Inland Empire Palliative Care Coalition (IEPCC) Description

The Inland Empire Palliative Care Coalition (IEPCC) is a non-profit organization operating under the Riverside County Medical Association. The IEPCC formed in 2005, when stakeholders within the healthcare community came together to evaluate the most effective approach to bringing comfort to individuals with chronic illnesses and their families in the Inland Empire. The Inland Empire is located in Southern California and includes San Bernardino and Riverside Counties.

Problem

Limited awareness and communication of patients’ preferred intensity of end-of-life care wishes across their continuum of care.

Process to Resolve Problem

We hypothesized that using a community-based approach to implementing Physicians’ Orders for Life Sustaining Treatment (POLST) in the Inland Empire would increase awareness and fulfillment of patients’ wishes for life-sustaining care.

One of the greatest challenges in palliative care is how to ensure that patients’ wishes for the preferred intensity of care are respected across the continuum of care. Through collaborative research, the IEPCC focused its effort on the lack of clear and adequate communication on end-of-life care between providers, patients, and facilities. This led the IEPCC to choose the POLST paradigm, developed by the Center for Ethics in Health Care at Oregon Health & Science University. This validated model is a standardized form, which is typically completed by the patient and their primary care physician—traveling with the patient through all points of care. The POLST form is complementary to the patient’s advance directive and does not replace it. The benefits of the POLST paradigm include the following:

1. It ensures higher compliance with patients’ end-of-life treatment desires,
2. It increases communication at all points-of-care,
3. It standardizes the approach used for establishing a patient’s wishes for preferred intensity of care (PIC).
4. It travels with the patient and is accepted by all providers—including emergency departments, emergency medical services, skilled nursing facilities, hospitals, and physicians.

Adopting a community-based approach,the IEPCC’s working group, comprised of volunteer representatives from hospices, hospitals, chaplains, nurses, physicians, nursing homes, and health care management organizations, developed a multi-phased approach to implement the POLST paradigm. The implementation of the POLST focused on educating the patients as well as healthcare providers at all points along the continuum. Key to the educational component was the utilization of a champion, a member actively involved in the healthcare and senior community.

Outcomes

Currently, 100 % of the pilot sites have been educated on the use of the POLST form. The IEPCC implemented the POLST form at 2 community hospitals, 4 nursing homes, 1 assisted living facility, local EMS, and 3 hospices. One factor that we attribute to the form’s success is that the POLST form is standardized across all sites. The IEPCC observed increased utilization of the form, as well as an increasing interest in its use by other facilities. Just weeks following the initial implementation of the POLST form, the IEPCC had 2 requests from sites to be trained on its use.

Lessons Learned:

The IEPCC community based approach to implementing the POLST has proven that a volunteer organization can be effective in improving the communication around patient’s preferred intensity of care. The initial implementation shows that further education must be undertaken to clarify the differences between the POLST form and the advance directive. Further, work must be done to ensure patient’s wishes for preferred intensity of care are maintained across the healthcare continuum.