss • Hope/resiliency • Meaning • Need for belonging in community • Need for reconciliation in relationships

Goals

Primary: • Increase % of patients screened for spiritual needs by

any member of the palliative care team Secondary: • Identify & implement best practices for screening pts

and families for spiritual needs

Updated PCQN Data Element Screening Result Intervened

Pain Positive Negative Yes

Non-Pain Symptoms

Positive Negative Yes

Psychosocial Issues Positive Negative Declined Unable Yes

Spiritual Needs Positive Negative Declined Unable Yes

ACP/Goals of Care Needs

Positive Negative Declined Unable Yes

Outcome measure: • Numerator: # of patients/families with documentation of

“screened positive” or “screened negative” • Denominator: # of patients seen by palliative care service • Exclusions: Patients/families who “declined” or were “unable”

QI Framework

QI Framework Examine baseline data

Set a SMART goal

Brainstorm barriers &

opportunities

How did it go? Keep track of

your progress

Amend your plan(s)

Detail your 1st test of change (who, what, when)

Report back to the group

PDSA Worksheet

Barriers & Opportunities for Improvement

• Clinicians don’t feel responsible • MDs don’t feel confident about how to screen • Inconsistent definition of spiritual screen • Not a priority • Spiritual screen isn’t documented • Concern that screen could reveal thorny issues

Initial Improvement Plans

• Standardized screening questions: – Where do you draw your strength? – What are the most important issues that have

been raised for you by your illness? – In the past, what has helped you cope during the

challenging moments of your life? – Are there particular beliefs or faith practices that

give meaning to your life?

Crosswalk between Instruments

Crosswalk between Instruments HOPE FICA SPIRIT Providence Hoag UCSF Other PCQN

Coping/Strength/Values

Religion/Spiritual practices

Application to medical care

Crosswalk between Instruments HOPE FICA SPIRIT Providence Hoag UCSF Other PCQN

Coping/Strength/Values ✓ ✓ Religion/Spiritual practices ✓ ✓ ✓ Application to medical care ✓ ✓ ✓

Crosswalk between Instruments HOPE FICA SPIRIT Providence Hoag UCSF Other PCQN

Coping/Strength/Values ✓ ✓ ✓ ✓ ✓ ✓ Religion/Spiritual practices ✓ ✓ ✓ ✓ ✓ ✓ ✓ Application to medical care ✓ ✓ ✓ ✓

Improvement Plans

• Standardized spiritual screening questions • Delineate “positive” answers to questions

• Vet questions with Literacy Review and Interpretive Services Department

• Incorporate questions into note templates • Develop spiritual screening pocket cards &

posters for awareness campaign • Plan for regular data feedback to team

Progress to Date

Member Comparison

Teams Report Out

• ZSFG • CHOMP • Providence • Hoag

ZSFG PCQN QI Collaborative

• Helps provide structure and accountability • Avenue to broaden horizons for team

members less familiar with the palliative care landscape

• Benefit from collective experiences

Zuckerberg San Francisco General Hospital and Trauma Center 28

ZSFG Spiritual Care Screening • Developed our own set of questions

mirroring the categories addressed by standardized screening tools

• Vetting with additional entities to ensure appropriate from multiple perspectives: – Literacy – Patients from diverse ethnic and cultural

backgrounds

Zuckerberg San Francisco General Hospital and Trauma Center 29

ZSFG Spiritual Care Screening

• Creating card with screening questions and indicators of a positive screen

• Disseminating this broadly beyond our palliative care team – Bedside nurses, therapists, trainees….

Zuckerberg San Francisco General Hospital and Trauma Center 30

Community Hospital of the Monterey Peninsula

• Working with clinicians to identify spiritual distress during initial visits, rather than waiting for chaplains to assess spiritual needs on day 3-4

• Will be making changes to our documentation to clearly note screening for spiritual needs

Providence Little Company of Mary QI Collaborative, Spiritual Screening

Feedback: • Team members felt that stronger reminders were needed • Team also felt that patient/family responses varied when

non-chaplains ask them Changes: • Screen positive spiritual themes will be added to consult

template to supplement screening questions • For non-chaplains, experiment with setting context for

screening questions ( i.e. “I’d like to ask you a few questions about your sense of wellbeing and peace”)

• Create evaluation form to be completed following completion of spiritual screening

Providence Little Company of Mary QI Collaborative, Spiritual Screening

Evaluation: Spiritual Screening done? How did it go? (Did it deepen your connection to/understanding of the patient/family? Did they understand what was being asked? Were you comfortable asking the questions?) Did any of the above themes surface during the consult?

Hoag

Affecting Broad Impact

• Bedside nurses • Spiritual care providers outside the PC team

QI Collaborative Next Steps: Coming in 2017…

Screening for Spiritual Needs

Anxiety Screening and Improvement

MONTHLY CALLS

QUARTERLY CALLS

Pain Management

ACP (POLST & SDM)