Compassion and Support
MARCH 2016
National Healthcare Decisions Day

The 9th Annual National Healthcare Decisions Day (NHDD) will be held on April 16. NHDD was created to inspire, educate and empower the public and healthcare professionals about the importance of advance care planning. Clinicians need to be at the forefront of this effort and lead by example. The 2016 NHDD theme is “It Always Seems Too Early, Until It’s Too Late.” This month’s featured resource illustrates this theme.

A number of educational events will be held the week leading up to NHDD across NYS and the country. In NY, speakers will discuss the advance care planning process and define the differences between advance directives, like the health care proxy (HCP) and living will, and medical orders like MOLST and its electronic version, eMOLST.

Members of the NHDD NYS Coalition host educational sessions for the community and clinicians year-round but efforts intensify to support NHDD and around Thanksgiving. The NHDD NYS Coalition is open to all. Coalition goals include:

1. Increase conversations that lead to completion of HCPs
2. Increase awareness of MOLST & eMOLST in the community
3. Support statewide implementation of MOLST & Family Healthcare Decisions Act, the Palliative Care Information Act (PCIA), the Palliative Care Access Act (PCAA ), and appropriate legislative changes to improve the quality of care near the end of life.

A community approach to advance care planning is encouraged in New York so that persons with serious health conditions of all ages receive high quality end-of-life care that is aligned with their values, beliefs and goals.

Most people near the end of life lack the ability to make their own decisions about the treatment they wish to receive, as well as what they want to avoid. A majority of patients will receive their care after a hospitalization and long-term care from physicians who do not know them. Advance care planning is essential to ensure that patients receive care and treatment that reflects their values, beliefs, goals for care and treatment.

Of people who indicate end-of-life care preferences, most choose care focused on alleviating pain and suffering. However, because the default mode is acute care and hospitalization in an emergency, advance planning and medical orders are needed to ensure that these preferences are honored.

Frequent clinician–patient conversations about end-of-life values, beliefs, goals for care, and preferences are necessary to avoid unwanted treatment, particularly life-sustaining treatment. Clinicians need to initiate conversations about end-of-life care choices and work to ensure that shared medical decision making is well informed, based on adequate information and understanding.

Featured Resource:
JoAnn's Story & PSA

JoAnn's story illustrates the 2016 NHDD theme,
"It Always Seems Too Early, Until It's Too Late"

MOLST FAQ: Is a DNR order on the MOLST invalid if it is not reviewed and renewed every 90 days?

NO, DNR remains valid. FHCDA (PHL § 2994-dd(4)) provides clarification:

“For each patient for whom a nonhospital order not to resuscitate has been issued, the attending physician shall review whether the order is still appropriate in light of the patient's condition each time he or she examines the patient, whether in the hospital or elsewhere, but at least every ninety days, provided that the review need not occur more than once every seven days. The attending physician shall record the review in the patient's medical record provided, however, that a registered nurse who provides direct care to the patient may record the review in the medical record at the direction of the physician. In such case, the attending physician shall include a confirmation of the review in the patient's medical record within fourteen days of such review. Failure to comply with this subdivision shall not render a nonhospital order not to resuscitate ineffective."


eMOLST Champion:
Watertown Internists, PC

Watertown Internists, PC is committed to providing exceptional healthcare services to the adult clients (age 16 years and older) of Northern NY. In partnership with clients, families and providers, their highly qualified staff renders a broad range of comprehensive services.

This group of dedicated clinicians delivers care in a compassionate and caring atmosphere, sensitive to the uniqueness of all persons and resolves to continually strive to exceed each individual’s expectations.

The practice was an early adopter of the MOLST program. The eMOLST team worked closely with Watertown Internists, PC to provide “hands-on” eMOLST training that solidified the commitment to begin eMOLST implementation.

Dr. Collins Kellogg values the seamless integration of the 8-step MOLST Protocol and NYSDOH MOLST Checklists in eMOLST, stating:

“In addition to its online accessibility, eMOLST has an advantage over the paper version, in that it includes assessment of the health status and prognosis of the patient. It starts the very important discussion with the patient about their values, beliefs and health care goals.”

The visionary leadership provided by Watertown Internists, PC has stimulated additional interest in adopting a community-wide approach to digital transformation of MOLST to eMOLST.

Left to right: Laura Boggs, DO; Jason White, MD; Kathryn Kolton, FNP; Collins Kellogg, MD; Phyl McKinney, FNP; Jeff Perrine, FNP; Nancy Spicer, ANP. Not pictured: Laverne VanDeWall, DO; Julie Lapointe, MD; Ann Lepine, FNP

Update on Dying in America

By Pat Bomba, MD, FACP
eMOLST Program Director, Excellus BlueCross BlueShield


Time for a status update: Have we improved quality of care for people nearing the end of life?

To assess progress since the release of the Dying in America report in September 2014, and to inform the work of a new Roundtable on Quality of Care for People with Serious Illness, the National Academy of Medicine is conducting a nationwide survey to track improvements over the past 18 months, discover barriers that have prevented progress, and better understand current areas of need.

Your feedback will help the new roundtable shape its work over the next three years. Please tell the National Academy of Medicine about your experiences, and encourage your friends and colleagues to take the survey as well.

For more information about the roundtable, contact Laurie Graig at lgraig@nas.edu.

A New Podcast Series on End-of-life Care

Providing high-quality end-of-life care is a major commitment and responsibility faced by millions of health care professionals every day. The National Academies of Sciences, Engineering, and Medicine have partnered with ReachMD to broadcast a new podcast series for health care professionals based on the 2015 Institute of Medicine report Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life.

In this series, sponsored by the National Academy of Medicine, hear about various aspects of end-of-life care from the perspective of experts in the field. Topics include palliative care, interdisciplinary teamwork, clinician-patient communication and advance care planning, and policies and payment systems for care near the end of life.

The Dying in America: Conversations About Care at the End of Life podcast series can be found on the ReachMD website and also on iHeartRadio, TuneIn, Stitcher, and iTunes.

I was honored to be the speaker on “Toward Higher Quality Communication and Advance Care Planning.”

Learn more and listen

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