“Empowering the Healthcare Professional to Support End of Life Discussions with Patients and Families”

Ann Marie Day, MBAAmanda Gagnon, BSN, RN

Who We Are…Healthcentric Advisors

• Nationally recognized, non-profit firm serving as

o Prime contractor for the Centers for Medicaid And Medicare’s Quality Improvement Organization for the 6 New England states.

o Goal: Improve the quality and efficiency of healthcare for all Medicare Beneficiaries

o Provide technical support, research, analytic and project management support to providers, health systems and community coalitions

o Serve as health care quality improvement consults

Who we serve…

Beneficiaries Quality Leaders

Families Infection Preventionists

PhysiciansNurses Social Workers

Pharmacists

Why is Palliative Care Important?

Ensures Patients Wishes

Improves Care for Patients

Decrease Cost to

Healthcare System

The Palliative Care Story

Patient history - 68 yo male with end stage COPD, diagnosed

30 years prior

O2 dependent with only 20% lung function

Coronary artery disease, cancer survivor and a history of

heart attack 15 years prior

In last 3 years he had 5 hospitalizations 3 of which required

intubation and ventilation and lengthy rehab stays to return

him to “baseline.”

Baseline activity consistent with very minimal mobility

Go Wish Activity

Situation: Patient arrives at Emergency Department in

respiratory distress. Had loss of consciousness but alert

and oriented upon EMS transfer. Patient states he wanted

to be intubate only. Doctor said “why would we bother to

intubate you if we can’t do CPR.” Patient decides to be full

code and is admitted to the hospital’s ICU. Patient unable

to tolerate bipap, intubated for 3rd time in as many years and

transferred to larger hospital.

Patient successfully extubated 3 days later but codes in the

ICU on day 5. Full code status remained in effect (was not

readdressed at any point). Patient resuscitated after 20

minutes of CPR - therapeutic hypothermia was offered as a

treatment option. Family declines. Patient was medicated 2

days later for a terminal wean from the ventilator and died

peacefully 53 minutes later. Both daughters were by his

side and playing the Eagle’s “Peaceful Easy Feeling.”

The End of the Story

What Sen. McCain’s death can teach us about end of life care?

http://thehill.com/opinion/healthcare/403878-what-sen-mccains-death-can-teach-us-about-end-of-life-care

“There’s no room for facts when our minds are occupied by fear.”

• Build trusting and respectful relationships

• Learn about the patient as a person

• Talk about “what matters most” to the patient

• Establish a surrogate decision maker

• Promote patient-family conversations

• Normalize the conversation

• Ensure a good understanding of diagnosis, prognosis, and treatment options

• Anticipate emergencies and make a plan when appropriate

Tips for having the talk

The Conversation Project

Go Wish Game

QIO – My Care, My Choice, My Voice

Resources

Key Take AwaysStart the Conversation

• Ask the Questions• Don’t wait until it is already too late

Document the Patient’s Wishes • Make sure patients complete their advanced directives, durable power of attorney for

healthcare • Have copies in the patient’s chart • Encourage patients to have copies share with family, friends, keep on the fridge for

Emergency Services to easily find

Revisit the Conversation• Decisions may change as the condition changes or progresses• The more you talk about end of life care and wishes the more normalized it becomes

I Didn’t Want That

I Didn't Want That - Dying Matters Video

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Ann Marie Day, MBA Program Administrator

aday@healthcentricadvisors.org

Amanda Gagnon, BSN, RNSenior Program Coordinator

agagnon@healthcentricadvisors.org