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Avista Hospital and TCPBC
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The Conversation Project at Avista Hospital

Amanda sat down with Avista Hospital’s Chief Nursing Officer, Susan Caneva to discuss the adoption and integration of The Conversation Project in Boulder County tools into their advance care planning (ACP) process. Check out the interview below. Congratulations to Avista for proactively addressing the importance of ACP in the patient experience!

How did Avista learn about The Conversation Project in Boulder County (TCPBC) and why did it appeal to your team?

Dr. Jean Abbott brought TCPBC to our ethics committee and shared the concept of “the conversation” as well as the tools. Many of the cases that come through our ethics committee are around how to make decisions for people without advance care planning (ACP) in place. We liked the idea of assisting patients and families to have these conversations earlier so that their wishes can be taken into account in critical situations. It makes all the sense in the world to have these things in place and TCPBC offers an easy way to talk about what matters most in life. Instead of asking onerous questions about feeding tubes or death-bed wishes, the tools allow people to think and share what is important to them. People tend to think about ACP only near end-of-life and don’t plan ahead. We want to help start the conversation earlier. 

Susan Caneva, Avista Hospital's Chief Nursing Officer

How is Avista incorporating The Conversation Project tools into your ACP workflow?

We have organized TCP implementation into three phases. In step one, we began sharing the ideas and tools within our organization, with our associates and providers. We felt that to become ACP ambassadors with patients and in the community, we needed to start in-house with our own staff. We set up TCP information tables and distributed materials in common areas.  Posters and flyers have been created and displayed throughout the hospital.

Step two is sharing ACP and with all patients who enter the hospital. We have created a checklist envelope system. When a patient checks into Avista, they receive an envelope with ACP educational material and tools. These include a Colorado Hospital Association’s advance directive booklet with the documents, the condensed Conversation Starter Kit, and the medical durable power of attorney wallet card. Materials are also available in Spanish. Each envelope has a checklist printed on the front to spur people to open and explore. They can check off each step as they complete it. We are also encouraging all physicians, especially those in primary care, to address ACP very purposefully with all of their patients.

The final step is readiness to have and share these tools anytime we have a community presence outside of Avista. We see this as a whole community project and want to be a partner in getting the word out there. Our implementation process is not revolutionary by any stretch, but a simple roll out will hopefully help ACP become part of the fabric of what we do for everyone that comes through the Avista system. 

Tell me more about Avista’s commitment to ACP for all patients.

The ACP tools are offered to all patients entering our hospital, not only those who are seriously ill or older. This process is not only for the sick and aged. Avista is a popular birthing hospital with about 200 births per month. A family with a new infant might want to consider that ACP is now more important than ever.  

The TCPBC tools have been branded with the Centura logo. They are centrally available to all in the system for easy ordering and printing. Each clinic and hospital won’t have to re-invent the wheel to get started. We are also working on integrating ACP more fully into the Centura healthcare app. There is an advance care planning section in which patients will be able to upload their advance directive documents directly to their electronic health record. The documents will be easily available in any setting throughout the Centura system. 

Our experiences with COVID have strengthened our commitment to ACP. People were walking into the hospital and then suddenly needing a ventilator. This brought home the notion that we don’t want this to get to the point where it’s urgent. We have the opportunity to be more thoughtful in our planning if we can get this word out about  ACP.

In the end, it is not enough to talk about ACP once with leaders, providers, or patients. It is about offering materials and guidance many times until it becomes part of the fabric of Avista. We have worked from the beginning with our staff so that they can see that the conversation is not difficult to start. We have them actually fill out the Starter Kit so they can feel what the process is like. If we encourage people to be passionate about ACP, they are more authentically sharing it with rest of the community.

Advance Care Planning Webinar Resources

The pandemic has fundamentally changed the way we interact with others. While this is certainly challenging, there are positive changes happening. With the proliferation of webinars, we have more opportunity to learn about new topics from field experts. There were a number of local advance care planning webinars over the past months—some of them led by TCPBC board members. Please find links below to catch up on the latest:

Myths, Facts, and Ethical Challenges in the Time of COVID-19 
University of Colorado Anschutz lecture

Talking to you Doctor About End-of-Life Care
Boulder Community Health presentation

Advance Care Planning Basics
TCP co-founder Jean Abbott discusses various advance care planning documents

Advance Care Planning in the Time of COVID-19
TCP co-founder Jean Abbot discusses strategies on how to have advance care planning conversations

Digital COVID-19 ACP Guide

Leading experts from Ariadne Labs, Cake and The Conversation Project (national headquarters) collaborated to release an advance care planning form designed to suit the new challenges that have arose in the era of COVID-19. It's easy to create, save and share your decisions. Click here to learn more.

Upcoming events

Grace Commons - Boulder
8/11/20 10:30-11:30am
The Conversation Project: History, Advance Directives, and COVID-19

Talking about medical and end-of-life wishes is an important way we can all have more control in this uncertain time. At The Conversation Project, we want to help you start or continue your advance care planning journey. Join us for a one-hour live webinar covering The Conversation Project, advance care planning basics, documents, how COVID-19 has raised the stakes, and how to start these important conversations with those that matter most. We can help ensure your wishes are respected.
Register Here

Parkinson’s Association of the Rockies
8/13/20 10-11am
Advance Care Planning in the Time of COVID-19

Talking about medical and end-of-life wishes is an important way we can all have more control in this uncertain time. At The Conversation Project, we want to help you start or continue your advance care planning journey. Join us for a one-hour live webinar covering advance care planning basics, documents, how COVID-19 has raised the stakes, and how to start these important conversation with those that matter most. We can help ensure your wishes are respected.
Register Here

Advance Directives Open House
8/20/20 8am-5pm

On August 20th, trained conversation coaches will be available by appointment via Zoom throughout the day. They can answer advance care planning questions, provide the right documents, and help you start this important conversation with those that matter most. We can help ensure your wishes are respected.
Sign up here

Grace Commons
9/15/20 1-2pm
Aging Solo: Finding and Preparing a Person to Represent You

50% of us will be unable to make healthcare decisions at the end-of-life. Many people have limited or no family who can come to the bedside. We help you identify your values; what is important to you and will provide guidance on how to choose a decision-maker (either a professional, family member or friend). Most importantly, we will help you prepare “your person.”

Expert Panel Discussion featuring Constance Holden, RN, Sue Mackey, owner of Out of the Box End of Life Planning, and Amanda Meier of The Conversation Project in Boulder County. Registration information to be announced on our events page.

TCPBC is looking for volunteers!

We are recruiting and training Conversation Project volunteers at TRU. If you have experience or significant interest in advance care planning and would like to help our neighbors clarify and express their wishes for end-of-life, contact Amanda at amandameier@trucare.org. You can start by filling out a volunteer application. The next training session is scheduled in mid October.

Donate to The Conversation Project here
Copyright © 2020 The Conversation Project in Boulder County in c/o TRU Community Care, All rights reserved.


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