Advance Care Planning 2012 Update

1. Advance Care Planning 2012 Update Patti Betlach Dawne Sipe Park Nicollet Health Services

2. Timeline • Sept 2006 Ethics/Palliative Care • June 2007 Grant Obtained • Feb 2008 Guidance Council led by CMO - EOL Care and ACP • March 2008 Site visit by Bud and Linda • October 2008 Respecting Choices Training • Jan-May 2009 3 Pilot Studies • Jan 2010 Organizational ACP Charter • Jan 2011 Pilots/POLST • April 2011 Program Manager Hired!

3. 2011 Targets/Results • Train 100 new facilitators – trained 106 • Increase facilitations to 150/Qtr by 4th Qtr – 204 tracked • Greater than 85% of facilitations result in an advancement - 95% by year end • 100% HCD’s retrievable/scanned – 97% • 50% patients who die at PNMH will have retrievable ACD – 52.2%YTD 2011 • Track number of HDC’s scanned – 3415 YTD • Track number of POLST scanned – 1169 YTD • ACP session held for 1:1 facilitations in St Louis Park project – 34 individuals assisted

4. 2012 Goals/Targets • Increase the number of HCD and POLST forms scanned per month by 100% • Increase the % of patients who die at PNMH who have a retrievable HCD from 52.2% to 57.4% • Continue to train ACP and POLST facilitators • Educate and communicate internally • Communication campaign • Online learning module • Assess workflows and processes for ACP • Train, maintain, and support facilitators

5. 2012 Goals/Targets • Implement plans to grow capacity in strategic Primary Care and Specialty Care areas • Develop processes for Outpatient Care Managers to assist with Advance Care Planning • Provide opportunities for staff to complete HCD’s • Maximize Epic opportunities for documentation • Hire additional facilitators • Provide community outreach and education

6. % Deceased Inpatients with Health Care Directive

7. # of Health Care Directives

8. # of POLST Forms

9. Value of Advance Care Planning for PNHS • Managing our ACO Population • Internal Medicine Pilot – Health Care Home • Multiple approaches including group classes, 1:1 facilitator assistance at clinic or home, telephonic assistance, ACP signs in exam rooms, letters to patients from their physician about advance care planning and offerings • Develop a model that can be replicated in other ambulatory settings • Partner with Palliative Medicine for advanced symptom support for complex patients

10. Value of Advance Care Planning for PNHS • Preventing Avoidable Readmissions • Coordinating Effective Care Transitions • Improving the Patient Experience – ACP is a tool for patient centered care • It needs to be embedded into our culture of care

11. Cancer Center Pilot • Palliative Care SW with dedicated hours for ACP work • Initiated July 2011 • What we’ve learned: -advantage of facilitator on-site with convenient accessibility -advantage of facilitator who can move from inpatient to clinic -building trust with CC staff critical to referrals -facilitator as part of PC team provides credibility -oncologists uncomfortable with triggers for referral -challenge to build relationship with nurses due to high rotation -resistance from patients to complete satisfaction survey

12. Cancer Center ACP 2012 Data

13. New Pilots and Projects • Prairie Center Clinic -Individualized staff education, use of signage -Develop workflow with one clinician -Use of group classes for clinic patients and community • Creekside Clinic -Measure effectiveness of signage -Trial of scripting for residents and nurses -Use of template for ACP visit summary • Pulmonary & Nephrology Departments -Use of expanded education for nurses -Trial a workflow that allows maximum flexibility

14. Community Outreach • NHDD – 5 locations including PN staff initiative to complete HCD • Successful Aging Initiative of St Louis Park – active ACP committee • Ongoing presentations in faith communities, local health fairs, and Caregiver Conference • Continued scheduled facilitator times at Lenox Community Center • Education for nurses and social workers at local LTC and AL facilities

15. Challenges • Delay of education and pilots due to Epic transition • Currently no access for centralized intranet page • Continued over-reliance on volunteers, only one staff with dedicated ACP time • Lack of intake personnel to receive ACP referrals • EMR not yet accommodating our needs for ACP documentation and to rapidly identify care plans • Locating older AD’s prior to EMR transition

16. Successes • Ability for clinicians to place order for ACP via Epic • Revision of Inpatient Nurse Admission Navigator, including consult order to ACP facilitator • Access to Problem List for facilitators • Growing awareness from staff with request for assistance • Creation of ACP webpage • Steady growth of referrals • New PM and Community Care department protocol to offer ACP to all hospice, home care, and palliative care patients • Development of online learning module initiated

17. Future Priorities Our VISION is that Advance Care Planning at PNHS will be widely recognized as an essential element of a comprehensive, person-centered care plan. Our MISSION is to embed the principles and practices of Advance Care Planning into the culture at PNHS and the community we serve. Our focus will be: • System-wide education and training • Effective, widespread ACP implementation • Optimize use of EMR