PCQN QI Collaborative. Screening for Spiritual Needs & Anxiety Screening & Improvement January 16, 2017

Transcription

1 PCQN QI Collaborative Screening for Spiritual Needs & Anxiety Screening & Improvement January 16, 2017

2 Agenda Spiritual screening data Structure for anxiety QI collaborative Anxiety data Strategy exchange summary Discussion: How? Who? Facilitators and barriers? Next steps 1/17/2017 2

3 Percent Screened for Spiritual Needs: Monthly Trends 1/17/2017 3

4 Percent Screened for Spiritual Needs: Member Comparison Chart 1/17/2017 4

5 Percent Screened for Spiritual Needs: Monthly Trends 80% 70% 60% 50% 40% 30% 20% PCQN Spiritual Screen Collaborative 10% 0% 1/17/2017 5

6 Percent screened:7/25/16 01/09/16 (numbers represent # of patients screened) 100% 90% 80% 70% 60% % % 30% 20% % 0% 1/17/2017 6

7 Sustaining the Process Design the process to fit into a natural work flow Put ownership in a group Ensure data is readily accessible & visible

8 Anxiety: Screening & Improvement 1/17/2017 8

9 QI Collaborative Commitments Open to learning / willingness to experiment Share experiences Join as many calls as you can

10 Background Why Anxiety? PCQN Conference: 70% of cancer patients have symptoms of anxiety Many cancer patients develop PTSD-like symptoms Anxiety closely associated with pain 1/17/

11 QI Framework Amend your plan(s) Brainstorm opportunities for improve. Examine baseline data Set a SMART goal Make your plan specific (who, what, when) Report back to the group Keep track of your progress Try out your plan(s)

12 Goals of Anxiety QI Initiative Primary: Increase % of pts screened for anxiety (at first visit and during overall admission) Increase % of pts with improved anxiety from 1 st to last assessment Secondary: Identify & implement best practices for screening pts for anxiety Improve our understanding of how to address anxiety with our patients

13 PCQN Anxiety Data - Inpatient 1/1/ /31/ % of patients were screened for anxiety at time of first symptom assessment

14 PCQN Anxiety Data - Inpatient 1/1/ /31/ % of patients were screened for anxiety during course of consultation.

15 PCQN Anxiety Data - Inpatient 1/1/ /31/ % of patients improved from 1 st to 2 nd assessment. 83.3% of patients improved from 1 st to last assessment

16 PCQN Data: Anxiety improvement Young people are less likely to improve Men & women equally likely to improve No significant differences by diagnosis Pain improvement is a/w anxiety improvement Anxiety improvement is a/w POLST completion Anxiety improvement a/w discharge to hospice Anxiety improvement is a/w shorter hospital LOS 1/17/

17 PCQN Report Variables (Trend, MC) Anxiety symptom assess first visit Anxiety symptom assess entire consult Symptom improvement anxiety

18 Summary of Strategy Exchange How do you typically screen for/assess anxiety in patients? Ask patient directly (0-10; 0-3 scale), use related words, or intuit from story Use validated instrument (e.g. NCCN distress thermometer) Ask family member / caregiver Incorporate into questions about psychosocial concerns Suggestions from Dr. Scott Irwin: Do you worry a lot? Are you often fearful? Do you feel anxious, nervous, or on edge? Would your friends or family say that you are a worrier? How s your sleep? Screening tools: HADS, GAD-7, PCQ-4 1/17/

19 Summary of Strategy Exchange What challenges have you encountered: Time What questions? How & who? Difficult to rate Seems obvious and/or suggestive to talk about Team discomfort / lack of training or tools Patient or family discomfort Cultural differences Difficult with intubated pts and patients w/ dementia 1/17/

20 Summary of Strategy Exchange What strategies have been helpful? Normalizing Asking open ended questions; Using words other than anxiety (e.g. worry, nervous) Use all members of the PC team Involve family Disconnect w/ technology Just do it! 1/17/

21 Summary of Strategy Exchange Treatments & Techniques: Listening, allowing patients to tell their story Normalizing, providing education to patient and family Giving patients sense of control (environmental, shared decision making, ACP) Spiritual or social work support Multimodal, integrative therapies Medications 1/17/

22 Management Supportive counseling Relaxation techniques Pharmacotherapy Combinations are best Slide from: Dr. Scott Irwin

23 Management: Supportive Counseling Weave into routine care Include family when possible Identify pt & family strengths, coping strategies Improve understanding of situation Educate about modifiable factors Create a different perspective Slide from: Dr. Scott Irwin

24 Management: Complimentary Therapies Guided Imagery Muscle relaxation Hypnosis Meditation Massage Aromatherapy Healing touch Energy therapy Biofeedback Exercise (if possible) Bright light exposure Avoid caffeine, alcohol Treat insomnia Slide from: Dr. Scott Irwin Payne DK, Massie MJ. Anxiety in palliative care. In: Breitbart W, ed. Handbook of Psychiatry in Palliative Medicine. New York, NY: Oxford University Press; 2000:435 Carter C, Holloway R, Schwenk TL. Patient Care. November 15,1994:36 52.

25 Management Medications Benzodiazepines SSRIs Gabapentin (100 mg q1hr) Trazodone (25-50 mg q1hr) Buspirone

26 Discussion of Screening 1. How can we best screen for anxiety? Not consistent Physicians mostly ask about anxiety directly Multi-question tool may not be realistic inpt Is it kosher to have family input? Different patients may relate to different screening questions; analogies to spiritual screening here Value of asking directly, though word choice may vary (anxiety, worried, concerned, stressed, nervous, on edge, sleep/keeps them awake at night) Just talk about it, perceived barriers > real barriers?, pts may be receptive Helpful to involve family when patients are non-verbal, signs of anxiety Pick up on non-verbal queues and reflect on it 1/17/

27 Discussion of Screening 2. Who should screen for anxiety and when? Bedside nurses, social work Every encounter Different members of the team may get different responses 3. What will facilitate practice improvement for your team? How will you overcome barriers? 1/17/

28 Discussion of Screening 3. What will facilitate practice improvement for your team? How will you overcome barriers? Discussion w entire team Anxiety screening needs to be paired with ability to intervene Keep track of this data 1/17/

29 Next Steps 1/17/

30 STEP 1: Plan Examine baseline data and current process Set a SMART improvement goal: Specific Measureable Achievable Relevant Time-Bound Make a plan for 1 st step(s) to achieve this goal

31 Thank you! See you on the next QI collaborative call: February 14 at 12:00pm PST Kara Bischoff: Angela Marks: Rachel Stone: 1/17/