PCQN QI Collaborative Screening for Spiritual Needs September 20, 2016
Agenda Data review Screening questions review & discussion Updates from teams Next steps 9/20/2016 2
Data Review 9/20/2016 3
Data Review 9/20/2016 4
Percent screened:7/25/16 9/16/16 (numbers represent # of patients screened) 100% 37 38 20 90% 80% 70% 60% 50% 68 13 34 33 21 18 41 35 156 81 27 88 17 97 55 25 53 61 22 81 48 89 25 53 64 33 76 54 74 28 44 40% 13 31 40 30% 20% 28 16 15 38 29 10% 0% CHOMP Scripps CV Baystate Sparrow Health Scripps LaJ UCCSF Mt Zion McLaren St. Joseph MC Christus St. M Marin Gen Baptist Health Lex Christus St. P SCVMC Mission UMASS Univ Christus Spohn S Spectrum Health Christus St. V Huntington Hoag San Joaquin GH John C Lincoln UCSF St. John PV Scripps SD St. John RMC USC Scripps Enc. Lakeland Providence LCM Riverside Scripps Green Queens Deer Valley Mercy General Beaumont Dearborn Henry Mayo Christus St. E Christus St. FC Overlake UMASS Health Alliance Bozeman 9/20/2016 5
Example Screening Questions Hoag 1. Where do you draw your strength? 2. What are the most important issues that have been raised for you by your illness? 3. In the past, what has helped you cope during the challenging moments of your life? 4. Are there particular beliefs or faith practices that give meaning to your life? Providence Little Co. of Mary 1. In difficult times, what brings you meaning or hope? 2. How have you felt connected to that during this illness/hospitalization? **Optional question if not already addressed: Do you have any religious beliefs or practices that are important to you? 9/20/2016 6
Mapping of Screening Questions Coping/Strength/Values Reglion/Spiritual practices HOPE FICA SPIRIT Providence Hoag UCSF PCQN NOS Do you have spiritual beliefs that help Where do you draw your strength? What gives you strength in difficult you cope with stress? times? What is there in your life that gives you internal support? What are the sources of hope, strength, comfort and peace? Is there a group of people you really love or are important to you? In difficult times, what brings you meaning or hope? How have you felt connected to that during this illness or hospitalization? What gives you strength/comfort in difficult times? How is that working? What are the most important issues that What are the most important issues What gives your life meaning? have been raised for you by your illness? that have been raised for you or your loved ones by your illness? What do you hold onto during difficult In the past, what has helped you cope Are you at peace? time? during the challenging moments of your How are you holding up? What sustains you and keeps you going? life? How are your spirits? Are you at peace? How do you feel you are coping? Do you consider yourself part of an Do you consider yourself spiritual or Do you have a formal religious Do you have a faith tradition or Do you belong to an organized organized religion? How important is that to religious? affiliation? Can you describe this? Do you have any religious beliefs or Are there particular beliefs or faith spiritual belief system? How is it religion? you? practices that are important to you? practices that give meaning to your life? helping or not helping now? What aspect of your religion are helpful and not so helpful to you? Are you part of a religious or spiritual community? Does it help you? How? Do you have personal spiritual beliefs that are independent of organized religion? What are they? Do you believe in God? What kind of relationship do you have with God? What aspects of your spiritual practices do you find most helpful to you personally? What importance does your faith or belief have in your life? Do you have a spiritual life that is important to you? Are you part of a spiritual or religious Describe the beliefs and practices of community? Is this of support to you and your religion that you personally accept. how? Describe those beliefs and practices that you do not accept or follow. In what ways is your religion or spirituality meaningful to you. Do you belong to any religious or spirtiual communities? How do you participate in them? What importance do they have for you? What types of support and help does or could they provide for you in dealing with health issues? Do you have a faith tradition? Is faith or spirituality important to you? Would you like a prayer? How do you get spiritual comfort? What specific practices do you carry out as part of your religious or spiritual life? Application to medical care Has being sick affected your ability to do things that usually help you spiritually? Have your beliefs influenced how you take care of yourself in this illness? As a doctor, is there anything that I may do What role do your beliefs play in to help you access the resources that usually regaining your health? help you? Are you worried about any conflicts between your beliefs and your medical situation/care decisions? Are there any specific practices or restrictions I should know about when providing your medical care? What lifestyle activities or practices do your religion encourage, discourage or forbid? To what extent do you follow those guidelines? Are there specific elements of medical care that your religion discourages or forbids? To what extent do you follow them? What aspects of your religion or spirituality would you like me to keep in mind as I care for you? How would you like me, your healthcare Are there particular aspects of medical provider, to address these issues in your care that you would wish to forgoe or healthcare? have withheld because of your religion/spirituality? Are there religious or spiritual practices or rituals that you would like to have available in the hospital or at home? What do I need to know about you (culture, family, religion) to give you the care you need? Are there religious or spiritual practices that you wish to plan for at the time of death or following death? As we plan for your medical care near the end of life, in what ways will your religion or spirituality influence your decisions? 9/20/2016 7
PDSA Updates 9/20/2016 8
PDSA Updates: ZSFG Baseline data: SMART goal: Current barriers and/or opp. for improvement: Unable to determine baseline information for patients screening positive from PCQN database for 2013 2015 {64.9% of patients screened positive } Short term: Develop and begin using standardized screening questions within PC by October 2016 Develop card on spiritual screening for broader dissemination November 2016 Long Term: Screen 90% of palliative care patients for spiritual care needs by June 2017 Lack of real time data entry into PCQN and difficult to evaluate impact of QI interventions Developing questions that are authentic to team members which are appropriate for patients and families from a literacy perspective and for diverse cultural and ethnic backgrounds with a high prevalence of LEP Varied background/comfort level of providers with spiritual care and screening Describe first test of change: Developing questions and finding agreement among the team Vetting the questions with literacy review and with the Interpretive Services Department Developing screening questions and card delineating positive answers to screens 9/20/2016 9
PDSA Updates: HOAG 9/20/2016 10
PDSA Updates: HOAG What are you currently doing to execute the plan? Describe what happened when you carried out the test of change. Observations, issues encountered. We have updated the data sheets and created pocket cards for the clinicians to use. Our chaplains have developed a documentation code that they use to allow our admin to easily pull the screening data onto our data sheet. We have discussed the same type of change with our physicians. Not sure anyone is actively using the pocket cards, but we have had a significant increase in discussion at daily IDTs and the focus on ensuring patients are screened has definitely increased. 9/20/2016 11
PDSA Updates: HOAG 7/1/16-8/31/16 Screened 46.9% Screened Pos 28.1% Intervened 96.8% Baseline screened positive: 19.1% Provide up-to-date data for your site. Act How is this plan working for you? Changes to your plan? Next steps? Additional tests of change? Physicians adding the screening to their symptom documentation template Looking at ways to partner with Chaplain Interns outside of CARES Program to expand the spirituality screen across the hospital Reallocating SW interns to assist in our Irvine location to increase breadth of screening 9/20/2016 12
PDSA Updates: UCSF Baseline Data: SMART Goal: Current barriers and/or opportunities for improvement: Describe first test of change: 65% of patients screened positive for spiritual needs between 7/1/2015 and 6/30/2016. We don t know what percentage of patients were screened. Screen 75% of patients for spiritual needs during the course of the inpatient palliative care consult (excluding patients who refuse the screening and who we are unable to screen). Clinicians of disciplines other than spiritual care don t consistently recognize it as their responsibility to screen for spiritual needs, and they also don t always feel confident knowing how to screen for spiritual needs. Clinicians pressed for time don t prioritize spiritual screening. Some clinicians feel concerned that a spiritual screen could reveal issues that they aren t able to address. Some clinicians worry that patients or family members might not be receptive to a spiritual screen, or that primary teams aren t interested in them doing this work. 1. Keep track of every instance when we do a spiritual screen, rather than simply when patients screen positive for spiritual needs, per revised PCQN data element 2. PC team uses 4 sample spiritual screening questions to standardize spiritual screening, lower barrier to spiritual screening, and bolster providers confidence in their ability to screen.
PDSA Updates: UCSF What are you currently doing to execute the plan? Describe what happened when you carried out the test of change. Observations, issues encountered. We have updated our PCQN yellow cards with new PCQN data element We have decided on suggested spiritual screening questions to ask We have incorporated them into our note templates in the EMR We have made a pocket card for clinicians We have made posters to help with awareness We scheduled time during our October team meeting to launch this project and seek input from all members of our team 9/20/2016 14
UCSF Card (Front) Screening for Spiritual Needs A simple probe to identify patients or family members with spiritual needs and/or distress who would benefit from further assessment or intervention. Can be done by any member of the palliative care team. Example of screening questions include, but not limited to: Do you have a faith tradition or spiritual belief system? If yes, how is it helping (or not helping) now? What gives you strength in difficult times? What are the most important issues that have been raised for you (or for your loved ones) by this illness? Are you at peace? How are your spirits? How do you feel you are coping? 9/20/2016 15
UCSF Card (Back) SCREEN POSITIVE: Themes expressed by patient/family warrant further assessment and intervention by a spiritual care provider. Themes include but are not limited to: Religious/theological themes Hopelessness or despair Inability to accept losses Feelings of abandonment by religious group or God, or anger at God Questioning meaning or purpose of illness, suffering, or life itself Feelings of guilt - feel self to be bad, sinful or unlovable Asking Why me? A history of broken relationships or need for reconciliation/forgiveness Evidence of poor coping Excessive guilt, regret or remorse Document on consult card and refer to chaplain if screen positive. 9/20/2016 16
Palliative Care Service Goal: Screen 75% of patients or their family for spiritual needs (excluding those who can t participate or decline screen) Example screening questions: How are your spirits? How are you coping? What gives you strength in difficult times? Do you have a faith tradition or spiritual belief system? If yes, how is it helping (or not helping) you now? What are the most important issues that have been raised by your illness? Themes that warrant further assessment by a spiritual care provider: Religious/theological themes Questioning meaning or purpose of illness or life itself Hopelessness Guilt Feelings of abandonment, need for reconciliation/forgiveness Asking why me?
PDSA Updates: UCSF Provide up-to-date data for your site. Starting after our October launch, we will review our spiritual screening data with our team every month: At our monthly meetings Via e-mail On posters in our rounding room and the bathroom across the hall ;-) Act How is this plan working for you? Changes to your plan? Next steps? Additional tests of change? We are saving time during our December team meeting to reflect on this project and update our plans 9/20/2016 18
Additional Updates? 9/20/2016 19
Next Steps 1. Continue to build & implement plans 2. In-person conference - report out? 3. Continuing spiritual screening project AND adding new project on anxiety screening & improvement 9/20/2016 20
Thank you! See you at the upcoming conference: October 13-14 OR on the next QI collaborative call: November 15 at 12:00pm PST Kara Bischoff: kara.bischoff@ucsf.edu Angela Marks: angela.marks@ucsf.edu 9/20/2016 21