Circles of Influence
Highlights of the Continuing Journey of Past Circle of Life Winners
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: Our inpatient CARES service continues to thrive with an annual census of over 1,100 in 2014. Our program is led by a Board-Certified Palliative Care Physician who works together with a team including one additional part-time physician who is also board-certified, a Clinical Nurse Specialist (CNS), two Clinical Social Workers (inpatient and outpatient), and a dedicated administrative assistant and is led by a Licensed Clinical Social Worker who focuses on program development and integration.
Our outpatient CARES symptom management clinic, run by our palliative care physician, continues to grow and is working to meet the needs of patients in the Hoag community through interdisciplinary care. This year we began to routinely add a visit with our outpatient LCSW immediately following the initial clinic visit. This session is designed to educate, provide resources and discuss advance care planning. This clinic complements our CNS led symptom management clinic in the outpatient cancer center and focuses on pain and symptom management with our oncology patients.
In 2015, we were blessed to add a full-time palliative care chaplain to our team, in addition to hosting a chaplain intern through the hospital’s Clinical Pastoral Education Program. This addition of a dedicated chaplain has provided the team with the opportunity to more deeply assess and intervene with the spiritual needs of patients and families. The chaplain has also brought in a sense of reverence and acknowledgement for the depth of the work that is done and has highlighted the need for on-going self-care for our palliative care clinicians.
The CARES program has been privileged to participate as a founding member in the Palliative Care Quality Network (PCQN). Through this collaborative, we have been able to capture quality data metrics, compare to similar palliative programs, participate in Quality Improvement projects and set benchmarks for the care we provide.
We continue to manage a comprehensive Bereavement Program, led by our inpatient MSW, which includes support and education to friends and family members of patients who die in the hospital. In addition, the CARES program hosts an annual Remembrance Service to honor those patients who died in the hospital while being cared for by the palliative care service.
Our No One Dies Alone program has been successfully providing compassionate companion volunteers to patients dying alone in the hospital since 2010 and was successful in opening this volunteer opportunity to the community in late 2013.
An on-going passion for the CARES program is to educate various disciplines in palliative care practices. To that end, in 2015, we started a Palliative Care Physician Fellowship training program, in collaboration with the University of California, Irvine.
Our CARES team continues to provide internships for Masters level social workers from local universities and provides rotational education to nursing students, clinical pharmacists and Clinical Pastoral Education students on an on-going basis.
Our team continues to provide community education regarding a variety of topics, including advance care planning, POLST and culturally competent practices. In the spring of 2015 our program, again, co-hosted a community event with the Orange County Aging Services Collaborative to celebrate National Healthcare Decisions day. This event was a “conversation café” that featured physician speakers talking about the decisionmaking processes that they witness and participate in.
Award Impact: The CARES Program team believes that the Circle of Life Award initially highlighted the palliative and end-of-life care program’s role and continues to affirm that the work is valued and noteworthy.
Award funds were used for staff education and family educational brochures now featured on the hospital website.
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.
Achievements since Circle of Life Recognition: In 2013, VCU Massey Cancer Center’s Thomas Palliative Care Program developed a specialized clinical palliative care education program for Advanced Practice Registered Nurses (APRNs). With initial seed funding from the Jessie Ball duPont Fund, Massey is offering a free palliative education and clinical experience to 36 APRNs. In a competitive application process, APRNs from a variety of settings, including hospitals, private practice, nursing homes, are represented. The program’s goal is to promote access to primary palliative care from APRN nurses in their institutions and communities, and to create a model that can be replicated on a national scale. The program received The Joint Commission’s Advance Certification in Palliative Care in 2012.
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.