Hey Everyone,

Some updates from your Palliative Care Champion:

- The Eight Annual Current Perspective on Palliative Care in the Acute Care Setting is Monday Oct
28th and Tuesday Oct 29th
- We are still looking at the ongoing issue of the healthcare directive section not being completed fully
* Make sure to chart on the healthcare directive section during an admission
- Joint Commission is coming November 12th for Advanced Certification in Palliative Care
* What this means for you is that they will follow patients through the hospital and may ask you
questions about palliative care
* Attached is the Joint Commission Jeopardy. Look over these questions and answers to be
prepared!
Let me know if you have any questions

Caitlin Kowalski




Hey ACE RNs,
A couple updates from Palliative Care:
- Tomorrow Joint Comission is coming! A cheat sheet is posted in the nursing lounge and at the
charge nurse desk.
- We still need to work on Advance Directive (AD) charting
Quick tip: A patient can't have a MDPOA and a Med Proxy. If there is no paperwork then
they are a Med Proxy even if they say they are the MDPOA. Once we get the paperwork we
can change it.
Attached is a flowsheet to help you better understand AD when charting in the history tab
A daily report has been printing out letting us know which patient's AD has not been
reviewed. Either Greg or the charge nurse will be addressing this each day with the
patients RN.
The next audit is in December so make sure to be checking your AD and making sure they
are complete!
Thanks
Caitlin Kowalski



Kowalski, Caitlin R
Sat 11/16/2013 10:43 AM
Palliative Care; Palliative Care
To: UCH-AIP Med-Pav RN

Hey Everyone,
As the palliative care champion I know that completing Advance Directives (AD) in EPIC is an issue
hospital wide. For my unit project I am going to educate all the floor nurses on our unit one-on-one
about AD, our policy on AD, articles on AD, and how to correctly complete the AD section in EPIC. I
am hoping this will help decrease our number of AD not being reviewed on our daily print off.

I have talked with Greg PSC about the daily print off of unreview AD and he will be contacting the
patient's nurse to look over the AD. I made a binder located at the PSC desk where we are going
to keep the daily print offs.

Thanks
Caitlin Kowalski


Few updates from Palliative Care
* Just a reminder the Palliative Care beds are 4 floating beds on the 11th floor. These are NOT hospice
beds. A palliative care consult order must be ordered prior to moving a patient to these beds and are
for patients with a high acuity needs for symptom management.
* The healthcare directive tab has a new "content of Advance Directive" freetext line were MDs
and RN can insert information. The Palliative Care team will be writing in this too
* The Advance Directive Dec audit is attached. Our unit did better than the previous audit but we
still had one patient where both the MDPOA and Med Proxy were filled out. It can only be one or the
other, not both. We also had some surrogates documented incorrectly which means either
nothing was documented, it was filled out as MDPOA but there was no paperwork, or it was charted
as a Med Proxy but there was paperwork in the media tab for an MDPOA.

A suggestion to help fix this is to check the media tab first and see if the paperwork has been scanned
to HMI and make sure you are filling out the Advance Directive section correctly.

The next audit is in May and I am hoping we improve even more :)

* Remember to add the Red light/Green light for the Admit Req Doc for a visual cue to know if all of
the admission has been completed. If you need help adding this let me know!

Caitlin Kowalski


Updates from Palliative Care
-New Advance Directive healthstreams are coming out to help RNs understand how to correctly fill
out the history section under the admission tab
- We still need improvement for charting on advance directives. Here are a couple different things we
can start doing to improve.
I have talked with Greg PSC and he will be looking at the redlight/greenlight icon for the
admission documentation in EPIC and be contacting the RN if they have a redlight for one
of their patients
When do LOOK report for change of shift look at the history section to see if the patient
has a Med Proxy or MDPOA. If they don't make sure to get a contact number during your
shift
I have noticed the our main problem is incorrect surrogates charted
o patient has MDPOA in chart review but in history section the same person isn't
listed- Make sure to look and see if patient has advance directive in their chart
review first .
o Remember if patient says they have an MDPOA but doesn't have the paperwork
then chart it as a medical proxy and once we get the paperwork we will change in in
EPIC
The next audit is in MAY. Lets do better this time around
Complete the history section during admission but remember to check it when a patient is
transferred to our floor and keep an eye out for your redlights!
- We are working on changing the view of the history section in EPIC so it's easier to understand and
less errors. This will take awhile to do

Caitlin Kowalski, RN, BSN
Charge Nurse
12th Floor ACE Medicine
University of Colorado Hospital


Updates from Palliative Care Champion meeting
-Advance Directive healthstream is here! Be looking for it.
- Attached is Top 10 Questions about Advance Directives. I thought this would be helpful for everyone
to have. This will also be included in the new Advance Directive policy
- Next AD audit is in May, let's improve from our last audit in December.

Caitlin Kowalski


Updates from Palliative Care

1. Annual Palliative Care Conference Oct 27th-28th
2. Next Advance Directive audits will be May 13th. Make sure your history section is filled
out correctly :)
1. Also is important not only for audit but for when Joint Commission comes
3. EPIC change
1. June 8th Advance Directive will be it's own tab under admission (not buried under
history tab anymore)
2. Waiting for approval to change the Advance Directive screen (hopefully June 8th)
3. Changes with red light/ green light icon- Med proxy, MDPOA, or general contact
will have to be filled out in order for icon to change to green (change will probably
happen June 8th)
Thanks
Caitlin Kowalski


Hello all,
Some exciting news! Today at the Palliative Care Champions meeting we discussed the advance
directive audits. We were one of three units with the most consistent improvement for correct
decision makers charted under the history tab. Our audit for incorrect decision makers in Sept 2013
was 8, December 2013 was 5 and this last audit May 2014 was 3. Keep up the great work on
completing the history tab for advance directives correctly. Remember if you need resources about
advance directives you can contact me, go the Palliative Care on the HUB, or if you can't find the
answer you can Palliative Care team. With the new Advance Directive policy there will be a link to
"Top 10 Questions".

Don't forget the 9th annual Palliative Care Conference will be Oct 27th-28th!

Caitlin Kowalski