Implementing the MOLST Program as an End-of-life Care Transitions Program in Your Community

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Implementing the MOLST Program as an End-of-life Care Transitions Program in Your Community. Patricia Bomba, M.D., F.A.C.P. Vice President and Medical Director, Geriatrics Chair, MOLST Statewide Implementation Team Leader, Community-wide End-of-life/Palliative Care Initiative
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Implementing the MOLST Program as an End-of-life Care Transitions Program in Your Community Patricia Bomba, M.D., F.A.C.P. Vice President and Medical Director, Geriatrics Chair, MOLST Statewide Implementation Team Leader, Community-wide End-of-life/Palliative Care Initiative Chair, National Healthcare Decisions Day New York State Coalition [email protected] CompassionAndSupport.org A nonprofit independent licensee of the BlueCross BlueShield Association Objectives
  • Recognize the MOLST as an End-of-life Care Transitions Program
  • Outline the barriers to implementation of the MOLST program and the methods used to overcome these obstacles.
  • Establish next steps needed to implement the MOLST Program in your practice setting.
  • Facility Implementation of MOLST Hospital Office LTC Six Steps to Develop and Implement Community-wide End-of-life/Palliative Care Initiative
  • Define Vision, Mission, Values
  • Employ results-oriented approach
  • Design effective, inclusive coalition membership
  • Create effective leadership
  • Demonstrate strong commitment to purpose
  • Monitor performance
  • http://www.compassionandsupport.org/index.php/about_us History of MOLST Program
  • Work initiated Fall 2001
  • Created November 2003
  • Adapted from Oregon’s POLST
  • Combines DNR, DNI, and other LST
  • Incorporates NYS law
  • Collaboration with NYSDOH – 3/04
  • Revised 10/05
  • Approved Inpatient DNR form
  • Legislation passed 2005
  • Community Pilot launched
  • Chapter Amendment 2006
  • Gov Paterson signed bill 7/8/08
  • MOLST consistent with PHL§2977(3)
  • Permanent change in EMS scope of practice, 7/08
  • MOLST permanent and statewide
  • Implementation - Early
  • Initial MOLST form
  • Pre-NYSDOH approval
  • 12/03 – 10/05
  • Began in Rochester
  • Spread to Syracuse
  • Areas surrounding
  • Implementation - Current
  • Revised MOLST,11/05
  • Consistent with NYS PHL
  • NYSDOH approval for use in all healthcare facilities
  • DOH DAL sent 1/06
  • Statewide interest
  • Consistent with PHL§2977(3), 7/08
  • Permanent change in EMS scope of practice, 7/08
  • 11/05 – Present
  • MOLST ProgramProject Dissemination
  • Systems Integration
  • NYS Healthcare Facilities
  • Community Pilot
  • Care Management
  • Partnerships
  • 39 county service region
  • Collaborators
  • EPEC Faculty & Attendees
  • Trained ACP Facilitators
  • Regional EOL Coalitions
  • NYSDOH
  • Professional Associations
  • SEMAC/SEMSCO
  • CompassionAndSupport.org/index.php/about_us CompassionAndSupport.org/index.php/about_us/collaborators MOLST Program Implementation Steps
  • Needs Assessment
  • Core Working Group
  • Task Force – Collaborative Model
  • Program Coordination
  • Key Components
  • Approvals; Legal Issues
  • Community Pilot Project - successful
  • Education and Training
  • Distribution and Fulfillment
  • Program Requirements
  • Relationship to Media
  • Available Resources
  • Needs Assessment
  • System responsiveness
  • Honoring patient preferences for EOL care
  • DNR, Life-sustaining Treatment, Site of Death
  • Interdisciplinary Approach
  • facilities: hospitals, SNFs, ALFs DM programs
  • disciplines: MD, RN, SW, EMS, Atty, consumers
  • Data-driven
  • Build on current research and conference
  • Core Working Group
  • Assemble a workgroup
  • Educate and empower
  • research - evidence base
  • NQF Preferred Practices
  • web resources: CompassionAndSupport.org
  • Broad representation – interdisciplinary
  • Leadership, passion, commitment
  • Willing to outreach and educate
  • Sustainability
  • Expand collaboration
  • Task Force – Collaborative Model
  • Broad representation
  • Local Department of Health
  • EMS
  • Hospitals
  • Long-term Care Facilities: SNF, ALF
  • Hospice and Home Care Agencies
  • County Office for Aging
  • Ombudsmen
  • Medical Society
  • Bar Association
  • Program Coordination
  • Leadership
  • Operations: CompassionAndSupport.org
  • distribution and fulfillment of educational resources
  • training
  • quality improvement
  • share best practices & lessons learned
  • Funding
  • Sustainability
  • Key Components
  • Standardized practices, policies and form
  • Education and Training
  • advance care planning facilitators
  • system implementation
  • community education
  • Timely discussions along continuum prompted by:
  • identification of appropriate cohort
  • prognosis
  • Clear, specific language on actionable form
  • Bright colored, easily recognized form
  • Medical orders honored throughout the system
  • Quality improvement process for form and system
  • MOLST Quality Audit Tool Approvals
  • Legal Review
  • Administrator
  • Ethics Committee
  • Forms Committee
  • Policy Committee
  • MOLST NYSDOH Approval Letter 1/16/06
  • Legal Issues
  • MOLST use in the community required legislation
  • approved by NYSDOH for use in health care facilities across New York State in October 2005
  • approved by NYSDOH for use in ALL settings, including the community throughout New York State in July 2008
  • Mandatory signatures for consent
  • varies for DNR and Life-Sustaining Treatment
  • Physician Signature required
  • NP/PA would need legislation
  • acceptable policies & procedures with current regulations
  • MOLST Education and TrainingTwo-Step Approach to Advance Care Planning
  • Advance Care Planning Facilitators
  • Community Conversations on Compassionate Care Program
  • MOLST Program
  • goal-based, patient-centered discussions
  • patient-centered program and process
  • educational resources on CompassionAndSupport.org
  • Program Implementation
  • facility: hospital, long term care, home care, hospice
  • physician practice – opportunity for process improvement
  • Community education
  • CCCC, MOLST, reliable information on web site
  • MOLST Education and TrainingTwo-Step Approach to Advance Care Planning
  • Use CCCC, MOLST videos and Web site
  • Obtain standardized educational materials from CompassionAndSupport.org
  • Medical and Dental Staff
  • mail educational materials to each provider
  • present at various business meetings
  • publish article in provider newsletter
  • educational materials available at different units
  • encourage use of on-line MOLST training
  • MOLST Education and Training Two-Step Approach to Advance Care Planning
  • Nursing
  • present at various meetings
  • present on each unit
  • send in-service packet as resource to each unit
  • establish Advance Directive liaisons as resource individuals
  • one for each nursing unit
  • attend educational program
  • meet monthly
  • Social Work / Care Managers
  • present at standing meetings
  • MOLST Education and Training Two-Step Approach to Advance Care Planning
  • Staff
  • letters to physicians from medical director
  • role of physician, RN, NP, PA, SW, Unit Clerk
  • how to initiate conversation
  • Family
  • integrate video into admission/discharge process
  • family/surrogate at patient care conferences
  • share CCCC and MOLST videos on facility TV
  • link to CompassionAndSupport.org Web site
  • videos in facility library
  • family council meetings and articles in newsletters
  • Distribution and Fulfillment
  • Distribution Center
  • centralized process to order forms, educational and training resources
  • tracking utilization and implementation
  • CompassionAndSupport.org home page
  • MOLST videos with CME/CE
  • MOLST Training Center
  • MOLST Trainers
  • Order MOLST Forms and other educational resources
  • Communication Plan
  • Communication Plan
  • internal
  • external
  • Messaging
  • consistent message
  • Prepare for interviews
  • consider 3 key messages
  • MOLST Program Initiation
  • Establish multidisciplinary team
  • Engage physician and system champions
  • Develop implementation plan
  • template at MOLST Training Center
  • MOLST LTC Implementation Process
  • interviews on MOLST video Honoring Patient Preferences
  • Develop educational training plan
  • template at MOLST Training Center
  • Educational Plan for Advance Directives and MOLST
  • Implementation
  • Establish start date
  • Start with all new admissions on all units
  • Provide units with supply of revised 2008 MOLST forms
  • Depending on degree of implementation, remove all old MOLST forms and/or old “DNR” forms and provide units with supply of revised 2008 MOLST forms
  • Scan into electronic medical record, as per protocol
  • Institute QI process to ensure accurate form completion
  • Lesson Learned: EMS Key to Success
  • Work in tandem with EMS
  • Have an EMS champion
  • Know how EMS works in your state and the regulations that bind them (state mandated out-of-hospital DNR forms)
  • Work with EMS medical directors
  • Listen to colleagues’ concerns
  • Related Search
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