National Hospice and Palliative Care Organization

Session : NHPCO1560
2A: The Role of the Hospice Team on the Hospital Heart Failure Committee: Improving Hospice Access for Cardiac Patients and Reducing Hospital Readmissions
Conference : 16th Clinical Team Conference and Pediatric Intensive: Expanding the Mission
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Cleanne Cass, DO, FAAHPM, FAAFP, Ohio's Hospice, Dayton, OH Ruth M. Thomson, DO, FAAHPM, FACOI, HMDC, Hospice of Dayton, Dayton, OH Lynda Weide, RN, BSN, CHPN, Ohio's Hospice, Dayton, OH

To improve end-of-life care for patients with heart failure, hospices must be able to successfully collaborate with community cardiologists and hospital heart failure committees. To achieve this collaboration, hospices need both innovative programs and a track record of proficient patient management. This session provides a blue print for developing a program of cardiac focused care that meets both these goals. The role of telemedicine, clinical protocols and staff education in advanced cardiac case management will be described. The use of analytics and information technology in providing data to demonstrate program effectiveness will also be discussed.

Learning Objectives: z Describe the organizational initiatives and staff resources required to implement a program of focused cardiac care in a hospice or palliative care program z Discuss the role of a telemedicine monitoring system, clinical protocols and advanced cardiac staff education in the successful management of high risk heart failure patients z Identify strategies for successful collaboration with community cardiologists and hospital heart failure committees

Session : NHPCO1561
2B: Take the Challenge: Building a Sustainable Business Model for Pediatric Hospice
Conference : 16th Clinical Team Conference and Pediatric Intensive: Expanding the Mission
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Holly Davis, MS, APRN, Gentiva Hospice, Nashville, TN Lizabeth Sumner, RN, BSN, MA, ORGL, The Elizabeth Hospice, Escondido, CA Diane Parker, RN, MSN, NE-BC, CHPN, CHPPN, Hospice Care of South Carolina LLC, Gaffney, SC

Despite many pediatric hospice programs emerging over the last decade in adult oriented organizations, the scarcity continues. Many hospice leaders are reluctant to tackle "the impossible" to create a sustainable model for delivery of high quality care, without exhausting all the financial resources. Just winging it even for a few pediatric patients per year is not a viable option for the children or the agencys wellbeing. A one size fits all solution does not exist. Faculty will share strategies and leadership goals to accomplish the establishment of a sound pediatric hospice program in the current healthcare environment.

Learning Objectives: z Conduct an internal inventory for expertise in pediatric/neonatal care or child development in your organization z Differentiate billing and coverage differences for traditional hospice care funding and concurrent care funding z Evaluate staffing models and service line strategies to create cost savings and increase efficiencies

Session : NHPCO1562
2C: Palliative Care at Prestonwood Rehabilitation and Nursing Center
Conference : 16th Clinical Team Conference and Pediatric Intensive: Expanding the Mission
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Alexander Peralta, MD, Palliative Medicine Consulting Services, Duncanville, TX Merritt Robinson, RNC, Prestonwood Rehabilitation and Nursing Center, Plano, TX Vicente Flores, ThM, Comfort Hospice - Dallas, Irving, TX Jacquelyn "Jackie" Kelley, MSW, ACSW, LCSW, CST-T, CT, Compass Hospice Dallas, Dallas, TX Ann Scharff, RN, BSN, CHPN, Compass Hospice Dallas, Dallas, TX

The care of acutely ill patients in long-term care facilities has been an overwhelming challenge in the healthcare arena. How do we address this conundrum and at the same time provide an innovative model of care? The answer lies in defining palliative care in long term care settings. The Department of Health and Human Services Resource Utilization Groups for the nursing home resident assessment provides an opportunity to initiate the National Consensus Projects Quality Palliative Care guidelines. Prestonwood Rehabilitation and Nursing Center has developed and implemented a palliative care program using a palliative care team for posthospitalized patients who did not meet criteria for skilled nursing care. This 90-day benefit has provided advanced palliative care for hundreds of patients over the last 4 years with a significant cost savings to the health care system, long-term care setting and families.

Learning Objectives: z Discuss the current state of palliative medicine and national guidelines for quality palliative care z Describe how the RUGs may be used in initiating palliative care in the long term care setting z Discuss clinical vignettes on how palliative care teams utilized this initiative to ameliorate pain and non-pain symptoms

Session : NHPCO1563
2D: Guided Imagery and Dream Processing: Providing Comfort Care and Support During Life's Final Journey
Conference : 16th Clinical Team Conference and Pediatric Intensive: Expanding the Mission
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Gretchen Franklin, LISW-S, Stein Hospice Services Inc, Sandusky, OH

Guided imagery and dream processing can be used as healing techniques for psychosocial and spiritual care. The purpose of this session is to increase knowledge and awareness of alternative methods of healing/care for palliative and hospice patients. The goal of the presentation is to encourage the use of guided imagery and dream processing by healthcare providers and agencies so that more patients may benefit from these amazing techniques.

Learning Objectives: z Discuss research-based evidence supporting use of guided imagery and dream processing z List the physical and psychosocial benefits of guided imagery and dream processing z Describe a plan for incorporating guided imagery and dream interpretation into palliative/hospice patient care

Session : NHPCO1564
2E: Identifying and Correcting Common Pain Management Errors
Conference : 16th Clinical Team Conference and Pediatric Intensive: Expanding the Mission
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Ronald Crossno, MD, FAAHPM, Gentiva Health Services, Rockdale, TX

Hospice and palliative care clinicians must be proficient in the use of opioids for pain management. However with recent growth in both hospice and palliative care, there has been an influx of new clinicians for whom the use of opioids for pain management is relatively new. Even for experienced clinicians, the use of shortcuts may become habit, leading to suboptimal opioid prescribing habits. This presentation reviews some of the most common pain management errors identified in an ongoing review of hundreds of hospice setting records. Remedies for these errors will be discussed with patient examples to reinforce best practices.

Learning Objectives: z Discuss the essential tenets of pain management within the hospice and palliative care setting z Identify and discuss commonly encountered pain management errors z Describe remedies for such errors

Session : NHPCO1565
2F: A Contemplative Care Model for End-of-Life Care
Conference : 16th Clinical Team Conference and Pediatric Intensive: Expanding the Mission
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Session : NHPCO1566
2G: Survey Readiness is a Culture, Not a Process
Conference : 16th Clinical Team Conference and Pediatric Intensive: Expanding the Mission
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Jennifer Kennedy, MA, BSN, RN, CHC, National Hospice and Palliative Care Organization, Alexandria, VA Kimberly Skehan, RN, MSN, Simione Healthcare Consultants LLC, Hamden, CT

The IMPACT Act was passed almost a year ago which means that a hospice provider can expect to have a CoPs (Conditions of Participation) compliance survey every 36 months. Survey readiness is part of a hospice provider's culture of compliance and is not an event that takes place 3 months before the surveyor is due. This session will discuss developing a culture of compliance and provide strategies for becoming survey ready at any given time.

Session : NHPCO1567
2H: Using the NOMADS Protocol to Treat Flash Pulmonary Edema in Hospice Patients
Conference : 16th Clinical Team Conference and Pediatric Intensive: Expanding the Mission
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April Perry, APN, MEd, Duke Home Care & Hospice- Hock Family Pavilion, Durham, NC

This session will address the conditions in which flash pulmonary edema may occur in patients at the end of life. In addition, faculty will describe the etiology and pathophysiology of flash pulmonary edema. Participants will learn interventions in the NOMAD protocol and the order in which they should be implemented.

Learning Objectives: z List the conditions in which flash pulmonary edema may occur in end-of-life care z Discuss the etiology and pathophysiology of flash pulmonary edema in the terminally ill heart failure patient z Discuss the 5 interventions in the NOMAD protocol and the order in which they should be administered

Session : NHPCO1568
2I: "You Want Chips with that HAM Sandwich?"
Conference : 16th Clinical Team Conference and Pediatric Intensive: Expanding the Mission
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Mary Lynn McPherson, PharmD, BCPS, CPE, University of Maryland School of Pharmacy, Annapolis, MD

Patients with advanced illnesses often present with a myriad of symptoms, which may be difficult to differentiate. To this end, practitioners are often tempted to initiate a polypharmacy regimen, including the famous HAM sandwich Haldol, Ativan and Morphine! Indiscriminate use of several psychoactive medications (especially CNS depressants) dramatically increase the risk of therapeutic misadventure for this fragile population. This session will illustrate discriminating assessment techniques useful in distinguishing between common presenting symptoms such as anxiety, delirium and physical pain, and how to select and dose these medications.

Learning Objectives: z Describe why practitioners often automatically reach for haloperidol, lorazepam and morphine to treat end of life symptoms, and the unintended consequences of this action z List discriminating assessment techniques useful to distinguish between anxiety, delirium and physical discomfort, and how this drives drug-therapy decision-making z Given an actual or simulated case of a patient with an advanced illness, assess the patient and make patient-specific recommendations for drug therapy to treat anxiety, and/or delirium, and/or physical discomfort

Session : NHPCO1569
3A: Increasing Hospice Use Through Community Partnerships
Conference : 16th Clinical Team Conference and Pediatric Intensive: Expanding the Mission
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Janelle Shearer, MA, BSN, CPHQ, Stratis Health, Bloomington, MN Barry Baines, MD, Celebrations of Life, Minneapolis, MN

Stratis Health, a Medicare Quality Improvement Organization, led a one-year special innovation project funded by CMS to help eligible patients receive hospice care sooner and to increase appropriate referrals and utilization of hospice care in three rural Minnesota communities. A summary of the community-based project, a review of the patient and provider resources, and the impact on hospice utilization will be presented. Practical strategies to promote conversations between patients and families and their physicians regarding goals of care and expectations of the outcomes of their serious illness will be offered along with tips on how physicians can reframe their approach to hospice appropriate prognosis and their conversations with patients and families.

Learning Objectives: z Describe a community partnership approach to increase earlier hospice referrals z Identify strategies to promote goals of care discussions when there is a serious illness z Identify data and apply lessons learned in the project