OUR STORY
HOW MINNESOTA COMMUNITIES WORK TOGETHER
TO PROVIDE PALLIATIVE CARE
Dr. Julie Benson
Cindy Sauber, Palliative Care Case Manager
Palliative Care Team
Lakewood Health System
Staples, MN
LAKEWOOD HEALTH SYSTEM
Located in Central Minnesota serving 38,000
Morrison, Todd, Wadena, and Cass Counties
Critical Access Hospital (25 beds)
Rural Health Clinic
- Five Clinics
Pillager-Eagle Bend-Motley-Browerville-Staples
Senior Services
- Long Term Care (100 beds)
- 2 Assisted Living Facilities (65 beds)
Hospice-Home Care (Home-based Palliative Care)
Behavioral Health Unit (10 bed)
BIRTH OF PALLIATIVE CARE AT LHS
2005: started Home Care based Palliative Care
program --A bridge (pre-hospice) between HC and Hospice
2007-2008: growing awareness of PC opportunities,
staff wanting to improve and expand service
CONTINUED GROWTH…
Early 2008 • Received MERC IPE Grant though MN AHEC (Area Health Education Center)
• Palliative Care brainstorming session with all disciplines at LHS
• Steering committee development
• Palliative Care Learning Center (Fairview Mpls)
Mid 2008 –
• Research, education of MD and staff
Late 2008 • Chosen by Stratis to begin Rural Palliative Care Initiative
(1 of 10 MN sites)
• 3 days at UM with PC team/inpatient consults
CONTINUED GROWTH…
Early 2009 –
• Hired RN case manager
May 2009 –
• Began pilot program serving pts
In Infusion Therapy (5 patients)
November 2009 • Approval for part time social worker
December 2009• LTC pilot with 5 residents
(hospice ineligible or graduates)
CONTINUED GROWTH…
2010 –
• Currently serving more than 20 patients
• Stratis Initiative Outcomes Congress
• Hired new social worker
• Networking group began
• Applied for grant with Northeast Minnesota Inter-professional Rural
Health Network (AHEC)
SUCCESS STRATEGIES
Four strategies to implement
palliative care in our
community…
SUCCESS STRATEGIES
One:
Administrative Buy-in
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Financial considerations
Quality of patient care
Philosophy of care (case management)
•
The Joint Commission
Financial considerations
In larger for-profit hospitals Palliative Care services have been shown to
decrease costs primarily by decreasing days in ICUs and decreasing
Lengths of Stay (LOS) as care is paid by DRGs
(diagnosis-related groups)
In Critical Access Hospitals which get paid cost of care,
this cost savings is not an advantage to the hospitals
and in fact is a disadvantage if we just look at the bottom line
Quality of patient care
The emerging philosophy of care at LHS is based upon case management
and coordinated care by care teams.
Examples of this are:
Medical Home
Joint Connections Program (joint replacement)
Obstetrical services
Hospice and Home Care
Palliative Care was a natural fit into this culture of patient care
THE JOINT COMMISSION
• 2008 TJC drafted voluntary standards for
palliative care programs that will be part of a new
certification program.
• TJC embedded the domains & philosophy of the
National Consensus Project (NCP)
Clinical Guidelines for Quality Palliative Care
NATIONAL CONSENSUS PROJECT FOR
QUALITY PALLIATIVE CARE
2001 palliative care leaders met to standardize
palliative care so as to improve quality of care
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AAHPM – American Academy of Hospice and Palliative Medicine
CAPC – Center to Advance Palliative Care
HPNA – Hospice and Palliative Nurses Association
NHPCO – National Hospice and Palliative Care Organization
Last Acts Partnership
2004 NCP released the Clinical Practice
Guidelines for Quality Palliative Care
SUCCESS STRATEGIES
Two:
Palliative Care Team
& Case Manager
PC TEAM
Interdisciplinary Team Model
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RN Case Manager
MD
Social Worker
Chaplain
Pharmacist
Psychiatric NP
In Patient Care Coordinator
Meet every 2 weeks for Infusion Therapy
Similar Team every 2 weeks for Long Term Care Center
SUCCESS STRATEGIES
Three:
Education
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•
Staff
Community
EDUCATIONAL OPPORTUNITIES
Staff
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ELNEC
Webinars
Nursing Students
Order set
Community
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Print
Women’s Health Expo
HealthBeats
Coffee & Conversation
Community & Service Groups
Ministerial Association
Lions
Homemakers
SUCCESS STRATEGIES
Four:
Use the 8 domains of Palliative Care to guide
our care
1. Structure and processes of care
2. Physical aspects of care
3. Psychosocial and psychiatric aspects of care
4. Social aspects of care
5. Spiritual, religious, and existential aspects of care
6. Cultural aspects of care
7. Care of the imminently dying patient
8. Ethical and legal aspects of care
Barriers to implementing
Palliative Care
BARRIERS
Defining Palliative Care
medical providers
nursing staff
patients
families
community
Turf issues
Timing – when to refer
Reimbursement
Future Plans
at LHS
FUTURE PLANS
Further Grant Funding
Volunteer position
Employee volunteer campaign
Community volunteer campaign
Clearing House for pairing patients and volunteers
Advanced Practice Nurse
Board Certification of MD
Active Inpatient Program
Networking group
FINALLY
JUST DO IT!!!
• start seeing patients
• slowly work out the kinks as you realize them
Resources
American Academy of Hospice and Palliative Medicine
www.aahpm.org
Hospice and Palliative Nurses Association
www.hpna.org
Association Hospice Palliative Care Chaplain
ahpcc.org.uk/
Social Work Hospice and Palliative Network
www.swhpn.org
Resources
Getpalliativecare.org provides clear, comprehensive palliative care
information for people coping with serious, complex illness.
Leading collaboration and innovation in healthcare quality and safety
www.stratishealth.org/palcare
Center to Advance Palliative Care
capc.org