Promoting Excellence : Promoting Palliative Care Excellence in Intensive Care : Lehigh Valley Hospital and Health Network

Updated September 2005

Grantee:
Lehigh Valley Hospital and Health Network, Allentown, Pennsylvania

Project Overview:

Title: Lehigh Valley Hospital Critical Care Palliative Care Project

The Lehigh Valley Hospital and Health Network (LVHHN) project is implementing and evaluating a palliative care model in three Intensive Care Units (ICUs) -- Medical, Surgical and Trauma Unit. A 689-bed academic community hospital (with 84 critical care beds), LVHHN is a major clinical campus for Penn State University's College of Medicine, and has affiliations with local nursing and allied health schools and a physician assistant program. Co-principal Investigators for the project are Daniel Ray, M.D. and Cathy Fuhrman, R.N.

Lehigh Valley Hospital and Health Network's project proposed a cultural change fusing palliative care practices with ICU practices. The intervention was first introduced and refined in the Medical ICU, and then implemented in the Surgical ICU and Acute Care Unit, using a quality improvement format.

Goals of the project are:

• Implement a palliative care model for all patients admitted to the medical critical care unit;
• Conduct staff education in palliative care;
• Implement communication tools; and
• Evaluate the model.

Palliative care model interventions for family comfort:

• Improvements to ICU waiting room;
• Development of an Ambassador program;
• Modified visiting hours;
• Formation of a weekly family support group; and
• Post-ICU referral to hospice program bereavement services.

Education component includes:

• Core curriculum development:
  • Based on EPERC, ELNEC and UNIPAC series;
  • Case studies and role playing exercises; and
  • Fast Facts from EPERC Web site.
• Re-formatted order set for palliative care issues;
• CA POE;
• Nursing staff-specific education;
• Physician staff-specific education;
• Palliative Care Symposium;
• Grand rounds on palliative care issues;
• Resident house staff-specific education;
• Family and patient education; and
• Community education.

Communication component includes:

• Multi-disciplinary rounds;
• Nursing empowerment;
• Chart documentation of family meeting;
• Family journal in patient areas;
• Medical Staff Progress Notes; and
• Family mailbox and communication boards.

Evaluation component includes:

• Critical Care Family Satisfaction Survey (all families); and
• Quality of Dying and Death (death on unit - patient families & nurses).

Other intervention components:

• Palliative Care Advisory Group; and
• Dedicated ICU Chaplain - 20 hours/week in ICU.

Dr. Ray explains the LVHHN model, "Using components and processes such as interdisciplinary rounding (with pastoral care and optional family participation), palliative/curative care planning (within 24 hours of admission) and formalized patient/family shared decision-making, each admission to the ICU will be provided the education and support needed to improve the quality of experience in the ICU for patients and their families - in medical, psychosocial and spiritual domains."

Tools:

Resources:

Related Resources:

This demonstration project was featured at the 2004 NHPCO 19th Management and Leadership Conference:

• Session 1: Building Bridges Between Hospices and ICUs: It Can Be Done

Lessons Learned:

• Nurses have a good understanding of palliative care and its relationship to end-of-life care.
• Nurses identify the greatest impediment to effective palliative care is physicians' unwillingness or inability to formulate and communicate prognosis.
• The waiting room experience often defines the family's perception of care provided within the walls of the ICU.

Team Members:

Daniel E. Ray, M.D., Principal Investigator
Lehigh Valley Hospital and Health Network
Pulmonary/Critical Care Medicine

Cathy Fuhrman, R.N., Principal Investigator
Palliative Care Program Coordinator
Lehigh Valley Hospital and Health Network

Lynn Dietrich, R.N., Ph.D.

Jack Geracci, R.N., MDiv.
Chaplain
Lehigh Valley Hospital and Health Network

Joan M. Schultes, R.N., B.S.
Case Manager, MICU/SICU
Lehigh Valley Hospital and Health Network

W. Glenn Stern, M.A.
Grant Scientist
Lehigh Valley Hospital and Health Network

Thomas Wasser, Ph.D.

Contact Information:

Daniel E. Ray, M.D., Principal Investigator
Lehigh Valley Hospital and Health Network
Pulmonary/Critical Care Medicine
1200 S. Cedar Crest Blvd.
Allentown, PA 18105
Phone: 610.439.8856
Fax: 610.439.1314
Daniel.Ray@lvh.com

Cathy Fuhrman, R.N., Principal Investigator
Palliative Care Program Coordinator
Lehigh Valley Hospital and Health Network
P.O. Box 689
Allentown, PA 18105
Phone: 610.402.8585
Fax: 610.402.1240
Cathy.Fuhrman@lvh.com

Web site:
http://lvhhn.org/services/excellence/palliative_care/

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Promoting Excellence in End-of-Life Care is a national program of the Robert Wood Johnson Foundation dedicated to long-term changes in health care institutions to substantially improve care for dying people and their families. Visit PromotingExcellence.org for more resources.