Pondering Pediatrics in Palliative Practice. PCQN Conference Call

Transcription

1 Pondering Pediatrics in Palliative Practice PCQN Conference Call

2 UHS Pallia?ve Medicine Team 1 Administra,ve Leadership - Dr. Bryan Alsip 1 Director- Julieanne Wisloff 4 Physicians- 3 adult, 1 Pediatric - Dr. Jason Morrow, Dr. Jennifer Healy, Dr. Ka?e Stowers, Dr. Glen Medellin 2 Advanced Prac,ce Nurses - MaryJo Perly, hire 2 Nurses (LVN s)/acp Facilitators - Becky Pompa, Edson Or?z 2 Chaplains (1 Adult, 1 Pedi) - Janet Tracey, Veronica Ybarra 2 Social Workers (1 Adult, 1 Pedi) - Susan Gardner, hire 1 Opera,ons Manager - Erin Sidle 1 Pediatric Program Developer - Emiko Dudley

3 Joint Commission Cer?fica?on Successful cer?fica?on by the TJC in April 2013 Only three programs in the na?on to have received zero official findings One of only three Joint Commissioned Cer?fied pallia?ve care programs in the en?re state of Texas Interdisciplinary note in the EMR cited as a na?onal best prac?ce Successfully recer?fied in May 2015

4 Program Development Joint Commission states that ALL services offered to the adult popula?on of a system must be fully and equally offered to the pediatric popula?on of that system to be recognized for cer?fica?on. New 2015 JC standards were released in July giving further details of the requirements specific to pediatrics in a pallia?ve care se_ng.

5 Pallia?ve Care Team Growth Summer FTE physicians March 2012 Social Worker November 2012 Chaplain Spring 2013 Joint Commission Cer?fica?on Nurse Prac??oner ACP Coordinator ACP facilitator/ Case Manager Spring 2014 Nurse Prac??oner 0.7 FTE Physician Fall 2014 Increase in pediatric nursing support Pediatric Chaplain

6 Pediatric Pallia?ve Care Program 2015 Led by Dr. Glen Medellin Program Developer- Emiko Dudley, RN Current FTE Opening for a Pediatric NP Pediatric Chaplain- Veronica Ybarra Pediatric Pallia?ve Fellow- Rachel Vandermeer, MD Current FTE Opening for a Pediatric PC Social Worker

7 Key Players Per Joint Commission standards PCPM.7- the core interdisciplinary program team consists of: 1. Licensed Independent Prac??oner 2. Registered Nurse 3. Chaplain 4. Social Worker

8 Pedi- Players Dream List Child Life Specialist Educa3on Specialist Nutri3onist Pediatric Pharmacist Pedi Trained Psychologist Pedi Physical Therapist

9 Popula?on Focus Perinatal Neonatal Pediatric Adolescent Adult ***** (why adult???)

10 Bridging the Gap Many Pediatric Pallia?ve Care pa?ents technically age out of the pediatric realm of prac?ce. But due to their disease process being pediatric in scope, their cogni?ve age level, physician specialty, or family comfort/trust and familiarity, they stay with their pediatric PC prac??oner. This causes many problems specific to a pediatric PC prac?ce.

11 Pedi Problems This produces an overwhelming burden to the prac?ce numbers. While there is always a con?nual onboarding on new pa?ents in need of PC, there is very lijle off boarding to make room for these new pa?ents. This off boarding cannot be a simple transfer of care. There must be a transfer of trust to a new provider that takes a lengthy period of cross coverage between the pediatric prac??oner and the new adult prac??oner.

12 Pedi Problems Finding a prac??oner with knowledge of the pediatric related disease process, but prac?ces in the adult world. At some point, insurance becomes a issue. Coverage for pediatric providers when the pa?ents technically qualifies in the adult range of insurances can be ques?oned. CHIPS may not be the best coverage. Pediatric providers are VERY vested in their pa?ents! They don t hand over care willingly at?mes. They have a long standing rela?onship with some of these pa?ents and their families and it becomes a majer of personal interest to the provider. This is problem but it is over all a posi?ve one!

13 So.what data majers??? Number of pa?ents by age group Number of pa?ents by disease process Death by age group Death by disease process Ethnicity LOS Interven?ons Pain control

14 - Data con?nued- Cons?pa?on/interven?on Family dynamic Spiritual interven?ons Readmission Coverage Hospice Disposi?on Trach/peg interven?on Outpa?ent/clinic se_ng data

15 Challenges in Data Collec?on Family resistance to divulge informa?on Can be difficult to assess pain in certain age groups Physician resistance to convey data EMR challenges/data retrieval methods Manpower of data collec?on Validity of data System support and value

16 Conclusion As Pallia?ve Care prac?ces grow, the inclusion of the pediatric popula?on must be taken in to considera?on. In 2012, CAPC sent a survey to 226 exis?ng PC programs na?onwide. 162 responded with 69% having ac?ve Pediatric PC programs. The total % of Pediatric PC programs out of the 226 is actually 49.6% regardless of response. So as you can see there is room for growth!