Anna Rahman, PhD, MSW

Anna Rahman, PhD, MSW

ADVANCE CARE PLANNINGPart 2: The Individual Perspective

The development and evaluation of the INTERACT quality improvement program and Curriculum are supported by grants from the Retirement Research Foundation and The Commonwealth Fund

INTERACT Curriculum Session 8

Doctoral Associate, Miami University, Dept. of Sociology &

Gerontology, Oxford, Ohio

If you are participating in a teleconference proceed to the next slide for instructions

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INTERACT Curriculum Session 8

Teleconference Instructions

Call in Number 1-888-808-6959

Conference Code 3588988 #To un-mute your line to ask questions:

Press # 6

After asking your question (s) re-mute your line:

Press * 6

If the leader is not on the call when you call in, please wait

Overview of the INTERACT Program and Curriculum

Welcome and Introductions

This session is designed for the entire interdisciplinary team, including the:

• Project champion and co-champion• DON, key RNs, LPNs, and CNAs• Medical director, primary care MDs, and NPs/PAs• Social workers• Administrators

ADVANCE CARE PLANNINGPart I: The Institutional Perspective

Anna Rahman, PhD, MSW is a doctoral associate at Miami University, Scripps Gerontology Center. Her work focuses on helping nursing homes implement evidence-based practices to improve care and quality of life for residents.


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[email protected]

The INTERACT Interdisciplinary Team

Laurie Herndon, GNP Mass Senior Care FoundationGerri Lamb, PhD, RN, FAAN Arizona State UniversityRuth Tappen, EdD, RN, FAAN Florida Atlantic UniversitySanya Diaz, MD Florida Atlantic UniversityJohn Schnelle, PhD Vanderbilt UniversitySandra Simmons, PhD Vanderbilt UniversityAnnie Rahman, MSW Miami UniversityJo Taylor, RN, MPH The Carolinas Center for Medical ExcellenceAlice Bonner, PhD, GNP Center for Medicare and Medicaid Services

In collaboration with participating nursing homes


The role of the interdisciplinary team in Advance Care Planning (ACP)

How to discuss ACP with residents and families Identifying residents who may benefit from comfort or palliative care Examples of comfort care measures Resources for discussing ACP and providing comfort and palliative

What This Session Will Cover


Advance Care Planning (ACP)

What is it?

ACP is a process of communicating with residents and others who may be making health care decisions for them

The focus is on preferences for treatment in the event of changes in condition, and in particular at the end of life

Discussions should include explanation of options, benefits, and risks



What is it?

ACP is a process of communicating with residents and others who may be making health care decisions for them

The focus is on preferences for treatment in the event of changes in condition, and in particular at the end of life

Discussions should include explanation of options, benefits, and risks



What are the Goals?

To honor resident preferences for care To document preferences clearly and

communicate them so they can be honored at the appropriate times in the facility as well as after discharge


Advance Care Planning

The Role of the Interdisciplinary Team (1)

Medical care providers (MD, NP, PA) are responsible for discussing risks and benefits of various treatments and writing orders consistent with preferences

But, ACP is a team responsibility

Good decisions that honor resident preferences must be made with a health care team the resident and their decision makers trust


Advance Care PlanningThe Role of the Interdisciplinary Team (2)

Social work staff should provide residents and families with information about ACP and advance directives at the time of admission and participate in ongoing ACP discussions

Licensed nursing staff should be aware of any advance directives and participate in ongoing ACP discussions as appropriate with residents, families, and health care decision makers

CNAs should understand their resident’s goals for care, and may become involved in ACP discussions because they are in constant contact with residents and families


Advance Care PlanningThe Role of the Interdisciplinary Team (3)

Clergy and consultant psychologists can play a critical role in working with residents and their health care decision makers who find ACP discussions difficult and distressing

Consultant pharmacists can be helpful in providing comfort and palliative care

Administrators should take a leadership role in making ACP and documentation of ACP discussions and advance directives a priority


Advance Care Planning

When?

ACP should occur at some time shortly after admission

Decisions should be reviewed regularly and at times of acute changes in condition



This material was adapted from the Birmingham VA Safe Harbor Project in 2007

ACP is especially important among residents at high risk of dying in the very near future

This tool provides examples of residents who are at such risk



ACP is especially important among residents at high risk of dying in the very near future

This tool provides examples of residents who are at such risk



What is the Role of INTERACT Tools in ACP?

INTERACT Advance Care Planning Tools are intended to be helpful in: Communicating with residents, families, and

other health care decision makers Providing examples of comfort care measures


Adapted from Tulsky, JA. Beyond Advance Directives – Importance of Communication Skills at the End of Life. JAMA 2005; 294:359-365.













Explain comfort care “Comfort care helps people live as well as they can for as long as they can.”

Reassure “Comfort care can help you and your family make the most of the time you have

left.”


Please wait while the video is showing



Comfort or palliative care, whether or not the resident is enrolled in a hospice program, should include standard orders that address: Nutrition and hydration Activity Monitoring in the least

disruptive way Hygiene Comfort and safety



Comfort or palliative care, whether or not the resident is enrolled in a hospice program, should include standard orders that address: Nutrition and hydration Activity Monitoring in the least

disruptive way Hygiene Comfort and safety



Comfort care orders should also anticipate symptoms that can cause distress and discomfort, such as: Shortness of breath,

dyspnea, and terminal “death rattle”

Pain Anorexia Anxiety Seizures

Coalition for Compassionate Care of California - Resources for both health care providers and for lay people who want to talk about advance care planning, including downloadable forms and factsheets. http://www.coalitionccc.org/advance-health-planning.php

Alzheimer’s Association - Comprehensive recommendations aimed at improving communication and care at end of life. http://www.alz.org/national/documents/brochure_DCPRphase3.pdf

Caring Connections – downloadable educational information and forms (www.caringinfo.org/Home.htm - click on Advance Directives)

Aging with Dignity - offers a document called “Five Wishes,” which makes ACP more user-friendly, valid in 40 states; downloadable for $5 (www.agingwithdignity.org/5wishes.html)

Resources for ACP and End-of-Life Care


http://www.coalitionccc.org/advance-health-planning.php

http://www.alz.org/national/documents/brochure_DCPRphase3.pdf

http://www.caringinfo.org/Home.htm

http://www.agingwithdignity.org/5wishes.html

Your facility’s project champion is responsible for coordinating INTERACT implementation, and she or he may ask you to complete specific activities before the next teleconference or before you review the next session on-line

Suggested implementation activities before the next session:– Take 10 minutes after the teleconference to discuss next steps for improving

advance care planning in your facility. – Plan an in-service that teaches staff how and when to use the INTERACT

ACP Tracking Form. – Begin to use the ACP Tracking Form on one unit and monitor outcomes for

a month or so. Make any changes necessary based on this evaluation and then implement the form facility-wide.

Implementation Activities Before the Next Session:


Un-mute the line: Press # 6Please re-mute your line after talking: Press * 6

Questions and suggestions on Session 8 can also be directed to Dr. Rahman by email at:

[email protected]

Please insert in the Subject Line: “Question about the INTERACT Curriculum”

For teleconference participants:Questions, Suggestions, Comments?


mailto:[email protected]

Session 9

QI Review Tool Revisited

Champions DON Key RNs and LPNs Medical Director

The Next Session

The topic and participants are listed belowFor teleconference participants, check the date and time for the next session


Please complete the Post-Session Quiz and Evaluation If you take the Quiz and complete the Evaluation in a paper and

pencil format, please make sure your facility champion or co-champion gets a copy

If you are reviewing this session on-line, you can take the on-line Quiz and complete the evaluation on-line.

Post-Session #8 Quiz and Evaluation


Documents

Anna Rahman, PhD, MSW