The Annual Assembly of the American Academy of Hospice and Palliative Medicine and the ...

108 Pages·2017·2.65 MB·English

548 Journal ofPainand SymptomManagement Vol.55 No.2February2018
The Annual Assembly of the American Academy of Hospice
and Palliative Medicine and the Hospice and Palliative
Nurses Association: Education Schedule With Abstracts
(cid:1)
March 14-17, 2018 Boston, MA
Wednesday, March 14 are not going well is the most common reason for an
inpatient consult. Discussing goals of care is difficult
8 ame5 pm
because it requires the consultant to accomplish a
number of interrelated, emotional tasks in a short
AAHPM & HPNA Preconference Workshops periodoftime:deliverbadnews,assess whatisimpor-
tant to the patient, and make a recommendation
Hospice Medical Director Update and Exam abouthowtobestproceed.Usingamixofshortdidac-
Prep (P01) tic talks and experiential practice, this workshop will
Ronald J. Crossno, MD HMDC FAAFP FAAHPM, help participants develop a toolkit of skills useful for
KindredHealthcare,Rockdale,TX.KathleenFaulkner, handling these difficult conversations. This workshop
MD FAAHPM, Good Shepherd Community Care, will be unique in that learning will occur predomi-
Newton, MA. Edward W. Martin, MD MPH HMDC nantly in small groups (one faculty member: eight to
FACP FAAHPM, Home & Hospice Care of Rhode Is- ten participants) to allow participants to practice the
land, Cranston, RI. Earl Quijada, MD HMDC, Kaiser skills, observe others, and give feedback. The groups
Permanente Home Health, Riverside, CA. willbemultidisciplinary,ledbyfacultywithexperience
infacilitation,andteachskillsappropriateforallpalli-
Objectives
ative care clinicians.
(cid:1) Employ the clinical, regulatory, leadership, and
administrative skills and ethical knowledge
8 ame5:30 pm
required in the role of hospice medical director.
(cid:1) Describe the hospice medical director’s role on
the interdisciplinary care team and within the AAHPM & HPNA Preconference Workshops
hospice organization.
(cid:1) Analyze regulatory issues affecting the hospice Palliative Nursing Leadership Intensive
medicaldirectorandfindstrategiestofulfillthese (P03)
requirements. Constance Dahlin, MSN ANP-BC ACHPN(cid:1) FAAN
Joinpeersandnationalexpertstoexploreandfurther FPCN,HospiceandPalliativeNursesAssociation,Pitts-
develop the skills needed to successfully navigate to- burg, PA.
day’s hospice environment. This intensive review will
Objectives
serveaspartofyourpreparationfortheHospiceMed-
(cid:1) Differentiate essential nursing leadership
icalDirectorCertificationBoardexamandisbasedon
qualities.
the exam blueprint (www.hmdcb.org). The workshop
(cid:1) Apply 5 areas of palliative nursing leadership
also serves as a great orientation for those new to
throughout workforce venues.
thehospicefieldorasacriticalupdatefor allhospice
(cid:1) Developanindividualizedleadershipcompetency
practitioners and managers.
plan to maximize knowledge, transfer and
application.
VitalTalk: Intensive Small Group
d Leadershipinpalliativecareischaracterizedbyleading
Training Addressing Goals of Care (P02)
others with a clear vision of palliative care initiatives,
Objectives motivating and inspiring others to achieve excellence
(cid:1) Respond empathetically to the patient’s expres- in care, positively relating to others to create healthy
sion of emotion. work environments, and changing the behavior of
(cid:1) Elicit details about the patient’s values. otherstoworkcollaborativelyinpalliativecare(Speck,
(cid:1) Make a recommendation about the treatment 2006). Palliative nursing leadership is neither defined
plan that best meets the patient’s values. nor grounded by level of nursing practice nor educa-
As a palliative care consultant from any professional tionbutratheronqualities.Theseleadershipqualities
background, discussing goals of therapy when things may be attained by any nurse at any level from the
Vol.55 No.2February2018 Schedule WithAbstracts 549
bedside nurse,thenursegroupleader ororganizer,to content areas based upon the Hospice and Palliative
the nurse in a designated leadership position. The Credentialing Center (HPCC) detailed test content
skillsofnurseleadersfocusonabroadviewofnursing outline. The educational content may also be used to
andtheabilitytorespondtochangeproactively,rather increasethehospiceandpalliativeadvancedregistered
than reactively, in anticipating the future landscape nurse’sknowledgeofpalliativenursing.OurHPNAfac-
(Wolf, 2012). Many organizations have focused time ulty are national subject matter experts with career
andresourcestoenhanceleadershipskillsintheirstaff. experience in hospice/palliative care and certified by
Theseinitiativesusuallyfocusondedicatednurselead- the Hospice and Palliative Credentialing Center in
ership positions, such as administrators, managers, di- the specialty of Hospice and Palliative Care.
rectors, or executives; however, leadership extends
beyond these roles. Leadership within hospice and 8e11:45 am
palliative must exist throughout the spectrum of
nursing roles from nursing assistant, to licensed voca-
tional/practical nurse, to registered nurse, and AAHPM & HPNA Preconference Workshops
advanced practice registered nurse. To be successful,
the nurse leader must assess their personal leadership HPM Fellowship Directors Program:
capabilitiespriortomovingtowardsteamdevelopment Managing the Good, the Bad, and the
d
and competence. Through didactic, role play, and Ugly Expert Strategies for the Assessment
interactive media, this session will articulate the value and Remediation of Palliative Care
ofpalliativenursingleadership,describethecharacter- Fellows (P05)
istics of leaders, explore leadership of nurses at all Jane deLima Thomas, MD, Harvard Interprofessional
levels of nursing practice, across the spectrum of Palliative Care Fellowship, Boston, MA. Laura Edgar,
nursing including clinical, management, education, EdDCAE,MilestonesDevelopmentatACGME,Chica-
research, and policy, and delineate necessary skills of go, IL. John Herman, MD, Massachusetts General
the palliative nurse leader. Hospital and the Partners HealthCare, Boston, MA.
John Co, MD, Brigham and Women’s and Massachu-
(cid:1)
ACHPN Certification Review: Advanced setts General Hospitals and the Partners HealthCare,
Practice Registered Nurse (P04) Boston, MA. Sarah H. Arnholz, JD, Partners Health-
Jennifer Gentry, MSN ANP-BC GNP ACHPN FPCN, Care, Boston, MA. O’Neil Britton, MD, Massachusetts
Duke University Hospital, Durham, NC. Bronwyn General Hospital, Boston, MA.
Long,DNPMBAACNS-BCACHPNAOCNS,National
Objectives
Jewish Health, Denver, Co. (cid:1) Recognize how to use the Milestones, run an
Objectives effective Clinical Competency Committee, and
(cid:1) Provide participants with a framework to prepare improve faculty development in using assessment
for Advanced Certified Hospice and Palliative tools.
Nursing (ACHPN(cid:1)) Examination (cid:1) Identify the range of issues that need to be ad-
(cid:1) Provide participants with a process to assess dressedinsituationsinvolvingstrugglingtrainees,
strengths and weaknesses of content for the includinglegal,administrative,andhealth-related
(cid:1)
ACHPN Examination issues.
(cid:1)
ThepurposeofthisHPNAEndorsedACHPN Review The fellowship directors program will provide partici-
Course is to promote education of the APRN seeking pantswiththeopportunitytolearnaboutthelatestad-
augmentation of their professional development vances in fellow-level education and to develop
throughspecialtyhospiceandpalliativeadvancedregis- connections with other palliative care educators.
tered nursing certification. This one-day, provider- This year’s program will focus on the assessment and
directed, provider-paced, live intensive course is remediation of palliative care fellows, two of the
designed to assist with preparation for the advanced biggest challenges program directors face. First, the
hospiceandpalliativenursecertificationexamthrough Executive Director of Milestones Development at the
didacticcoursepresentationwithactivelearnerengage- ACGMEwillleadasessionaboutusingtheMilestones,
ment,casestudyexaminations,practiceexamquestions leading an effective Clinical Competency Committee,
and self-check/reflection to highlight self-identifying and performing faculty development using the Mile-
topics that require further preparation and study in stonesandassessmenttools.Next,institutionalleaders
(cid:1)
advance of sitting for the ACHPN examination. The representing the perspectives of director of an
ACHPN(cid:1) Review Course provides a review of the EmployeeAssistanceProgram, GMEdirector,hospital
550 Schedule With Abstracts Vol.55 No.2February2018
legal counsel, and hospital Chief Medical Officer will LCSW, Seasons Healthcare Management, Inc., Rose-
discuss considerations and strategies for dealing with mont, IL.
struggling trainees. By the end of the seminar, partic-
Objectives
ipantswillhavetoolstohelpthemperformmoreaccu- (cid:1) Assess how mental health issues and substance
rate and helpful assessments, and to intervene and
usemaybeimpactingpatients’and families’ abil-
remediate underperforming fellows.
ity to cope with serious illness.
d (cid:1) Identify which areas of concern may be reason-
AAHPM Leadership Forum: Ignite Using
able to address in the limited time available for
StrengthsFinder Leadership Strategies to
assessment and intervention.
Increase the Performance of You and Your
(cid:1) Develop and advocate for an Integrative Behav-
Team in Palliative Care and Hospice
ioral Health model that incorporates mental
Settings (P06)
health and addiction issues, effective program
Christina Rowe, MSOL, The Collaborative LLC,
models and policies, and evidence-based assess-
Denver, CO.
ment and treatment strategies
Objectives Managingmentalhealthandaddictioninhospiceand
(cid:1) Distinguish between the 34 Talent Areas of palliativecareisacriticalcomponentofqualitycarefor
Strengths for self and other team members. patients facing serious illness who also have pre-exist-
(cid:1) Evaluate where individuals are in their develop- ing behavioral and/or substance use issues. Reports
ment, and devise plans to encourage growth underscore the high prevalence and burden of behav-
and improve abilities to apply talents. ioral health disorders, particularly in the presence of
(cid:1) Create actionable solutions to career and team otherphysicalhealthconditions.Despitethisconcern,
challenges with a strengths-based approach to patients can experience fragmented care that leads to
create consistent positive outcomes. suboptimal services and outcomes, including poor pa-
Would you like to discover what makes you stand tient and family satisfaction, and higher costs. While
out? This half-day session will focus on utilizing a effective integrated care models have been described
strengths-based approach to create consistent and andtested,veryfewintegratedmodelshaveadequately
positive outcomes to everyday challenges in hospice been described in the context of serious illness care.
and palliative care settings. Strengths are the unique Some of the challenges are: how to assess and define
combination of talents, knowledge, and skills that interventions that work with existing mental health
every person possesses. Participants will complete a and substance issues that present as barriers to pa-
StrengthsFinder assessment which will help to iden- tient, family, or team goals; how to support the most
tify personal strengths to focus on to become a functional aspect of behaviors, while tending to the
more effective leader. They will also learn how to goalsofpalliativecare; howtointerpret trustedthera-
develop these strengths in order to do what they peutic interventions to fit what are often very time-
do best every day. Research will be presented and access-limited situations; and how to assist other
demonstrating strengths-based methods heighten providers in managing reasonable expectations and
personal and team engagement, clearer communica- goals with patients and families with pre-existing
tion, understanding, and overall productivity. This mental health and substance problems. The clinical
session will include both large and small group dis- social worker on the interdisciplinary palliative care
cussions, self-reflection, and scenario-based activities. team has the mental health expertise, and skill set,
Participants will learn strategies and tactics for to provide these services.
applying a strengths-based approach to individual First, we will provide an overview of the existing land-
and team challenges. scape, including historical and epidemiological back-
ground, and current service models. An Integrated
Providing Palliative Care to Patients and Behavioral Health model will consider strategies for
Families with Pre-Existing Mental Health promotingmentalhealthandaddictioncareinpallia-
and Substance Use Issues (P07) tive care settings. Opportunities and challenges for
Gary L. Stein, JD MSW (moderator), Yeshiva Univer- improving care will be considered.
sity Wurzweiler School of Social Work, New York, NY. Second, we will assess how mental health and sub-
Vickie Leff, LCSW BCD ACHP-SW, Duke University stance abuse may be impacting the patient and fam-
Hospital, Durham, NC. Harold Alan Pincus, MD, ily’s abilities to cope. This includes identifying what
Columbia University/New York-Presbyterian Hospital, areas of concern are reasonable to address in light
New York, NY. Stacy S. Remke, MSW LICSW of the limited time to assess the situation and effec-
ACHP-SW, University of Minnesota School of Social tivelyintervene.Providereducationwillbeconsidered
Work, Minneapolis, MN. Russell Hilliard, PhD to help avoid labelling and stereotypes.
Vol.55 No.2February2018 Schedule WithAbstracts 551
Third, we will consider how mental health and sub- (cid:1) Createpersonalized,evidence-basedcareplansto
stanceuseissuescanimpacttheprovisionofpediatric maximizequalityoflife,andpreventorminimize
palliativecare.Thisincludesconcernsaboutaddiction distressing behaviors.
whenstrongopioidsareneeded.Wewilldiscussfamily As our population of aging baby boomers, sometimes
dynamics, implications for interprofessional team dubbedthe‘‘silvertsunami,’’continuestoswell,sodo
practice, adapting best practices in addictions treat- their risks of developing some form of dementia. Alz-
ment to a palliative setting, and ethical issues. heimer’s, the most common type of progressive and
terminaldementia,isthe6thforemostcauseofdeath
The ABCs of MOC and Exam Prep (P08) inAmericawithcurrentprevalenceof5.5millionesti-
AAHPM MOC Advisory Committee mated cases (Alzheimer’s Association, 2017). The Alz-
ChristopherM.Blais,MDMPHFACPFAAHPM,Ochs- heimer’s death rate soared by 55% between 1999 and
ner Medical Center, New Orleans, LA. Daniel Pomer- 2014,andcontinuestoclimb,impactingallraces,eth-
antz, MD MPH FACP, Montefiore New Rochelle nicities,andgenders(CentersforDiseaseControland
Hospital, New Rochelle, NY. Miguel A. Paniagua, MD Prevention, 2017). In 2014, dementia accounted for
FACP,NationalBoardofMedicalExaminers,Philadel- 14.8% of primary terminal diagnoses of hospice ad-
phia, PA. Lauren Mazzurco, DO, Eastern Virginia missions in the U.S. (National Hospice and Palliative
MedicalSchool,Norfolk,VA.KiraSkavinski,DO,Uni- Care Organization, 2015).
versity of California, San Diego Health Sciences, San The unprecedented numbers of people living and
Diego, CA. dying with dementia underscore the imperative for
widespread development of dementia-capable pallia-
Objectives
(cid:1) Describe the general MOC requirements and tive and hospice care clinicians who can skillfully
guide and support both patients and their families
AAHPM resources available for MOC
(cid:1) Access and review HPM blueprint for HPM along the journey of dementia in a collaborative
manner that avoids futile, burdensome interventions
examination.
(cid:1) Participateintest-taking skillsandcontentreview that can add to suffering, while focusing on promot-
ingmeasuresthatupholdtheperson’sgoalsandsense
using HPM-PASS exam questions in a board re-
of well-being.
view format.
This workshop will cover evidence-based care for per-
In 2018, the first recertification examination in HPM
sons with dementia beginning withdiagnosis through
will be offered to members certifying in 2008. The
end-of-life. Particular emphasis will be given to effec-
purpose of this session is to provide a high-level over-
tive, person-centered, palliative dementia care prac-
view of the MOC process,examination blueprint, and
tices that address a wide range of physical and
AAHPM resources available to those taking the exam-
psychosocial needs, in order to maximize comfort
ination. Most of the session will be spent reviewing
and optimize quality of life for those living with de-
selected questions from the HPM-PASS product
mentia and their families. Attendees will have an op-
and include the use of an Audience Response System
portunity to refine care planning, education, and
as a platform to discuss the correct answers and
goal setting conversations.
rationale. Additionally, attendees with receive
Case studies will be utilized to define comfort care,
information of techniques to improve exam-taking
including medication simplification, assessment and
skills.
management of pain and delirium, understanding
and responding to distressed behavior, and compas-
Tsunami Preparedness: Developing
sionate environments and approach styles. Working
Dementia-Capable Palliative and Hospice
in small groups, attendees will practice creating
Care Skills (P09)
personalized,non-pharmacologicalcareplansfocused
Amy McLean, ANP-BC, Hospice of the Valley,
on maximizing quality of life, as well as preventing or
Phoenix, AZ. Maribeth Gallagher, DNP PMHNP-BC
minimizing distressed behaviors.
FAAN, Hospice of the Valley, Phoenix, AZ.
Objectives
(cid:1) Discuss essential considerations in caring for the Right-Sizing Medication Regimens inSerious
person with dementia along the trajectory of the Illness: Doing the Prescribing and
disease from diagnosis to death. Deprescribing Dance (P10)
(cid:1) Identify and explain the core elements to be ad- MaryLynnMcPherson,PharmDMAMDEBCPSCPE,
dressedinaplanofcareforthosechoosingpalli- University of Maryland School of Pharmacy, Balti-
ative dementia care. more, MD. Kathryn A. Walker, PharmD BCPS CPE,
552 Schedule With Abstracts Vol.55 No.2February2018
University of Maryland School of Pharmacy and Med- (cid:1) Describeessentialaspectsofoperatingapalliative
Star Health, Baltimore, MD. Jennifer Pruskowski, care clinic including: a business plan, marketing
PharmD BCPS CGP CPE, University of Pittsburgh strategy, opioid and prescribing policies, clinic
SchoolofPharmacy,Pittsburgh,PA.ShaidaTalebreza, workflow and staffing.
MDAGSFHMDCFAAHPM,UniversityofUtahSchool (cid:1) Applyappropriatemethodsofbilling&codingto
of Medicine, Salt Lake City, UT. maximize productivity.
As the benefits of early palliative care are increasingly
Objectives
(cid:1) Describeconsiderationswhenprescribingandde- recognized, expanding into the outpatient arena is a
logical next step for many programs. However, palli-
prescribing medications in serious illness
ative care remains far less prevalent in the ambula-
including goals of care, remaining life expec-
tory setting than in the hospital, and practice
tancy,treatmenttargetandlagtimeuntilbenefit.
(cid:1) Givenanactualorsimulatedpatientwithaserious models vary widely (Hui et al., 2010). Drawing on
the real-life challenges and successes of several pro-
illness,demonstrateacriticalthinkingprocessfor
grams that employ different models of care and oper-
prescribinganddeprescribingmedications
(cid:1) Given an actual or simulated patient with a ate in a variety of healthcare settings, this workshop
will equip participants with the tools to build or
serious illness, model best practices in communi-
expand a palliative care clinic practice. The work-
cation when right sizing the medication regimen
shop will focus on the core considerations needed
Experienceandresearchhasshownthatupto50%of
to design, implement and expand a successful outpa-
more of medications taken by patients with a serious
tient palliative care program. The models discussed
illness may be considered inappropriate. Participants
will include academic & non-academic programs,
in this program will learn how to critically evaluate a
and embedded, co-located & free-standing clinics.
medication regimen, and make thoughtful decisions
The first half of the workshop will use didactic and
about continuing or discontinuing medications. We
interactive teaching methods to review basic informa-
will discuss the Good Palliative-Geriatric Practice
tion for determining the optimal practice model and
algorithm, and the Model for Rational Prescribing
location of the clinic, engaging key stakeholders, the
for Patients. We will apply these models to a series of
basics of creating the business proposition, antici-
case-based vignettes that incorporate consideration of
pating staffing and productivity expectations
medicationbenefitandburden,goalsofcare,remain-
(including utilizing a multidisciplinary team) and
inglifeexpectancy,treatmenttarget,andlagtimeuntil
considerations for integrating into the broader
benefit. Most importantly, participants will learn how
healthcare system. The second half of the workshop
toandpracticehavingconversationswithotherhealth
will use a small group format and participants will
care providers, patients, families and caregivers about
rotate through 3 of 6 stations, which will offer a
‘‘right-sizing’’ the medication regimen in serious
more in-depth discussion of staffing, clinic manage-
illness. This preconference is a MUST for any practi-
ment principles (including referral management
tioner in hospice or palliative care.
and creation of policies & procedures), measuring
success, and managing clinic expansion. All partici-
Building a Palliative Care Clinic: Lessons
pants will be provided with information for each of
from Real Life (P11)
the stations, and by the end of the workshop will
EsmeFinlay,MD,UniversityofNewMexico,Albuquer-
have an actionable resource toolkit to take back to
que,NM.MaryBuss,MDMPH,BethIsraelDeaconess
their home institution. The final portion of the
Medical Center, Boston, MA. Kristina Newport, MD
workshop will include a session on billing and cod-
FAAHPM, Hospice & Community Care, Lancaster,
ing, and facilitators from established outpatient palli-
PA. Victoria Gurfolino, MSN PMHNP-BC, Beth Israel ative care programs will share their successes and
Deaconess Hospital, Boston, MA. Michelle Owens, challenges.
DO, Baylor Scott & White Health, Round Rock, TX.
Leo Newhouse, MSW, Beth Israel Deaconess Medical TheOpioidCrisisandPalliativeCare:Tools
Center, Boston, MA. Christopher Jones, MD HMDC and Strategies to Help Turn the Tide (P12)
FAAHPM,UniversityofPennsylvaniaPerelmanSchool
Kashelle Lockman, PharmD MA, University of Iowa
of Medicine, Philadelphia, PA. Laurel Kilpatrick, MD,
College of Pharmacy, Iowa City, IA. Pina Patel, MD,
Baylor Scott & White Health, Round Rock, TX.
OhioStateUniversityWexnerMedicalCenter,Colum-
Objectives bus, OH. Kathleen Broglio, DNP ACHPN ANP NP
(cid:1) Compare different examples of successful pallia- CHPN FPCN, Dartmouth Hitchcock Medical Center,
tive careclinicsinordertodesignamodelsuited Lebanon, NH. Justin Kullgren, PharmD, Ohio State
to your practice setting. University Wexner Medical Center, Columbus, OH.
Vol.55 No.2February2018 Schedule WithAbstracts 553
8:30 am-Noon
Brook Calton, MD, University of California, San Fran-
cisco, San Francisco, CA.
Objectives
A Morning at the Museum: Using Art to
(cid:1) Identify the potential impact of opioid use in
Find Meaning and Enhance Teaching (P13)
Palliative Care on the opioid crisis.
(cid:1) Evaluate a palliative care patient’s risk for opioid Cosponsored by Boston Museum of Fine Arts.
Laura Morrison, MD, Yale University School of Medi-
misuse, abuse, and diversion.
(cid:1) Develop an opioid stewardship proposal for cine and New Haven Hospital. Gordon Wood, MD
FAAHPM, Northwestern Memorial Hospital, Chicago,
ambulatory Palliative Care that incorporates four
IL.
different components of opioid risk
management. Objectives
Given the ongoing public health crisis of the opioid (cid:1) ‘‘See deeply’’ when examining a piece of art
epidemic, clinicians encounter increased scrutiny and describe how similar strategies could be
when prescribing controlled substances. Palliative used in hospice and palliative care clinical
Care clinicians are squarely faced with the chal- settings.
lenges of balancing patients’ comfort and the (cid:1) Gain insight into an aspect of meaning from
greater societal concerns from the misuse, abuse, the participant’s clinical work through a work
and diversion of opioids. This preconference work- of art.
shop harnesses the expertise of clinicians from (cid:1) Describe how to use museum teaching strategies
diverse settings and disciplines in Ambulatory Palli- with hospice and palliative care trainees, learners
ative Care to share their experiences in opioid risk in other disciplines, and practicing clinicians
assessment and management for palliative care pa- and team members in the participant’s home
tients receiving chronic opioid therapy. This high- setting.
yield, interactive workshop will provide interdisci- AAHPM is excited to present this unique half-day
plinary members of outpatient palliative care teams preconference session at the Boston Museum of
withpracticaltoolstoinitiateorimproveopioidrisk Fine Arts. The workshop will allow attendees to
management at their practice site. experience ‘‘museum teaching’’ through a collabo-
Throughout this workshop, participants will learn ration between the museum’s educators and pallia-
about and apply opioid risk management tools to tive medicine faculty who are pioneering the use
simulated patients, inspired by cases from the front- of museum teaching in hospice and palliative care
lines of daily outpatient palliative care practice. Risk at institutions across the country. Museum teaching
factors for opioid misuse, abuse, and diversion will encompasses a variety of strategies in which medical
be discussed and participants will learn strategies to and museum educators take their learners to mu-
incorporateopioidrisktoolsintoabusyclinicalprac- seumsanduse artto impartlessonsaroundobserva-
tice. Prescription drug monitoring programs and tion and reflection. This teaching has been studied
opioidtreatmentagreementswillbereviewedascom- with many audiences, including medical students,
ponentsofsafeopioidprescribing.Inaddition,urine residents and faculty as well as nurses and interpro-
drug screening and naloxone coprescribing will be fessional groups. Well-designed trials show a variety
explored as elements of opioid stewardship. Partici- of positive outcomes including improved observa-
pants will develop skills in choosing and interpreting tion skills, empathy and awareness of multiple
urine drug screens as well as addressing unexpected perspectives.
results. A pragmatic protocol for coprescribing This preconference workshop has two aims.
naloxone to appropriate patients will be introduced. First, attendees will experience museum teaching
AclinicianfromanexperiencedambulatoryPalliative in order to improve their own observational skills
Careteamwilldiscussintegrationofthesetoolsintoa and connect to meaning in their practice.
‘‘UniversalPrecautions’’approachforallpatientspre- Second, attendees will learn how they can use these
scribedopioids.Resultsofthefirstyearofimplemen- methodstorunsimilarsessionsforlearnersandcol-
tation will be shared, and challenges and leagues in their home setting. Only 50 spots are
opportunities of embedding this practice into a available and registration includes the price of
busy palliative care setting will be highlighted. The admission, transportation to the museum, a light
workshop will conclude with an interactive panel dis- breakfast and a snack, as well as time to enjoy the
cussion of strategies to effectively manage pain in art and share this unique experience with col-
high-risk patients. leagues.
554 Schedule With Abstracts Vol.55 No.2February2018
1:15e5 pm
AAHPM Leadership Forum:
d
Ignite Utilizing DISC Behavioral Styles to
Increase Leadership and Team Effectiveness
AAHPM & HPNA Preconference Workshops
in Palliative Care and Hospice
Settings (P15)
d
Jump Starting Culture Change Engaging
Lisa A. Bouchard Data Dome, Inc., Atlanta, GA.
Students, Trainees, and Clinicians in a
Objectives
Transdisciplinary Approach (P14)
Toluwalase (La(cid:1)se_) Ajayi, MD, University of California, (cid:1) Understanding the DISC MethodologydRecog-
nizing your strengths and limitations as a leader.
San Diego, San Diego, CA. Emmie Gardner, MSW
(cid:1) UnderstandingYourTeamdHowtobestmanage,
LCSW, Intermountain Healthcare, Salt Lake City,
motivate, and communicate with them.
UT. Dominic Moore, MD FAAP, University of Utah
(cid:1) UnderstandingYourPatients(andFamily)dRais-
and Primary Children’s Hospital, Salt Lake City, UT.
ing awareness of their needs, concerns, and how
Jennifer Reidy, MD FAAHPM, University of Massachu-
to make better decisions together.
setts Medical School, Worcester, MA. Alicia Wierenga,
Palliativecareandhospicesettingscanbefilledwith
MSN NP, University of Massachusetts Medical School,
stress, change, and tension. What separates the best
Worcester, MA.
organizationsfromthe strugglingarestrongleaders
Objectives
thatfocusonbuildinghighlyproductiveteams.This
(cid:1) Identifywaysthattransdisciplinarylearner educa-
half-day session will focus on utilizing the DISC
tion leads to institutional cultural change.
Behavioral Styles methodology to take your leader-
(cid:1) Integrate generalist palliative care principles into ship skills and team to the next level. Awareness of
curricula for learners of different disciplines at behavioral styles directly impacts trust, collabora-
different levels of training. tion, and engagement. Participants will complete a
(cid:1) Createaprocessforevaluatingeducationalefforts
personalized DISC profile, which will help to deter-
and measuring institutional change.
mine how to best leverage their style to build the
The subspecialty consultation represents a power-
most effective team. They will also learn how to
ful educational opportunity for referring teams,
adapt their communication to the specific style
including learners of all disciplines. Increasing
needs of both team members and patients, leading
attention to palliative care education has created to stronger relationships, better decisions, and
major opportunities for improving education about unprecedented results.
the principles of hospice and palliative medicine.
Optimizing these educational efforts can lead to
Managing Pain in the Face of Substance
successful institutional culture change, ingraining
Misuse: Practical Approaches and Tools in
palliative medicine as an institutional norm as
the Palliative Care and Hospice
well as cultivating generalist palliative medicine
Settings (P16)
principles. This faculty development half-day ses-
Bridget Scullion, PharmD BCOP, Dana-Farber Cancer
sion will start with an overview of how teaching stu-
Institute, Boston, MA. Benjamin Kematick, PharmD,
dents and residents from different disciplines
Dana-Farber Cancer Institute, Boston, MA. Daniel
establishes and spreads palliative care principles
Gorman, NP, Dana-Farber Cancer Institute, Boston,
within different institutions. Then, the presenters
MA.DouglasBrandoff,MD,Dana-FarberCancerInsti-
will focus on how to integrate generalist palliative
tute and Brigham Women’s Hospital, Boston, MA.
medicine principles into the learners’ curricula.
Kathy Selvaggi, MD, Butler Memorial Health System,
This part of the session will hone in on the
Butler, PA. Michele Matthews, PharmD CPE BCACP,
different types of cultural change that can be
MCPHS University and Brigham and Women’s Hospi-
brought about with educational pursuits, and how
tal, Boston, MA. Larissa Lucas, MD, Care Dimensions,
to map said pursuits into the learner’s educational
Danvers, MA. Amanda Moment, LCSW, Dana-Farber
blue print. Participants will leave this session with
CancerInstituteandBrighamWomen’sHospital,Bos-
concrete tools for starting and expanding their
ton, MA.
educational programs for student and resident
trainees. They will also leave with a general knowl- Objectives
edge of how to evaluate the effect of their educa- (cid:1) Identify strategies for assessing patients to deter-
tional efforts. mine the potential use of opioids in the manage-
Vol.55 No.2February2018 Schedule WithAbstracts 555
ment of pain in the palliative care patient with a FACP FAAHPM, OhioHealth, Columbus, OH. Jean
history of or active substance use disorder. Acevedo, LHRM CPC CHC CENTC, Acevedo Consul-
(cid:1) Createabestpracticeapproachutilizingavailable ting Inc., Delray Beach, FL.
toolstominimizetherisktoboththepatientand
the clinician when treating patients with sub- Objectives
stance use disorder with opioids. (cid:1) Describe the expanding array of professional fee
(cid:1) Discuss patient case examples to illustrate chal- billing codes available to palliative care providers
lenges including clinician distress in the care of across inpatient, outpatient, facility and home
this patient population. settings.
The pendulum is swinging again but where should (cid:1) Identify opportunities to align billing and coding
it land? The use of opioids for the treatment of practices with clinical workflow, including
pain has been endorsed and renounced countless complexity- vs time-based billing, using multiple
times over centuries. What is the role of opioid- complementary codes for specific encounters
containing pain medications in the palliative care and leveraging interdisciplinary team members
setting? Where does the palliative care end and to optimize coding.
chronic pain due to serious illness begin? How (cid:1) Develop specific strategies to maximize code use
can we apply lessons learned in the chronic pain and billing revenue to your practice.
setting to address the management of patients Professional fee billing revenue is essential to sus-
withahistoryof,orcurrent,substanceusedisorder tainandgrowinterdisciplinarypalliativecareteams.
in the setting of advanced illnesses such as cancer? While often perceived as burdensome and periph-
How and when do we set a new course of therapy eral to patient care, billing and coding practicesd
for patients who have been treated with high doses when optimizeddcan help expand your team’s abil-
of opioids in the long-term palliative care or hos- ity to provide high-quality care to the patients and
pice setting? These questions and more have caregivers you serve. Ineffective billing and coding
been postulated and many of us are faced with can limit growth, and even threaten your team’s
treating patients who present as high risk for devel- viability.
opment of substance use disorder including those This interactive, half-day workshop is designed for
with a history of substance misuse or ongoing palliative care teams practicing outside of the hospice
misuse and abuse. This session is designed to build benefit.Itwillfocusonmaximizingbillingrevenueus-
(cid:1)
the participants’ knowledge and comfort with man- ing a steadily expanding set of CPT codes available
aging these patients using evidence-based estab- through the Medicare Physician Fee Schedule. These
lished tools and best practices as outlined new codes describe services frequently provided by
through patient cases. In this interactive workshop, palliative care teams, including advance care plan-
participants will review current best practices ning, chronic care management, complex chronic
including opioid risk tools, including integration care management, transitional care management
of PDMP review into clinical care, use of medica- and prolonged non face-to-face services, among
tion management agreements, when to incorpo- others. The workshop will also take a deep dive into
rate urine toxicology screening, provision of Evaluation and Management (E/M) coding tech-
naloxone for patients deemed high risk for over- niques relevant to palliative care teams, emphasizing
dose, management of patients who present to palli- complexity- vs. time-based billing, use of multiple co-
ative care or hospice on methadone maintenance des to describe complex patient encounters, docu-
or suboxone therapy. We will look to participants mentation requirements, minimizing clinician
to share their experiences and strategies they burden,andcapturinginterdisciplinaryteammember
have utilized. work where possible.
Participants will engage with expert physician and
Overcoming Barriers to Better Billing: billing professional faculty throughout the
Maximizing Revenue to Sustain and Grow workshop, through both information sharing and
Your Palliative Care Program (P17) case-based learning. Content will be tailored to
Phillip Rodgers, MD FAAHPM, University of Michi- participant needs and stress relevance across prac-
gan, Ann Arbor, MI. Christopher Jones, MD HMDC tice settings. At the end of the workshop, partici-
FAAHPM,PerelmanSOMattheUniversityofPennsyl- pants will be better prepared to develop or refine
vania, Philadelphia, PA. Charles von Gunten, MD their approach to billing and codingdand to
556 Schedule With Abstracts Vol.55 No.2February2018
survive and thrive in a changing reimbursement California, San Francisco and Benioff Children’s Hos-
landscape. pital, San Francisco, CA. Laura Tycon, MSN RN FNP-
BC, University of Pittsburgh Medical Center, Pitts-
Caging the Beast: Wrestling with Difficult burgh, PA.
Pain Syndromes in Serious Illness (P18)
Objectives
MaryLynnMcPherson,PharmDMAMDEBCPSCPE, (cid:1) Review the scope of the current Palliative
University of Maryland School of Pharmacy, Balti- AdvancePracticeRegisteredNurse(APRN)work-
more, MD. Mellar Davis, MD FCCP FAAHPM,
force and list available options for education and
GeisingerMedicalCenter,Danville,PA.PaulA.Sloan,
training in specialty practice.
MD, University of Kentucky, Louisville, KY. (cid:1) Introduce the HPNA Professional Practice
Objectives Guide as a tool to aid in job seeking, contract
(cid:1) Describe the clinical presentation and manage- negotiation, and necessary infrastructure
ment of opioid-induced hyperalgesia. supports.
(cid:1) Describe best practices for managing pain in pa- (cid:1) Integrate a plan for professional development as
tientswithimpairedliver,reducedrenalfunction, a Palliative APRN to optimize professional
or both. growth, commit to career sustainability, and
(cid:1) Assess and treat pain in nonverbal critically ill contribute to others’ professional growth.
patients. Nursesenterourfieldfrommanyavenuesandexpe-
(cid:1) Managepaininpatientswithseriouscomorbidis- riencesdwe must ask ourselves how best to align
sues such as sleep-disordered breathing, dialysis, our interests and leverage our experience. In this
or previous drug/alcohol abuse. workshop, the Palliative Advance Practice Regis-
(cid:1) Discuss the potential benefits of combining tered Nurse (APRN) in hospice and palliative care
different opioids to achieve enhanced analgesia. will explore the current state of the workforce,
The majority of pain associated with serious illness includinggapsintrainingandprofessionalsupport,
canbeadequatelymanagedwithusualandcustomary and review best practices and expert opinions on
therapies including non-pharmacologic interven- how to approach barriers and ensure a sustainable
tions, non-opioids, opioids, and co-analgesics. Occa- professional practice. The APRN will gain insight
sionally practitioners encounter patients with intooptionsforeducationalpreparation,navigating
special circumstances or comorbid conditions that a new or existing APRN role, contract negotiation,
make it difficult to control pain. This case-based, ev- and committing to career-long professional devel-
idence-based presentation will take the learner on a opment. Faculty will integrate the perspectives of
journey that addresses difficult poorly-responsive nurse practitioners and clinical nurse specialists
opioid pain, complicated neuropathic pain, opioid- on the essential building blocks for a fulfilling
induced hyperalgesia, and pain management in careeratanystageforthePalliativeAPRN.Thispre-
renal/hepatic impairment. Additional examples sentation will be interactive for the participants, us-
includepaininpatientswithsleep-disorderedbreath- ing video technology, small group discussion and
ing, nonverbal patients receiving intensive care, and case studies addressing career paths and prospects
the management of pain in highly opioid/alcohol- for Palliative APRNs in various setting, including
tolerant patients. The faculty will also briefly discuss practicing in the community and at academic med-
the implications of research questioning the utility ical centers.
ofusingtwodifferentopioidssimultaneouslytomaxi-
. .
mize pain relief. Palliative care practitioners in the We Built It They All Came Now How to
trenches need this presentation to get the tough Keep from Drowning? Pediatric Palliative
job done! Care Program Development 202: Skills in
Your Toolbox for Growth and
Navigating Your Specialty Palliative APRN Sustainability (P20)
Career (P19) Tammy Kang, MD, Texas Children’s Hospital,
AnessaM. Foxwell,MSN CRNPAGACNP-BC ACHPN, Houston, TX. DebraLotstein,MDMPHFAAP,Chil-
Hospital of the University of Pennsylvania, Philadel- dren’s Hospital Los Angeles, Los Angeles, CA. Lisa
phia, PA. Barbara Reville, DNP ANP-BC ACHPN, Humphrey, MD, Nationwide Children’s Hospital,
Dana-Farber Cancer Institute, Boston, MA. Margaret Columbus, OH. Jeffrey Klick, MD, Children’s
Root, MSN RN CPNP-AC CHPPN, University of Healthcare of Atlanta, Atlanta, GA. Conrad
Vol.55 No.2February2018 Schedule WithAbstracts 557
Williams, MD FAAP, Akron Children’s Hospital, PENN Medicine at Lancaster General Health, Lancas-
Charleston, SC. ter, PA. Thomas LeBlanc, MD MA MHS FAAHPM,
Duke University School of Medicine, Durham, NC.
Objectives
(cid:1) List thecomponents ofboth a hospitaloperating Sara Kim, PharmD BCOP, Mount Sinai Hospital, New
York, NY. Joshua Jones,MD MA, University of Pennsyl-
budget and a pediatric palliative care (PPC) pro-
vania Health System, Philadelphia, PA.
gram operating budget.
(cid:1) Identify strategies for maximizing clinical Objectives
revenue. (cid:1) Verbalize the need for increased knowledge of
(cid:1) Describe key factors important for pediatric palli- topics in Hematology/Oncology.
ative care program sustainability and growth. (cid:1) Defineanddescribethelanguageandassessment
In a 2012 survey, 69% of children’s hospitals re- tools utilized by Hematologist/Oncologists.
ported having a pediatric palliative care (PPC) pro- (cid:1) Describe available treatment and prognosis for
gram. Most of these programs offered inpatient advancedsolidtumormalignancieswithemphasis
consultation during the work week only, with a var- on emerging treatments such as immunotherapy
iable number of consults annually depending on and targeted treatments.
hospital bed size and number of funded PPC staff. Hospice and palliative care (HPC) clinicians are
Most of these programs reported being highly increasingly called upon to care for patients
dependent on hospital funding. In addition, there receiving active treatment for hematologic or onco-
was wide variability in program staffing resources logic malignancies due to growing evidence that
with the mean FTE of physicians at 0.45, social early palliative care improves survival, symptoms,
workers at 0.29 and chaplains at 0.16. More notably, mood, cost, and patient satisfaction. To ensure the
41% of programs reported having no physician sup- success of upstream HPC involvement, it is impera-
port, 36.6% were without support from advance tive HPC clinicians competently care for the pa-
practice nurses, and 66% had no social work tients in question and ‘‘speak the language’’ of the
support. hematologist/oncologist. Current HPC training
The rate of new PPC programs being developed and certification does not guarantee competency
peaked in 2008. While the significant increase in the in these areas. In fact, HPC clinicians may not
total number of PPC programs is worth celebrating, have had any direct exposure to hematology/
inrealitymanyprogramsareunderresourcedthereby oncology care before entering the field while at
threatening the longevity of the program or its func- the same time, care of patients with hematologic
tionality.ThenextdecadeofPPCgrowthanddevelop- or oncologic malignancies is increasingly complex.
ment will require a focus not just on new program Novel therapies emerge rapidly with mechanisms
development, but on expanding and sustaining exist- and side effects that differ from traditional chemo-
ing programs. therapy and allow for treatment of patients with
This session will focus on the second phase of pallia- more limited performance status. This workshop
tive care program development: Now that your pro- will ensure HPC clinicians are equipped with the es-
gram has been formed, how do you sustain your sentials needed to approach the care of these pa-
program and grow to meet expanding clinical needs tients, including; terminology, treatment options,
and academic demands? prognostic uncertainty, targeted therapies, hematol-
In this workshop, specific issues related to PPC ogy/oncology emergencies, financial toxicity, radia-
program sustainability and growth will be addressed tion therapy, hospice coverage of cancer care,
including: 1) Finances: understanding hospital and caregiver support, expected side effects of treat-
programoperatingbudgets;2)Clinicalrevenue:iden- ments and navigating relationships with hematolo-
tifying common billing and coding issues; 3) Leader- gists/oncologists.
ship skills: building negotiation skills and managing The workshop will target attendees’ specific needs
conflict; 4) Program development strategies: main- and questions, with real-time adjustment of the cur-
taining relevance, and finding creative ways to use ex- riculum to fulfill their goals and provide appro-
isting resources and philanthropy. priate resources. This second generation workshop
builds on the well-attended 2017 session with im-
provements based on participant feedback. Upon
Oncologist in My Pocket: What the Hospice completion of this workshop, HPC clinicians will
& Palliative Clinician Needs to Know About have the clinical tools necessary to develop an
Hematology/Oncology (P21) approach to the care of patients with hematologic
Kristina Newport, MD FAAHPM, Hospice & Commu- or oncologic malignancies along the continuum of
nity Care, Lancaster, PA. Shanthi Sivendran, MD, cancer care.