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