Pain Management and symptom control:

Targets

• 100% routine assessment of pain, depression, dyspnea, anxiety

• Use of all appropriate modalities and severe symptoms always quickly appropriately, aggressively, managed with skilled consultants available in all settings.

• Pt and family expect comfort, competence, involvement in decisions and care.

• Routine review of care and system feedback for QI, public education.
   

Sample Aims

• 100% Compliance with assessment protocols

• Guaranteed initial assessment of serious pain within 5 min in hospital, 15 min nursing home and initial intervention within 15 min hospital, 1 hour in nursing home or home.

• All patients have pain <5 in last 2 days of life, per family report.

• Reduce by 50% number who report pain >5 in a time period.

Advanced care planning:

Targets

• Likely course of disease including potential urgent complications and major decision points articulated and written for al chronically ill patients

• Plans written for all aspects of “last phase of life”.  One setting, one set of providers honoring plans with family and communicating throughout healthcare system.  Services provided as complications develop

Sample Aims

• Decrease unplanned admissions by 50%

• Patients/families are aware of eventual fatal nature of disease >75% of those so identified

• Written care plan documents priorities and plans for >80% of those in “last phase of life”

• ER and 911 use decline by 50% in target population

• Plans for after death made and documented for 50%

Family and Meaningfulness:

Targets

• Center the experience in terms of spirituality and meaning rather than medical/physiological issues.

• Make relationships central so care providers habits are subservient.

• Use episodes of serious illness as “dress rehearsals” for eventual death.

• Create rituals that mark stages.

• Always reassure counsel family pre- and post death.

Sample Aims

• Have >90% of families report they would want same care as their loved one received

• Increase by 50% rate at which families agree the last weeks or months were especially meaningful

• Have >90% of families report families emotional state was noticed and responded to, cannot, recall a time they were “kept in the dark”, heard an uncaring remark from a provider.

Continuity of Care

Targets

• People dying with cancer, old age, dementia virtually always die where they live.  Services and family support mobilized to these settings.

• People requiring more nursing care die in places under care of someone who knows them, in some family-attentive setting

• Not transfers for utilization issues in last 2 days of life.

• Changing key personnel viewed as unfortunate and uncommon.

Sample Aims

• For cancer patients, >50% are in hospice >4 weeks and <20% are in hospice for <2 weeks.

• <10% deaths have change in setting in last 2 days

• >80% in nursing homes should die there with good care

• 90% families know who was on charge and how to reach that person at all times.

• DNR orders in 1 setting are transferred to another all the time.

For more information contact Patty Launer.

Email: mail@vpqhc.org
Phone: 802.229.2152
Fax: 802.229.5098

Vermont Program for Quality in Health Care, Inc.
132 Main Street, P.O. Box 1356, Montpelier, VT 05601