1 Carole Morgan RN, MPA LNHA Marian McNamara RN,MSN Palliative Care

2 Faculty Disclosures: Carole Morgan RN. Director of Nursing Marian McNamara RN. Associate Director of Nursing Sea View Hospital Rehabilitation Center And Home

3 Learning Objectives By the end of the session, participants will be able to: Implement a Successful Palliative Care Program. Implement a forum to allow staff to express their feelings related to death and dying. Identify 3 Quality outcomes as a result of the implementation of the Palliative Care Program

4 Facility Demographics Sea View is one of 16 facilities in the New York City Health and Hospitals Corporation 304 Bed Facility located in Staten Island, NY. 22 Bed Traumatic Brain Injury Unit 76 Bed Alzheimer Unit

5 Problem Statement In LTC death is often prolonged and hospice is not always a feasible option Interdisciplinary staff not familiar with Palliative care

6 Goals Establish a Palliative Care program that provides a Comphrehensive Interdisciplinary approach to prepare residents and families for coping with expected end of life. Relieve suffering and pain by aggressively treating symptoms with both Pharmacologic and Non-Pharmacologic approaches. A Forum for the staff to express feelings related to multifaceted End of Life issues.

7 Implementation Development of Interdisciplinary team Development of Educational Curriculum Develop a Policy and Procedure incorporating Advanced Directives Revision of pain management program including assessment and interventions Palliative Care Handbook Tea and Comfort program

8 Interdisciplinary Team Medicine Nursing Social Work Activities Pastoral care Dietary Pharmacy Front line caregivers RN, LPN, PCT’s Housekeeping Resident Representative Care Planning Coordinator

9 Educational Curriculum Palliative Care for Nursing Homes at Fordham University EPEC Training : 12 module/60 min Train the Trainer sponsored by ELNEC: 2 day intensive curriculum Visit to Calvary & Shriver's Hospital Conferences & Membership to HPCANYS On-going education through CAPC

10 Advanced Directives Developed and Implemented Policy on Palliative Care with emphasis on early discussion of Advanced Directives Discussion on Advanced Directives begins upon admission, and at each Interdisciplinary Team Conference Ethic committee convenes as needed to discuss bio-ethical concerns. Feeding Tube use has decreased from 14.6% in 2004 to 11.6% in 2009

11 Pain Management Program Complete revision of assessment tool to include verbal and non-verbal assessment (admission, readmission, new onset, and significant change) Palliative care physician takes lead in pharmological therapy which includes scheduled dosing instead of PRN’s Incorporated non-pharmacological interventions in our practice Moderate to Severe pain indicator has gone from 6.4% in 2004 to 2.7% in 2009.

12 Sensory Room

13 Palliative Care Handbook Commenced in 2004 completed in page document that is easily replicated Resource guide for Residents, Families and Staff Developed by the Interdisciplinary team based upon area of expertise on a specific topic

14 Tea and Comfort Tea is the universal symbol of comfort and friendship Combination of staff education and support. Allows staff to express their own feelings in relation to death, dying and human suffering. Encompasses Stress reduction techniques such as biofeedback, Reiki, message, meditation, prayer and music.

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16 Enhanced Staff Performance Empowered staff to embrace comfort care as well as curative care. Prepared staff to help resident/families make informed decision as it relates to advanced directives. Provision of Palliative Care Carts to each resident unit. Increased knowledge of the pain management process and the use of non- pharmological approaches

17 Lessons Learned To effectively implement change it takes time, patience, trial and error. Staff become experts, with extensive education and working with real life issues. For the program to be effective allow staff an outlet to express their personal feelings Share best practices between facilities for growth and quality care Palliative Care program has had significant impact in regard to resident satisfaction and quality of life

18 Those who have the strength and the love to sit with a dying patient in the silence that goes beyond words will know that this moment is neither frightening nor painful, but a peaceful cessation of the functioning of the body. E. Kubler Ross