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Wishard Health Services in Indianapolis focused on improving family support. The group tested changes within eight major areas: family and loved one support, staff education and training, staff support and self-care, community involvement, patient education, facility modification/hospitality, hospice development and palliative care service, and physician/medical student education.
One change involved training "family consolers" or "rovers," volunteers trained to provide resources, information, and comfort to families of patients dying in the ICU. Experienced bereavement counselors trained volunteers. Among the measures used for the program were the number of families seen, conversations held, staff contacts, consolers involved, and patient deaths in the ICU.
For families keeping vigil, a door tag with an end-of-life logo is posted to notify staff that a patient is near death and to alert them to modify care. In addition, staff stock a hospitality cart for the room, offer shower facilities, and provide or assist with meals, parking, and toiletries. The group set up a "relaxation room" for ER and ambulance services staff.
As the project progressed, the team found that a primary barrier to success was a lack of knowledge about hospice, palliative care, and end-of-life options. The team believed that this situation was made worse by staff who were unwilling or afraid to try anything other than what they were used to doing. In a short survey of ICU staff and junior medical students, 50 percent of the former said that they were in any way familiar with hospice and palliative care services; 63 percent of the students said they were. As a result, the group developed a staff education program that included a monthly presentation on end-of-life issues; a quarterly summary of the Breakthrough Series team's work, which was sent to more than 850 doctors and others; and quarterly classes on chronic illness and death by violence.
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This online version of the book Improving Care for the End of Life: A Sourcebook for Health Care Managers and Clinicians is provided with permission of Americans for Better Care of the Dying [ www.abcd-caring.org ] and Oxford University Press. All rights reserved. For further information on quality improvement in end-of-life care visit The Palliative Care Policy Center [ www.medicaring.org ]. |
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