Date of Publication

2023

Project Team

Lili Martin, DNP, RN, PCCN, Lila Fuller, MSN

Abstract

Background: The core hospice interdisciplinary team, which consists of a nurse case manager, social worker, and spiritual care counselor, assists hospice patients in addressing most of their end-of-life needs including physical, psychosocial, and spiritual needs. Many patients at the site of this project were not utilizing the full interdisciplinary team. Objectives: 1) Identify barriers of patient acceptance of hospice social work and spiritual care services by January 15, 2023. 2) Increase patient acceptance of hospice social work and spiritual care services at start of care (first 7 days) by April 1, 2023. 3) Increase utilization of hospice social work and spiritual care services at end-of-life (last 7 days) by April 1, 2023. Methods: A staff survey and staff interviews were used to identify barriers. Joint admissions were introduced to increase acceptance of social work at start of care. An admission guide for nurses was created to help nurses introduce the hospice team. A daily voicemail update to the team was piloted with two nurses for patients imminently dying. Results:Barriers were identified and used to inform interventions. Patients were slightly more likely to accept a second visit from social work (77.8% vs 70.8%) if they had a joint admission. Patients with a stay of 14 days or longer were more likely to accept a second visit from social work (81% vs 93.3%) if they had a joint admission. Joint admissions with nursing and social work increased to approximately 50%. There was no upward trend in visit rate in the last week of life during the project. Discussion: Patients with initial visits from social work or spiritual care were likely to have more than one visit from these team members during their length of stay. The short length of the study may have contributed to the lack of upward trend in end-of-life visits.

Document Type

Project

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