Transcript Hospital Survey on Patient Safety Culture

Belle Morte Committee:
Seeking to Improve End-of-Life
Care at Loyola
Confidential: Quality Improvement Material
Team Membership
Barbara Pudelek RN, MSN, ACNP
Judy Mc Hugh RN MSN
Beverly Kopala PhD RN
Lawrence Reuter SJ
Caroline Kelly RN, BSN, MSC
Marie Shanahan RN
Christine Adams RN
Marie Coglianese MPS
Daniel Dilling MD
Marilyn Reinish RN MSW
Jacalyn Kareb RN MS CHPN
Mary Kay Larson MSN, NP
Jeanne Sadlik MLS
Pam Clementi PhD RN
Karen Thomas MS RN
Rita Vercruysse RN, BSN MPH
Kathleen Fujiu BSN, MBA
Susan Tuzik RN MSN
Kathy Supple ANP
Theresa Kristopaitis MD
Katherine Wasson PhD, MPH
Valerie Bednar RN
Confidential: Quality Improvement Material
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Belle Morte
Belle Morte, which translates to ‘beautiful death,’ is a multidisciplinary
committee created to evaluate and reduce restraint use in patients during
end-of-life, in response to CMS requirements.
The committee was charged to improve practices within the scope of nursing
to improve end-of-life care for patients, in and outside the critical care areas.
We began by examining current, institutional data on restraint use in patients
at or near time of death. This provided a problem-focused trigger to which
the University of Iowa Model for Evidence Based Practice was applied.
Titler, M.G. et al. (2001) The Iowa Model of Evidence-Based Practice to promote quality care.
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Aim Statement
Decrease the use of restraints during the end of life
process
Evaluate
data on restraint-related deaths in response to CMS requirements.
Evaluate the removal of restraints at EOL if patient will not be harmed.
Review Policy & Procedure on restraints to include discontinuing restraints
during the dying process.
Develop educational tools and training programs in providing end-of-life care
in response to an Educational Needs Survey.
Create Multidisciplinary Bioethical Rounds to address end-of-life issues.
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Solutions Implemented
Evaluated data on restraint-related deaths in response to CMS requirement.
 Developed a multidisciplinary committee as joint effort of the Nursing Quality
and Safety and Nurse Practice Councils to explore end-of-life care and use of
restraints at Loyola.
 Followed Iowa Model for Evidence-Based Practice to examine current practices
at Loyola and current best practices.
 Reviewed and internally reported on relevant literature and research.
 Identified four areas of need:
 Development of staff education and training in end-of-life skills.
 To examine potential cost savings by using a Palliative Care Consult Team.
 Identification of a Physician Champion to lead consult team.
 Development and completion of an on-line EOL needs assessment survey
for RN Staff, Social Workers, and Nursing/Medical Students.

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Solutions Implemented

Presented Belle Morte Project at the Evidenced-based Practice Day and Shared
Governance Day
 Authored
article on Belle Morte Committee in “Nurse Link”, February, 2009.

Produced and presented ELNEC Core Curriculum two-day course March, 2009.

Held a round-table discussion with Belle Morte members and Palliative Care
expert, Dr. Winifred Teuteberg, as to steps to begin multidisciplinary bioethical
rounds.

Designed and developed MICU Bioethics Rounds.

Presented proposed policy changes regarding use of restraints in end-of-life care
at Restraint Reduction Liaison Committee meeting.
Confidential: Quality Improvement Material
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Results
Confidential:
Quality
Improvement
Material
Confidential: Quality
Improvement
Material
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Analysis of Data

Restraint use during EOL as a process (CMS Restraint
Death Reporting) has decreased from 35.4 % in the
1st Q CY 08 to 11% in the 4th Q CY 08.

Restraint use at time of death has decreased from 38.8%
in the in the 1st Q CY 08 to 0% in the 4th Q CY 08.
Confidential: Quality Improvement Material
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Next Steps
Include
guidelines for the use of restraints at EOL within Restraint Policy and
procedure and educate staff to new guidelines.
Work
with Ethicists and Pastoral Care to assist physicians and nurses in the
active process of caring for patients and families at EOL.
Establish
Multidisciplinary Bioethics Rounds and present case studies to
address challenges in caring for patients and families at EOL.
Continue
educational opportunities for healthcare providers in promoting
Belle Morte (Beautiful Death), including an E-Learning Module.
Establish
a support group for caregivers in dealing with EOL issues affecting
their personal and professional lives.
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