Circles of Influence
Highlights of the Continuing Journey of Past Circle of Life Winners
2005
Organization: High Point Regional Health System, High Point, NC. The system’s innovative highlights included integration of patient-centered care and palliative care throughout, strong team model for patient care, and leadership by chaplains.
Recent Achievements: The hospital continues palliative care in any area, with all staff involved in identifying those who need palliative care assistance, and is striving to work with individuals earlier in the disease process. Palliative care has become even more integrated in the health system as demonstrated by an increase in the number of orders written for consults, especially by hospitalists.
To strengthen that approach, the system has launched a palliative care consultation program in conjunction with the Hospice of the Piedmont to reach individuals at any stage of a serious illness. Based on a screening, physicians are asked to consider a palliative care consultation. The physician order for a palliative care consultation triggers a palliative care physician consultation on symptom management, goal setting, and end-of-life decisionmaking as well as a chaplain visit for every patient to assess and address emotional and spiritual needs as well as to offer help with the decision making process. Social workers and patient care coordinators are also involved as part of the palliative care team. The team has provided particularly valuable support to hospitalists when patients are admitted repeatedly. The system now has a system in place to alert the chaplain when a palliative care patient is readmitted as an inpatient. The chaplains again assess for concerns and may ask for another palliative care team consult if there is a need to revisit care plans/decisions made in the previous consult. Chaplains now also follow up after discharge to offer further support and/or bereavement care if the patient has died.
The hospital commissioned an award-winning, 20-minute film telling the story of a patient and her journey dealing with cancer and the end of her life. Her caregivers also shared what they had come to understand about palliative care. It was very touching…very powerful…but in addition it carried an educational message about palliative care. It was screened for everyone working in the hospital (including administration, department managers, and non-medical areas such as finance and registration) and helped them connect with the individual’s passage and the important of treating individuals with sensitivity and care at all encounters.
Award Impact: The Circle of Life Award was affirming and motivating. It raised interest within the organization and in the community. The organization used receiving the Circle of Life Award as impetus to move ahead.
The team has done some consulting with other hospitals in North Carolina and presented a program for the state chaplains’ association.
Award money (which is still being used) has promoted an interdisciplinary team process and support staff (a nurse-patient coordinator, social worker, chaplain, and palliative care consult nurse practitioner attended a palliative care education program). Patient and family education materials were developed, including on decisions about palliative and end-of-life care decisions. Award money continues to be used for continuing education for staff.
The application process actually accelerated the program’s development by one or two years—causing it to think about where it was and where it wanted to be. It forced it to put more-generalized concepts into more-specific words.
Organization: Palliative and End-of-Life Care Program at Hoag Memorial Hospital Presbyterian, Newport Beach, CA. Supportive and palliative care was initiated as a routine part of treatment for the seriously ill, using a social worker-led “triage” model. The program was cited for broad physician leadership and involvement, innovative pain measurement and monitoring system, and as a high impact, replicable, low cost program.
Recent Achievements: The hospital’s board of directors, with the support of the cancer center and foundation, adopted a resolution that palliative care should be available to all patients. The resolution codified how the program has grown and matured.
In 2005, when it received the Circle of Life Award, the hospital conducted a hospital-wide program using one FTE (a social worker) and a team representing departments throughout the hospital that believed end-of-life and palliative care was important to address.
With the hiring of an advance practice nurse with expertise in symptom management, the program began focusing on medication delivery, physician education about symptoms at the end of life, clinical pharmacist involvement, and use of traditional hospice medications in the hospital setting. A physician order set/comfort care pathway on medication is continually revised to help physicians choose medications.
Originally headquartered in the social services department, the program has been relocated to the cancer center. At that time, staffing increased to include a fulltime social worker.
The hospital’s foundation has since funded a palliative care physician and, since he started a year ago, bedside consultations can be held by the physician, nurse, or both. The physician presence has been an important link to hospitalists and intensivists on medication management.
The monthly palliative care case conference and perinatal loss program continue.
Initially hospital-based and primarily near the end of life, the program is moving into the community and earlier in the illness—months and sometimes years earlier. The program has assisted local nursing agencies in coordinating palliative care delivery and financing when patientstransfer from the hospital to a long-term care facility. Two private practice palliative care physicians make home or long-term care facility visits.
The hospital has started a “no one dies alone” program with 160 specially-trained hospital staff volunteers.
As part of its outreach, the program is working with pulmonary medicine organizations on dyspnea management with opioids.
Award Impact: Program staff believes that the award has contributed to the program’s success. The Circle of Life Award highlighted the palliative and end-of-life care program’s role (the team was invited to a Board of Directors meeting) and affirmed that what it was doing was noteworthy.
Award funds were used for staff education and family educational brochures now featured on the hospital website.
Externally, the hospital received visits from other hospitals seeking to build similar programs and was requested by the federal Agency for Heathcare Research and Quality to provide palliative care information. Program staff continues to speak about the program.
The program staff continues to track the Circle of Life each year as a “forum to learn from others.”
Organization: Thomas Palliative Care Unit, VCU Massey Cancer Center, Richmond, VA. Innovations include the palliative care unit for both consultative and palliative care team patients, use of teen volunteers at bedside, and use of palliative care beds for mothers with stillborn children.
Recent Achievements: The number of patients served has expanded, the outpatient practice has grown, and it is providing services to a new ALS clinic and concurrent with indigent cancer patients. The palliative care unit’s reach has become international with ELNEC teaching in multiple sites including Kenya, Tanzania, Kazakhstan, and Portugal. Recently, it worked with the Center to Advance Palliative Care to set up a special Veterans Administration curriculum and VA funding to enhance palliative care. The research program continues to grow with important contributions in health service research and new ways to control pain by "Scrambler therapy."
Award Impact: The award helped continue national recognition (which led to increased opportunities for outreach and teaching) and boosted internal recognition. Attention to the award in house publications and news releases helped publicize the palliative care concept.
Completing the application made the organization think about its program and its achievements—a practice which is also useful in completing other applications--and, to replicate that value, it now draws up a summary each year.
Award funds, along with some additional funding, secured a full-time chaplain.