The Common Sense Guide to Improving Palliative Care > Caring for Caregivers > 6.6 Measuring Your Success

Sick To Death book cover This extract from the online edition of The Common Sense Guide to Improving Palliative Care is used with permission.

Caring for Caregivers: Measuring Your Success

Tracking progress is key to understanding the effects of your efforts. It is also important when you need to tell your story to administrators and colleagues, often to gain their support. Whatever your aim, three basic measures (see Chapter 2, Basics of Quality Improvement, for more details) are the kinds of things you will count to determine the following.

Your team needs to decide which data to collect, who will be responsible for collecting it, and how often to collect it. Depending on how big your patient population is, you might want to establish a sampling plan to get unbiased, yet manageable, data. You also need to figure out how to display your data: daily, weekly, every two weeks, monthly, or quarterly. Weekly measurement is best, as it provides quick turnaround of information to track progress, but be sure you have enough patients to do so (usually, five patients per week are enough to measure weekly). If you have too few patients to measure weekly, then try every other week. Only measure those things on a quarterly basis that are long-term outcome measures or that can only be collected quarterly. In addition, be sure to collect enough data to build your case (or to see quickly when an improvement is not working).

Team Fairlawn

The team identified the following sub-aim.

Sub-aim: Within six months, 100% of families/caregivers of patients who are at-risk of dying in our medical/surgery ward will have participated in an enhanced family conference/team meeting, within 72 hours of admission, with the multidisciplinary clinical care team.

Consequently, Team Fairlawn decided to track the following measures.

Process measure: Percent of target patient families for whom the enhanced multidisciplinary team/family meeting was conducted within 72 hours of admission to the ward.

Outcome measure: Percent of the target patient families participating in the enhanced multidisciplinary team/family meeting who express satisfaction because the team did the following:

To address other components of the project, a few team members also focused on reviewing and collecting baseline data on how family meetings were currently conducted by staff on the medical/surgery ward. They sampled five team meetings over the course of a week to observe the interaction and take notes on the content of information provided to families. They then asked families to describe what they had learned in the meetings and what questions they had. Another group of team members reviewed all printed materials that the medical/surgery ward currently gave to family members about local resources. (Many patients and caregivers came from surrounding areas and were unfamiliar with the city.) A third group collected baseline data on 15 recently deceased patients in the medical/surgery ward and studied what kind of advance care planning had been documented in each patient's record and whether the patient's and family's wishes were honored. They spoke to 10 caregivers of deceased patients to ask them about the experience and how the facility might have helped them more. They agreed to meet again in one week with results from their baseline data collection to review the information and identify next steps.

Following are some other examples of measures of caregiver support measures:

Process Measures

Outcome Measures

Adverse-Effect Measures

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