"EXCEL" Meeting Minutes
February 15, 2000
 

Present: Diana Peirce, Tim Thompson, MD, Denise Niemira, MD, Virginia Fry, John Campbell, Marie Whedon, Judy Hills, MD, Arnold Golodetz, MD, Julie Tonks, Lori Waite, Madeleine Mongan

EMS DNR

John Campbell met with Ellen Thompson and Dan Manz from the Department of Health, and explained that VMS and EXCEL are interested in playing a leadership role in establishing a procedure to ensure that DNR Orders and Advance Directives are used in community settings and followed by emergency personnel. Denise has obtained an article about how other states address this and Diana suggested that a model from Connecticut be looked at. Judith Hills and Madeleine will participate as this effort moves forward.

DAD Funding Update

Diana Peirce and others have participated in various meetings with DAD. As best we can figure out, DAD is working on an RFP for 3 community end-of-life care coordination and quality improvement projects that will include nursing homes and other providers and facilities in the three communities. There will be $10,000 to $30,000 available for each community. Additional money may be available to support the two annual end of life conferences - VEN and Hospice Council, and to support work by VPQHC.

Standing Guideline Orders
This task force has completed its work developing standing orders for symptom management at the end of life, which has been circulated through the list serve. The standing orders have been approved by the clinical group of the Vermont Hospice Council. The EXCEL group and the VMS Medical Ethics committee voted unanimously to approve the report, which will be submitted to the VMS Council for approval on March 25. Diana Peirce and Tim Thompson will present the report to the Council. The guideline orders report will then be circulated to hospital medical staff and nursing homes.

Pharmaceutical
Maura McClure has been leading this group that has been looking at a formulary of end-of-life drugs, which Maura will circulate. Because its numbers have dwindled, this task force will be combined with the standing order group.

Pain as a 5th Vital Sign
This group, Marie Whedon, Jim Hunt, Rose Lemieux and Pam Murray, developed a brief survey and cover letter to send to acute care hospitals and nursing homes to determine the status of pain assessments in these institutions. Marie will work with VMS to ensure that the letter is circulated.

Standards for End of Life Care - VPQHC Quality Page
Denise Niemira, MD, chair of this group has been working with Virginia Fry, from the Hospice Council and Lori Waite and Cy Jordan, MD from VPQHC to design a page on end of life care to include in VPQHC's annual report on health care quality in Vermont. Denise and Ginny will work with Lori to edit and finalize this page.

Hospital Mission Statement
This group is working to establish model sites in 3 or 4 hospitals that would develop mission statements and meaningful end-of-life care programs that will be ultimately be expanded statewide. Tim, Denise and Arnold will work to develop a presentation to make to the Vermont Association of Hospitals and Health Systems at their board meeting. EXCEL would request funding from the hospitals, and in return would offer (1) to make presentations to trustees, administrators and medical staff about palliative care; (2) to make educational presentations to physicians and nurses about pain and symptom management; (3) to support local palliative care initiatives and services and (4) promote a network of communication between tertiaries and local hospitals/providers regarding terminal patients who are transitioned between settings in the final phases of life.

Julie Tonks described a VAHHS program on ethical decision making that will look at decisions at the end of life that Denise had brought to the attention of EXCEl participants. The VAHHS is presenting this program on March 22, 2000 in Lebanon. The program is designed for trustees, chairs of hospital ethics committees, presidents of medical staffs, and CEO's, but others could attend. Robert Potter, from the Midwest Bioethics Center will be the speaker. Contact Julie Tonks at 223-3461 for more information.

Hospice /EXCEL Conference June 8 and June 9, 2000 at Lake Morey
Ginny asked for feedback on a proposed speaker, Dr. Eugenie Obbens from the Netherlands who was part of the World Health Organization's cancer pain initiative on symptom control. She needs to hear ASAP. She will be circulating the agenda on the web page.

EPEC Update

Judy Hills is using part of the EPEC curriculum with medical students. Diana Peirce, John Valentine and Marilyn Hart are planning a series of noontime discussions for CVMC medical staff on end-of life care. EPEC might be used for this, but it is so massive that it is difficult to sift through it to get useful presentation pieces. A question was raised as to whether this was something that would be appropriate for VPQHC to do. Arnold felt that VPQHC would be most useful in identifying baseline and improvement measurements with respect to high quality end of life care. These measurements and feedback loops could be used to let doctors, nurses and facilities compare how they are doing vis a vis their peers.

DUR

David Fassler, MD has been asked to participate in the DUR advisory group. Tim Thompson, MD and/or Cy Jordan, MD will contact him to discuss ways to use Medicaid data to study and improve end-of-life prescribing.

NEXT MEETINGS:

Tuesday, March 14th 2 to 4 pm at VMS - FACE TO FACE MEETING