Development of an Integrated EMR Across Multiple Hospitals to Meet The Joint Commission’s Standards for Inpatient Palliative Care (FR460)

Abstract

ObjectivesDiscuss the spectrum of usages of the term palliative sedation in clinical practice. Evaluate the scientific evidence regarding the effects and efficacy of palliative sedation to relieve suffering.Discuss the ethical claim that sedation to unconsciousness is inherently questionable. Palliative sedation is widely practiced as a method of last resort to alleviate intractable suffering at the end of life. Recently concerns have arisen over whether the procedure creates suffering or does irreparable harm to the integrity of the dying person. The two goals of this workshop are to (a) consider the different understandings of palliative sedation common in clinical practice and (b) examine the validity of the scientific and ethical objections to palliative sedation. The questions we will address include the following: Can we reliable identify those people for whom palliative sedation may be useful? Is it ever harmful? Can we effectively mitigate that harm, if it exists? We will begin with a summary of the definitions of palliative sedation by professional bodies and a review of how providers in clinical practice operationalize those definitions. Next we will review the scientific claim that we lack the clinical and radiologic tools to determine whether noncommunicative people remain in pain and the ethical claim that sedation to unconsciousness is inherently questionable. Case studies will be used to determine the clinical relevance of these challenges and the difficulties encountered in clinical practice when faced with intractable suffering. By the end of this session, it is anticipated that participants will be able to provide a definition of palliative sedation and discuss some of the more recent ethical and scientific objections to the practice identified in the literature. ObjectivesDefine the need for an effective EMR to improve patient care and meet industry standards.Describe the elements needed for The Joint Commission's accreditation for palliative care. Identify measureable operational, clinical, and financial outcomes. The Joint Commission (TJC) established advanced certification for palliative care programs. The electronic medical record (EMR) provides an opportunity to meet these standards. There are multiple delivery systems that hospital programs use to deliver palliative care. CHE Trinity is the second largest Catholic healthcare system in the country, serving 21 states nationwide, and is standardized using the Cerner EMR system of Powerchart. Palliative care was identified as a system-wide strategic initiative for FY 13-FY 16 . The FY 13 focus was in the acute care setting, and two of three key deliverables were to standardize and centralize documentation and data reporting. It was determined to incorporate both TJC certification standards and NQF palliative care endorsed measurement standards in an effective and user friendly format that meets the need of the palliative care core team. Two workgroups were initiated, documentation and metric, that would support the subsequent delivery system ...