Bensinger, Rochelle, RN, OCN

Detweiler, Erin, BSN, RN

Ring-Striba, Monica, RN, CHPN

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksPatient Care Services / NursingExcellence in End-of-Life Care for Patients Dyingin an Acute Care HospitalRochelle Bensinger RN, OCNLehigh Valley Health Network, Rochelle_L.Bensinger@lvhn.orgErin Detweiler BSN, RNLehigh Valley Health Network, Erin_L.Detweiler@lvhn.orgMonica Ring-Striba RN, CHPNLehigh Valley Health Network, Monica_M.Ring-Striba@lvhn.orgFollow this and additional works at: http://scholarlyworks.lvhn.org/patient-care-services-nursingPart of the Nursing CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtBensinger, R. Detweiler, E. Ring-Striba, M. (2017, May 04 & 05). Excellence in End-of-Life Care for Patients Dying in an Acute CareHospital. Poster Presented at: Oncology Nursing Soceity, Denver, CO.Bensinger, R. Detweiler, E. Ring-Striba, M. (2017, May 10 & 17). Excellence in End-of-Life Care for Patients Dying in an Acute CareHospital. Poster Presented at: 2017 PHPCN Annual Conference - "The Changing Face of End of Life Care", Harrisburg, PA.   PURPOSE/PROBLEM RESULTS - continued© 2017 Lehigh Valley Health NetworkReferences:  1.  Institute of Medicine Report: Dying in America, 2014, http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2014/EOL/Report%20Brief.pdf 2.  CDC, https://www.cdc.gov/nchs/data/nhsr/nhsr084.pdf   RESULTSHospice Response Team (HRT) Effect on MortalityHRT Intervention   INTERVENTIONSCreation of a Hospital/Hospice Quality Project -    “Better Care for the Hospitalized Dying Patient”  •  Identification of hospital and hospice stakeholders •  Formation of End-of -Life Care Task Force and the “Hospice Response Team" •  Definition of patient population criteria   −  24 to 48 hour prognosis   −  Too fragile to transport   •  Hospital staff education on end-of-life care  •  Upon each patient identification, Hospice Response Team meeting with the patient or loved ones to identify goals of care  •  Patient/Family Visits   −  Hospice nurse at minimum twice/day   −  Hospice aide once/day   −  As needed     •  Social worker, spiritual counselor, volunteer, pet and massage therapyADAPTABILITY & FUTURE FOCUS •  Evaluate ease of program access by managing barriers created by the electronic medical record •  Increase referrals from the emergency room which may reduce hospital readmissions and impact patient flow •  Focus education efforts on multiple disciplines and specialties •  Improve documentation of patient symptom management  •  Integrate care planning process •  Adopt a culture of continuous improvement to assure all of our dying patients’ and their loved ones’ goals are consistent with their expressed wishes  •  Improve the physical “medical” environment of the patient’s room•  Provide excellence in end-of-life care for persons dying in an acute care hospital•  1/3 of 1,904,640 deaths among persons ≥ age 65 in the US occurred in hospitals in 2013 •  Most die without the benefit of end-of-life care as evidenced by   −  Discrepancies in assessment of patient comfort   −  Lack of comprehensive emotional and psychosocial support   −  Physician orders reflective of acute care rather than best practices for comfort care   OBJECTIVES •  Recognize the different care needs of persons dying in hospitals that necessitate improved end-of-life care expertise and creation of strong hospital and hospice team partnerships •  Promote provision of comfort care to the dying and their loved ones as an active, desirable, and important skill and integral component of nursing care in the hospital environmentHospital Nurses Perception of Care (N=40)How Would You Rate the Quality of Your Patient's Dying1Terrible2 3 4 5Almost Perfect Don't Know Patients with HRT intervention 0% 0% 5.88% 35.29% 52.94% 5.88%Patients without HRT intervention 3.92% 15.69% 35.29% 27.45% 15.69% 1.96%In your experience, rate the care your patient received in the last several days of his/her life from the healthcare team1Worst2 3 45Best Possible Patients with HRT involvement 0% 0% 9.8% 39.22% 50.98%  Patients without HRT involvement 1.96% 17.65% 47.06% 21.57% 11.76%  Hospice Education Series Pain and Symptom Management Evaluation ResultsN=36 Strongly Agree Agree Undecided Disagree Strongly Disagree Learned new knowledge 85% 15% 0% 0% 0%Able to apply new knowledge 95% 0% 0% 0% 0%Training activity will improve job performance 90% 10% 0% 0% 0%Chart Audit Comparison of Hospital and Hospice Electronic Medical Record (EMR)EMR Comparison 2015 2017Identified Pain Hospital RecordHospice RecordHospital RecordHospice Record Identified Pain 20% 35%   35% 50%Identified Respiratory Distress 55% 90% 48% 78%Identified Anxiety 15% 35% 15% 20%Identified need for comfort care-prior to hospice 30% NA 35% NACounseling and support prior to hospice start of care 70% NA 70%Counseling and Support after hospice start of care 100% 100%Spiritual Care referral made prior to start of care 30% 43%Spiritual Care referral made after hospice start of care  82%  68%80706050403020100 0.000.100.200.300.400.500.600.700.800.901.00Mortality Goal Mortality Rate HRT ReferralsHRT Pilot HRT StartMar-15May-15Jun-15Jul-15Aug-15Sep-15Oct-15Nov-15Dec-15Jan-16Feb-16Mar-16Apr-16May-16Apr-15Excellence in End-of-Life Care for Patients Dying in an Acute Care Hospital Rochelle Bensinger, RN, OCN, Erin  Detweiler, BSN, RN, Monica Ring-Striba, RN, CHPNLehigh Valley Health Network, Allentown, PennsylvaniaMagnetTM Since2002

Excellence in End-of-Life Care for Patients Dying in an Acute Care Hospital

https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=1825&context=patient-care-services-nursing

Excellence in End-of-Life Care for Patients Dying in an Acute Care Hospital

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