Beyond POLST Great Plains QIN Huddle July 21, 2020 A partnership - - PDF document

1

Better Together

Beyond POLST

Great Plains QIN Huddle – July 21, 2020

A partnership activity of the University of North Dakota (UND) Geriatric and Age Friendly TeleECHO series Mobility‐Prescription for Physical Activity: August 11, 2020 Featured Speaker: Donald Jurivich, DO Chair of Geriatrics, UND School of Medicine & Health Sciences

Geriatric and Age Friendly 4Ms Framework

• What Matters?
• Medication
• Mentation
• Mobility

2

2

3

3

How The Documents Differ

Advance Directive POLST Order DNR Order

Is a legal document Is a medical order Is a medical order For anyone 18 or older For those who may die within 12 – 18 months given advanced life‐limiting illness

• r advance frailty

For those who are critically ill and do not want CPR attempted when close to death May name a decision maker Does not name a decision maker Does not name a decision maker Communicates general wishes about medical treatments in future states

• f health. Reviewed periodically

Communicates medical treatments specific to the current state of health. Patient has a specific diagnosis and prognosis when discussing goals of care and treatment

• decisions. Reviewed regularly

Communicates specific decision about preference to attempt resuscitation in light

• f current state of health. Reviewed during

inpatient stays and on all admissions Filled out by patient Filled out by health care professional after conversation with the patient and/or their health care decision maker Filled out by attending provider after discussion with patient, family or from POLST order Risk and benefits of particular treatments are rarely reviewed Risk and benefits of particular treatments are reviewed by trained facilitator and the provider Risk and benefits of particular treatments are reviewed by provider Valid when the patient signs in presence of two witnesses or notary Valid when the physician signs and is valid across all care settings. Patient/agent may sign Valid during current admission once the physician signs. Not signed by patient/agent.

What Matters Activity

Take a moment to think of a time when someone you loved was dying. Think about who this person was and how this news/process made you feel.

Did the person you thought of have Advance Care Planning? [post in the chat]

• If yes, do you feel it helped?
• If no, do you feel one would have been helpful and

if so why/how?

4

5

What Matters

My Story

"I do not want to get to the end of my life and find that I just lived the length of it. I want to have lived the width of it as well." ‐ Diane Ackerman

5

Best Practices

• Ask the older adult What Matters most, document it and

share What Matters across the healthcare team

• Align the care plan with What Matters most
• Review high‐risk medication use and document it
• Deprescribe or avoid high‐risk medications
• Identify and manage factors contributing to depression

6

6

7

Best Practices...[continued]

• Screen for mobility limitations
• Include the family/caregiver
• Patient portal access and visit summaries
• Interdisciplinary care team
• Motivational interviewing
• Share advance care planning between settings with

care transitions

7

Life Context & Priorities

8

http://www.ihi.org/Engage/Initiatives/Age‐Friendly‐Health‐Systems/Documents/IHI_Age_Friendly_What_Matters_to_Older_Adults_Toolkit.pdf

8

9

Goals and Preferences

9

http://www.ihi.org/Engage/Initiatives/Age‐Friendly‐Health‐Systems/Documents/IHI_Age_Friendly_What_Matters_to_Older_Adults_Toolkit.pdf

When to Hold Discussions

10

• Medicare Annual Wellness Visits and other clinic

visits

• New diagnosis or change in health status
• Life‐stage change
• Chronic disease management
• Inpatient visits
• Financial/legal planning
• Holiday gatherings

10

11

Resources

• Motivational Interviewing
• South Dakota MOST
• Advance Care Planning SD
• Comfort One SD
• Honoring Choices North Dakota

11

National Initiatives

• What Matters Most
• Advance Care Planning‐The Conversation Project
• Five Wishes
• Center to Advance Palliative Care
• AFHS What Matters to Older Adults
• Serious Illness Conversation Guide
• Better Care Playbook
• The Conversation Project

12

12

13

Summary

Beyond POLST

• Personal Impact
• Other Factors
• Best Practices
• Assessment and Community Resources
• National Initiatives

13

What has been the COVID‐19 impact?

Beyond POLST

14

14

15

Commitment to Act

What is the first/next step you can take to improve advance care planning in your organization or with your family? [Post your ideas in the chat]

15

Geriatric and Age Friendly TeleECHO

Upcoming Topics 2nd Tues 12 PM CT 3rd Tues 12 PM CT Mobility: Prescription for Physical Activity August 11 August 18 Medications: Medication Update September 8 September 15 Mentation: Depression in Older Adults October 13 October 20 What Matters: Decision‐Making Capacity November 10 November 17

16

https://ruralhealth.und.edu/projects/project‐echo/topics/geriatrics

16

Great Plains Quality Care Coalition

Better Together.

Improve care in your community and organization Partner with an experienced team of quality improvement experts Access to tools, resources and education Connect with healthcare partners in your community Share ideas and best practices Learn how to better utilize data to drive improvement

FREE assistance through funding by the Centers for Medicare & Medicaid Services

Learn more, sign up or access current participants: https://greatplainsqin.org/initiatives/quality‐care‐coalition/

17

North Dakota Team

North Dakota

Jayme Steig, PharmD, RPh Quality Improvement Advisor Jayme.Steig@greatplainsqin.org Nikki Medalen Quality Improvement Advisor Nikki.Medalen@greatplainsqin.org Michelle Lauckner, RN Quality Improvement Advisor Michelle.Lauckner@greatplainsqin.org

18

19

South Dakota Team

South Dakota

Stacie Fredenburg, BA Quality Improvement Advisor Stacie.Fredenburg@greatplainsqin.org Lori Hintz, RN, CDP, CADDT Quality Improvement Advisor Lori.Hintz@greatplainsqin.org

Great Plains QIN Team

Krystal Hays Dee Kaser, RN, CDE Jeremy Frink Nancy Beaumont DNP, RN, CADDCT, CDP, RAC‐CT Quality Improvement Advisor Information Technology Director Task Order Director Regional Project Manager Tammy Wagner Ryan Sailor, MBA 20 Lorrie Lendvoy Keri McDermott, BA RN, LSSGB, CADDCT, CDP Chief Executive Officer Statistician Communications Director Quality Improvement Advisor

20

21

Better Together

Great Plains QIN aspires to make health in our region the best in the nation

https://greatplainsqin.org 800/458‐4262

This material was prepared by the Great Plains Quality Innovation Network, the Medicare Quality Innovation Network ‐ Quality Improvement Organization for North Dakota and South Dakota, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 12SOW‐GPQIN‐24/0720