the pcqn qi collaborative · the pcqn qi collaborative spiritual screening project & next steps...
TRANSCRIPT
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The PCQN QI Collaborative Spiritual Screening Project
& Next Steps
Kara Bischoff PCQN Fall Conference
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Agenda
• Review of the PCQN QI Collaborative • Summary of the spiritual screening project • Team report out:
1. ZSFG 2. CHOMP 3. Providence Little Company of Mary 4. Hoag
• Next steps
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Components of the QI Collaborative
Interactive didactic sessions to teach QI methods
Monthly calls to review data, learn from best
performers, discuss stumbling blocks Ongoing support
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Why Spiritual Screening?
• Pain ACP Spiritual care • Alignment with MWM / national QI trends • Interest among PCQN members • Wide range of clinical practice • PCQN data shows room for improvement
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0%
10%
20%
30%
40%
50%
60%
70%
2013 2014 2015 2016
Percent of Patients with Spiritual Needs
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May 2016 Strategy Exchange
Themes: • Coping/meaning • Beliefs and practices • Interest in further care from chaplain
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May 2016 Strategy Exchange
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May 2016 Strategy Exchange
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May 2016 Strategy Exchange “Positive screen”: Patient comments about…
• Grief/loss • Hope/resiliency • Meaning • Need for belonging in community • Need for reconciliation in relationships
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Goals
Primary: • Increase % of patients screened for spiritual needs by
any member of the palliative care team Secondary: • Identify & implement best practices for screening pts
and families for spiritual needs
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Updated PCQN Data Element Screening Result Intervened
Pain Positive Negative Yes
Non-Pain Symptoms
Positive Negative Yes
Psychosocial Issues Positive Negative Declined Unable Yes
Spiritual Needs Positive Negative Declined Unable Yes
ACP/Goals of Care Needs
Positive Negative Declined Unable Yes
Outcome measure: • Numerator: # of patients/families with documentation of
“screened positive” or “screened negative” • Denominator: # of patients seen by palliative care service • Exclusions: Patients/families who “declined” or were “unable”
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QI Framework
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QI Framework Examine baseline data
Set a SMART goal
Brainstorm barriers &
opportunities
How did it go? Keep track of
your progress
Amend your plan(s)
Detail your 1st test of change (who, what, when)
Report back to the group
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PDSA Worksheet
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Barriers & Opportunities for Improvement
• Clinicians don’t feel responsible • MDs don’t feel confident about how to screen • Inconsistent definition of spiritual screen • Not a priority • Spiritual screen isn’t documented • Concern that screen could reveal thorny issues
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Initial Improvement Plans
• Standardized screening questions: – Where do you draw your strength? – What are the most important issues that have
been raised for you by your illness? – In the past, what has helped you cope during the
challenging moments of your life? – Are there particular beliefs or faith practices that
give meaning to your life?
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Crosswalk between Instruments
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Crosswalk between Instruments HOPE FICA SPIRIT Providence Hoag UCSF Other PCQN
Coping/Strength/Values
Religion/Spiritual practices
Application to medical care
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Crosswalk between Instruments HOPE FICA SPIRIT Providence Hoag UCSF Other PCQN
Coping/Strength/Values ✓ ✓ Religion/Spiritual practices ✓ ✓ ✓ Application to medical care ✓ ✓ ✓
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Crosswalk between Instruments HOPE FICA SPIRIT Providence Hoag UCSF Other PCQN
Coping/Strength/Values ✓ ✓ ✓ ✓ ✓ ✓ Religion/Spiritual practices ✓ ✓ ✓ ✓ ✓ ✓ ✓ Application to medical care ✓ ✓ ✓ ✓
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Improvement Plans
• Standardized spiritual screening questions • Delineate “positive” answers to questions
• Vet questions with Literacy Review and Interpretive Services Department
• Incorporate questions into note templates • Develop spiritual screening pocket cards &
posters for awareness campaign • Plan for regular data feedback to team
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Progress to Date
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Member Comparison
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Teams Report Out
• ZSFG • CHOMP • Providence • Hoag
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ZSFG PCQN QI Collaborative
• Helps provide structure and accountability • Avenue to broaden horizons for team
members less familiar with the palliative care landscape
• Benefit from collective experiences
Zuckerberg San Francisco General Hospital and Trauma Center 28
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ZSFG Spiritual Care Screening • Developed our own set of questions
mirroring the categories addressed by standardized screening tools
• Vetting with additional entities to ensure appropriate from multiple perspectives: – Literacy – Patients from diverse ethnic and cultural
backgrounds
Zuckerberg San Francisco General Hospital and Trauma Center 29
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ZSFG Spiritual Care Screening
• Creating card with screening questions and indicators of a positive screen
• Disseminating this broadly beyond our palliative care team – Bedside nurses, therapists, trainees….
Zuckerberg San Francisco General Hospital and Trauma Center 30
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Community Hospital of the Monterey Peninsula
• Working with clinicians to identify spiritual distress during initial visits, rather than waiting for chaplains to assess spiritual needs on day 3-4
• Will be making changes to our documentation to clearly note screening for spiritual needs
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Providence Little Company of Mary QI Collaborative, Spiritual Screening
Feedback: • Team members felt that stronger reminders were needed • Team also felt that patient/family responses varied when
non-chaplains ask them Changes: • Screen positive spiritual themes will be added to consult
template to supplement screening questions • For non-chaplains, experiment with setting context for
screening questions ( i.e. “I’d like to ask you a few questions about your sense of wellbeing and peace”)
• Create evaluation form to be completed following completion of spiritual screening
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Providence Little Company of Mary QI Collaborative, Spiritual Screening
Evaluation: Spiritual Screening done? How did it go? (Did it deepen your connection to/understanding of the patient/family? Did they understand what was being asked? Were you comfortable asking the questions?) Did any of the above themes surface during the consult?
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Hoag
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Affecting Broad Impact
• Bedside nurses • Spiritual care providers outside the PC team
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QI Collaborative Next Steps: Coming in 2017…
Screening for Spiritual Needs
Anxiety Screening and Improvement
MONTHLY CALLS
QUARTERLY CALLS
Pain Management
ACP (POLST & SDM)