Multicare Health System Description

Multicare Health System includes 4 community hospitals and approximately 90 outpatient clinics. Our palliative program has been in its "infancy" for several years, but we've seen significant over the past 18 months. We have focused our efforts in the critical care areas. Our goal is to expand support into the CHF and out-patient oncology clinics. We have been focusing our efforts in the critical care areas; our goal is to expand support into the CHF and out-patient oncology clinics. We just hired 2 new physicians (Drs Mosby and Shah) and we look forward to getting acquainted at the CAPC Grapevine conference!

Description of Topic

Palliative care research often addresses the importance of providing bereavement support. Many hospitals provide bereavement packets containing resource lists as well as specific information that explains the grieving process. At Multicare we take this to the next level and provide follow up.

These are the steps of our Critical Care Bereavement Follow Up

• We display a poster in the staff lounges of our ICUs. When a patient dies, a note with their name, room number, date of death, and other pertinent information is completed. In addition, a blank card with a beautiful Pacific Northwest scene is posted for approximately 2 weeks; RNs, physicians, and RTs who cared for the patient may write notes to the family. We also commit to a follow up phone call in a few months.
• At 2 to 3 months the RN who primarily cared for the patient or the palliative team coordinator follow through and place a call to the family. Generally the calls are relatively brief and the family member expresses normal sadness as well as appreciation for care delivered; however, there have been several occasion, however, when the family member's lingering questions have been addressed and significant concerns allayed.
• We send a card at 6 months to acknowledge that the changing seasons can bring new layers of sadness. The care team's continued awareness of the family's grief is expressed.
• On the 1 year anniversary, a final card is sent to commemorate the patient's death. (On rare occasions - generally young trauma patients - a 2 year anniversary letter is also sent.)

Impact on Program

The significance of support given by staff at the end of life is underscored by the efforts of our Critical Care Bereavement Follow Up. Palliative care emphasizes the significance of emotional support and bereavement recognition. This project has impacted our palliative program and has helped to bring about a cultural change in our critical care areas. By including caregivers in bereavement follow up, we emphasized their "ownership" of the palliative approach. Our palliative team members can not always be present to provide direct support when a family's loved one is dying. We have developed rituals to assist a family in their "final goodbyes." Handprints, locks of hair, and keepsake photography are available if a family so desires. All of these efforts aid our physicians, nurses, respiratory therapists, social workers, and chaplains in recognizing their role in creating sacred memories when people are experiencing a death in their family.

Lessons Learned

The technical approach of critical care medicine must be softened with efforts to reach out in caring ways. Bereaved families, as well as the staff involved in Critical Care Bereavement Follow Up, benefit when we acknowledge the tender, human side of our important work.