expanding them beyond their physical, social, psychological, and existential/spiritual aspects. Expect this workshop to be a door opener, introducing new ways ...
Vol. 47 No. 2 February 2014
Schedule With Abstracts
impermanence, compassion), identify one or more they plan to use in the home or work setting. 3. Expand the concept of pain and suffering beyond the physical, social, psychological, and existential/spiritual to incorporate the meaning and functional consequences of the pain and how it can trigger suffering; recognize the pitfalls of reductionism, positivism, and the need to rescue, and help suffering patients heal through a renewed focus on function, purpose and meaning. The complex problems we face in the care of the patients who are our responsibility are daunting and can lead caregivers to burnout and compassion fatigue. We haven’t been taught to recognize when reductionism, positivism, and instrumental definitions of pain and treatment lead to frustration and misalignment of therapeutic expectations among staff, patients, and families. This workshop opens up better ways of seeing and managing the intellectual and emotional challenges presented by sick and diseased patients. We will introduce a different definition of sickness, tying together suffering, well-being, and healing. Starting there and based on clinical experience, we will show the utility of a narrative understanding of sickness and sick persons. We’ll introduce the discipline of narrative medicine, which uses the characteristics of stories to teach clinicians at any stage of training to see that what is happening to the patient is one storydone processdprogressing from the molecular to the spiritual. We’ll review what a story is, and how reflexive writing captures aspects of the story to which we were blinded by habit. Participants will write, reflect on the process, and identify a place for it in their usual work. Mindfulness Meditation is another powerful tool to help ourselves; it supports presence, compassion, and connection; decreases anxiety and stress; and helps people cope with impermanence. Workshop participants will experience Mindfulness Meditation to become aware of its benefits in clinical situations for our colleagues, our patients, and ourselves. Finally, the facilitators, using pain as an example, will help participants understand the effect of meaning and impaired function on the patient’s experience of symptoms,
385
expanding them beyond their physical, social, psychological, and existential/spiritual aspects. Expect this workshop to be a door opener, introducing new ways of understanding sickness and dealing with our patients’ problems and our own dilemmas.
Quality Improvement: Getting Started, Making Changes, Getting Results (P24) Joy R. Goebel, MN RN PhD, School of Nursing, California State University, Long Beach, CA. Marie Bakitas, RN NP-C ACHPN AOCN FAAN, School of Nursing, University of Alabama, Birmingham, AL. Karen Kehl, PhD MSN RN, School of Nursing, University of Wisconsin, Madison, WI. Karl Lorenz, MSHS MD, University of California, Los Angeles and VA Palliative Care Quality Improvement Center, Los Angeles, CA. (All authors listed above had no relevant financial relationships to disclose with the following exception: Lorenz is a DMC member and receives consulting fees from Otsuka Pharmaceuticals’ phase II trial of Sativex.) Objectives 1. Discuss quality improvement (QI) conceptual frameworks for translating evidencebased practices into quality bedside care. 2. Identify actionable palliative care targets for QI in your setting. 3. Design a QI project appropriate for your setting. Increasing emphasis in performance based payment, public reporting, and quality improvement (QI) has led to widespread interest on measuring and improving the quality of care. With high level political interest and additional funding streams opening for QI projects, clinicians can anticipate widespread support for initiatives to benefit patients and institutions. The aim of this preconference is to enable attendees to plan, implement, and evaluate a QI project at their clinical setting. During this seminar the participants will: 1) identify a project to improve the knowledge, skills, or attitudes of palliative care providers in their practice setting; 2) name approaches for maximizing buy-in by bedside clinicians and program managers for QI implementation; and 3) develop skills for designing, implementing, and evaluating a QI project. In the
386
Schedule With Abstracts
initial presentation, participants will receive a general overview of QI methodology and approaches to improve palliative care clinical practice. Examples of successful QI projects will be presented from a range of settings. Then participants will rotate through stations, where they will have the opportunity of interacting with other participants, and create a plan for a QI project using a plan, do, study, act (PDSA) framework.
How Many Diagnoses Does it Take for a Hospice Patient to Die? (P25) Mary Kay Tyler, MSN CNP CHPCA CHPPN, Hospice of Western Reserve, Cleveland, OH. Jeffrey L. Spiess, MD FAAHPM, Hospice of Western Reserve, Cleveland, OH. Janice Scheufler, PharmD RPh FASCP, Hospice of Western Reserve, Cleveland, OH. (All authors listed above had no relevant financial relationships to disclose.) Objectives 1. Discuss the 2013 Centers for Medicare & Medicaid Services clarifications relating to dual diagnosis and multiple diagnoses on hospice claims. 2. Identify clinical decision-making steps in using dual diagnoses. 3. Explain methodology for authorization of medications related to dual diagnoses. Hospices have been provided with several clarifications from the Centers for Medicare & Medicaid Services (CMS) relating to the submission of claims. CMS has clarified that Debility Unspecified and Adult Failure to Thrive will not be allowed as reportable principal diagnoses on a hospice claim. In addition, CMS is requesting more definitive coding of the principal diagnosis and coding of related diagnoses. This is a paradigm shift for most hospice staff and physicians. The clarification has necessitated that hospices better understand the relationship of the patient’s principal diagnosis to the terminal prognosis. This interactive session will allow for case studies utilizing decision-making tools and processes that will assist the clinician in determining which diagnoses should be coded and the corresponding authorization of medications and treatments. This is a must for all clinicians.
Vol. 47 No. 2 February 2014
Thursday, March 13 11ameNoon
Concurrent Sessions Culture Change at the Systems Level: Implementing a Palliative Care ‘‘Bundle’’ (TH301) Lynn Hallarman, MD, Stony Brook University, Stony Brook, NY. Sara Kaplan-Levenson, MPH MSW, Greater New York Hospital Association, New York, NY. (All authors listed above had no relevant financial relationships to disclose.) Objectives 1. Know key elements of bundle construction. 2. Define palliative care in the context of a bundle project. 3. Apply the bundle method to a key hospital palliative care initiative. The Greater New York Hospital Association (GNYHA) Palliative Care Leadership Collaborative (PCLC) brought together 35 hospitals across the greater NY region to implement and measure the impact of a standardized set of best practices for palliative care. Participating hospitals selected a cohort of patients on which to focus their efforts, develop and institute a process for identifying those patients, apply a set of actionable care and treatment guidelines, and document the provision of key palliative care services. These elements of the palliative care ‘‘bundle’’ were consensus-derived by an advisory group comprised of a subset of GNYHA’s Palliative Care Leadership Network, a forum of regional palliative care experts. Hospital teams, with the support of GNYHA staff, shared best practices and educational resources, as well as supported one another in overcoming common challenges and barriers, through didactic learning sessions, conference calls, data collection, and analysis to measure progress. The aim of the PCLC is to help hospital teams build sustainable and entrenched palliative care programs, increase their capacity to identify and provide palliative care services to all appropriate patients, and comply with laws regarding palliative care, and to poise them to seek advanced certification status from The Joint Commission. During this session, we will share
