(Amanda) Hello, everyone, and welcome to today's webinar
for Advanced Palliative Care Certification.
Before we get started, I'd like to go over a few items
so you know how to participate in today's event.
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I'll now turn it over to Francine Topps, Business Development Manager
of Hospital Business Development and Certification.
(Francine) Welcome, everyone, to today's webinar.
I'm Francine Topps,
Business Development Manager for Hospital Certification.
And with me, I have Tammy Croney,
who is the Palliative Care Surveyor
for Inpatient Palliative Care.
For today's webinar,
this webinar is for,
Inpatient Palliative Care Certification.
And this will not go over
any community-based palliative care accreditation
or certification.
Today's webinar is for Inpatient Hospital Palliative Care Certification.
Once a hospital has achieved Accreditation with The Joint Commission,
you do have the opportunity to apply for our certifications.
Next slide, please.
Some of you might ask, "Why do I need certification?"
The Joint Commission has been around for over 60 years
and our Seal is recognized by our peers, payers, and insurers.
By earning the Seal,
it validates the work that you and your staff have done
to achieve this or any of our other certifications.
Next slide, please.
Once you achieve the certification,
it does show your commitment to our continuous performance improvement
by providing high quality patient care, and it reduces patient risk of harm.
It also helps with their interdisciplinary program structure.
Certification provides utilization
of evidence-based clinical practice guidelines,
which we will talk about today,
and a formal approach to certification.
Down at the bottom, we have a quote from our customers.
It says,
"92% of our customers tell us Joint Commission certification
directly impacts the safety and quality of their patient outcomes."
Next slide, please.
Now I'm going to turn it over to Tammy Croney,
and she's going to talk about the details of the certification.
- Tammy? - (Tammy) Thank you very much.
I am happy to be here today
and talking about my very favorite subject,
Advanced Palliative Care Certification.
Next slide.
Advanced Certification for Palliative Care,
the Performance Measures became effective 1/1 of 2017.
All hospitals certified in Advanced Palliative Care Programs
are required to implement this data collection
for the five standardized measures
and report them to The Joint Commission.
On survey, we look at those,
and we go over them and we look at them
ahead of time as well.
It kind of gives you
a pulse point, if you will.
Next slide.
Okay.
The orientation to the program.
When I walk in,
and there's myself and there's two physicians
that do the certification, maybe with me,
I'm the only full-time one.
That's why you see me as the palliative care nerd,
all excited to tell you about what will happen.
I think If you talk to any of the programs who have been through certification,
they will tell you they were nervous at first,
but that, once they started the process,
that it sort of was a relaxing event,
that they got to show off their program, if you will.
Is there without any issues or opportunities?
No, there's usually something here or there.
There's also opportunity to talk about best practice.
But, getting back to orientation to the program.
When I arrive, there's a 45 to 50-minute activity,
which is an exchange between the organization and the reviewer.
This 45-minute exchange covers a variety.
It's the opportunity for the Palliative Care Program
to explain the structure and scope of care.
Also, it's the opportunity for the organization to go over
some of their particular processes
and particular policies in place.
Next slide.
Advance.
Oh, thank you.
This slide kind of breaks it down for you.
What do we go over?
We say hello, we sit down,
and the program itself tells the reviewer about its mission,
its goals, its objectives.
Also, I will explain the Palliative Care Program structure.
Because let me be clear here.
Each program,
while they have to adhere to the National Consensus Guidelines,
which they've adopted for palliative care,
the program is unique.
And the worst thing a program can do
is trying to exactly mimic another program.
I always tell organizations with palliative care programs,
look at your National Consensus Guidelines and build your program from there.
It might not look the same as the next person's,
but as long as it's built on the structure of the National Consensus Guidelines,
you're going to be fine.
During this orientation,
the organization will tell the reviewer the process for referring patients
to palliative care.
The program will also explain their team composition,
how it was developed, and how they're evaluating their program.
Because, many times, before certification,
the program has been in existence for a length of time.
And they will talk about that
and, if this is their initial survey,
how they came to the conclusion that they wanted certification.
They will tell the reviewer the target population for the program,
Identified needs of the program and the population.
Organizational support for the program, very important.
A lot of times organizations will say,
"Who needs to be in the opening?"
Also known as the orientation to the program.
And it definitely depends on the organization,
and they can decide who needs to be there.
But, oftentimes, leadership is there,
which also kind of is self-evident at that point to the reviewer,
the organization's involvement with palliative care.
The implementation of the clinical practice guidelines
is also expressed during that time.
Sometimes it's just part of the slide,
and this is the guidelines,
which is usually the National Consensus Guidelines for Palliative Care.
They talk about how the evaluation
of evidence-based practice guidelines is appropriate to their target population.
The performance improvement process.
I just alluded to, in a couple of slides ago,
the five that we require.
But oftentimes, organizations will have some of their own.
They will have processes that are important to them
or performance issues that might have given them some problems.
So they might be gathering data on that,
and they may have even evolved and corrected whatever issue.
They're very proud of that,
so that's worthy of showing during that time.
The program,
the program integrity,
the program's recognition within the organization,
that is when leadership-- integration, I'm sorry, program integration
and the recognition oftentimes when leadership will step up
and talk to that process.
Not that they have to.
Again, this is a time in which you decide as an organization,
as a palliative care team,
what this will look like.
And then, again, leadership involvement in this opening,
oftentimes is sealed, you know, with their few words--
their few words about palliative care and their involvement.
They don't have to.
Again, I know this is repeating, but it is worth repeating.
You decide what the program orientation will be.
In Joint Commission's guidelines
for setup and getting ready for this review,
they will tell you some items that need to be there
but, clearly,
it is for the organization
to decide everything that they want to put into that time.
Next slide.
After the organization gives their opening,
this is probably the most misunderstood piece,
reviewer planning session.
It's not for me to step away and be alone.
At this point, I usually thank any leaders,
or any other people from the organization,
any other clinicians from the organization,
and I ask that a smaller group stay
and let's talk about exactly how the day will follow,
which will include going through the agenda to some degree.
At that point, there's a goodbye,
there's a few minutes of turning things around,
and then we sit down.
At this point, when we're talking about your program,
this is the rest of the day
that we are discussing and laying out here.
There is nothing that can't be moved around.
What do I mean by that? The agenda.
When you look at the agenda,
you see that we're going to go through individual tracer activities
until the afternoon, lunch and then some in the afternoon.
And then we have two system tracers in the afternoon.
Now, all of this is laid out in the agenda.
However, during this planning session,
sometimes we have to move something around.
That's fine. This is your review. This is your day.
I can't express that enough for all of us reviewers
that do palliative care.
It's very important.
The next activities involve,
yes, we need a list of the current patients
that are receiving care.
If the number of patients currently being seen
by palliative care program is limited,
a list that was seen within the past month--
past four months would be available to the reviewer.
And from that, we could review a record.
We also need a current list of palliative care program leadership
to include physicians and other licensed clinicians,
i.e. MPs usually,
and other professionals that are part of the interdisciplinary team
with their credentials, job title, program-related job responsibilities.
Examples of order sets,
pathways that reflect the evidence-based clinical practice
currently being followed by the program.
Let's take a breath.
That's like we would do while we are planning all of this.
What do our individual tracers look like?
We have our current list of patients and we're looking at them.
I will ask you, and usually the other reviewers do the same,
"In this venue,
tell me how I can best understand your program?"
"If you have pediatric patients, how do the referrals come in?"
"What is the volume?"
From there, also I'll ask about team meetings.
Sometimes, in fact, during this session,
we will actually do a small version of that,
where I can observe the team
going through a small portion of the patient
to best understand the process.
Sometimes, that's inclusive of the patients
that have just been selected.
How many patients? It's usually five.
If there's not five available,
or if some of the patients that we will be seeing are more complex
and, for whatever reason, a piece of that will take longer,
we can adjust that slightly.
We can also pull from patients
that have been seen within the past four months
and kind of look at them from the perspective of a record review.
Also during this piece,
the organization will usually tell me,
"Oh, we have a family meeting coming up," or whatever is highlighted for that day.
If I get the opportunity,
there are times when a family meeting
might be part.
It might be the patient that is selected is having a family meeting.
I usually don't stay for the whole thing, and oftentimes-- not oftentimes,
always, you would ask the family for permission,
but of course, explaining what the reviewer does.
This is difficult because we don't do easy.
We're not doing stroke here,
we're not doing...
...some of the other reviews that are a little bit--
we're doing, a lot of times, end of life.
And so this is complex.
But I've never, when a team said,
"I think this would be good for you to observe,"
I've never been turned down
if the team approaches the family with what I do, who I am,
and that I'm just observing them for the best care.
A lot of times, in fact, families request being heard.
Several times, I've done five tracers
and I have the team saying,
"Well, this family and that family wanted to talk to you."
And, well, I don't ever turn down a family.
If they want to talk about palliative care and what it meant to them,
we make time for that.
we may talk to a few more families if we need to,
we will do whatever we need to do.
But during this timing session, that's where we decide that.
That's where we lay out
these individual tracers and opportunities.
Now, sometimes, also, I get teams all upset
because a family's changed their mind
or they can't go and take the individual tracers
in the direction that we thought that was going to be possible.
That's not a hiccup for me.
I usually tell them-- I usually tell you guys in the beginning,
"We pick five,
is there one that we can kind of put to the side just in case?"
And we go from there.
There's nothing that should be that stressful for you guys
related to this process.
You do difficult all the time.
We're going to design this during this session
to be an opportunity for you to showcase your Palliative Care Program,
and for me to see that,
but also for me to see and compare you to what's going on,
compare you to the Consensus Guidelines that you have adopted
and that you're following.
Of course, our standards are included in that,
and if there's an opportunity,
then I will identify that for you,
and I also try and point out best practice.
Next slide.
Okay.
Now, several slides ago,
I alluded and kind of teased you with the Palliative Care Measures.
What are they? What are those five PAL measures?
And how can you extrapolate them?
That's a question I get asked sometimes by organizations.
And depending on the electronic medical record you have,
a lot of times, extrapolation is quite simple.
It actually is just a click of a button or two
for those in quality to help you obtain the ability
to easily get this information.
The five that you will be doing and reporting to The Joint Commission
is PAL-01, which is just the Pain Screening;
PAL-02 is Pain Assessment, it's a little bit further,
I'll get more in detail in a minute;
PAL-03 is Dyspnea Screening;
PAL-04, Treatment Preferences and Goals of Care;
and then PAL-05
is the Treatment Preferences Discharge Document.
Next slide.
Okay.
As promised, more detail.
The PAL-01, Pain Screening,
is a portion of palliative care patients who were screened for pain
during the palliative care initial encounter,
which you have to do for each patient.
The Denominator and the Numerator are as follows.
Denominator.
Patients receiving specialty palliative care
in your acute hospital setting for one or more days.
The Numerator.
Patients who are screening for the presence
or the absence of pain and its severity,
utilizing a standardized quantitative tool.
Lots of times, that tool is Edmonton, also known as ESAS,
and probably 90% of the programs use that one.
Next slide.
PAL-02,
a little bit further into Pain Assessment.
This description is the portion of palliative care patients
who have screened positive for pain
during the palliative care initial encounter.
They have identified pain as an issue.
From that point, the assessment of pain,
which includes five of seven components required,
within one day of the screening.
Patients receiving specialty palliative care
in an acute hospital setting is your denominator,
whoever reported the pain.
And then the numerator would be the patients
who received a comprehensive clinical assessment,
which would include five of the seven components.
And that's within one day.
Next slide.
PAL-03, Dyspnea.
Portion of palliative care patients who are short of breath
during the palliative care initial encounter.
Same thing,
the patients receiving specialty palliative care
in acute hospital setting for more than one day
would be your denominator.
And then the numerator would be the patients
who were screened for the presence or the absence.
I feel it necessary here to say
that sometimes programs get confused here
and they think they don't have to document
if the patient is not having symptoms of shortness of breath.
Whether or not they have it, it needs to be documented.
So again, read this carefully. It's the presence or absence.
Otherwise, you really don't know or you could miss,
the potential is missing somebody who has it,
and then you don't capture.
I want to make that clear for that part, because I see that not consistently,
but I do see it here and there.
Next slide.
PAL-04, Treatment Preferences and Goals of Care.
PAL-04 and 05 have been a little bit problematic for some organizations.
I think it's just capturing, not as much capturing that it is
as documentation that you have captured it.
Patients receiving specialty palliative care
in an acute hospital setting, again, is going to be your denominator.
And then the numerator,
again, it's the patients with medical record documentation,
you just heard me say it,
the Treatment Preferences and Goals of Care.
That documentation does have to occur,
whether or not you've assessed it is another issue.
I oftentimes see organizations,
or organizations will tell me, sorry, I can't read my own writing here,
will tell me that,
"Oh, we've been doing this, but it wasn't until this point
or going through certification that we realized
how often we were not documenting."
This measure sort of highlighted for them the need for documentation,
and then they started documenting.
So I did want to share that.
And PAL-05.
Next.
Okay. The Treatment Preference Discharge Document.
This is probably the most troublesome.
With some organizations,
and then I'll go to others,
they don't know why other people have issues.
Sometimes it comes down to the electronic medical record
and actually processes in place.
There are some articles actually have been written about this issue.
If you think you might have an issue with this,
you can reflect on that.
Description: A portion of the patients
for whom a transition of care document
containing information regarding the goals of care
and the treatment preferences is completed
and then accompanies the patient to their next level of care at discharge.
The denominator would be patients receiving specialty palliative care,
again, that old acute hospital setting for more than one day.
And then the numerator,
patients for whom a transition of care document
containing information regarding treatment preferences
and goals of care is completed
and accompanies patients to the next level of care at discharge.
It's problematic, but oftentimes this measure is highlighted
with organizations as something that--
by palliative care team, sorry,
that their organization finds very valuable
because they want that hard work that they have done
to go over the goals of care
and to possibly
get treatment preferences and goals
advanced from the previous.
And what do I mean by that?
A patient comes in and they might not have a DNR.
During this hospitalization, they become a DNR.
And if hard work isn't done
and this measure isn't completed,
and this document doesn't either get finished
nor does it go with the patient,
there's a whole lot of unnecessary events that might happen.
Organizations are telling palliative care,
and they tell me many times in the opening,
this is an important measure for them as well,
as a hospital, as a whole.
Although it might be a little bit more difficult,
although it does take some time
to maybe put into your electronic medical record,
and in process change,
it is a very important document
and does oftentimes make a huge difference
to patients and their families.
Next slide.
I'm not sure if that one's mine or not. Nope.
Thank you all very much.
I'm holding on for any questions also,
and I'll turn it back over.
(Francine) Yes, hi, this is Francine Topps.
Thank you, Tammy. That was a lot of fantastic information.
And as she said,
if you have questions, you can put them in the chat.
And we have question and answer session at the end of the presentation.
Next slide, please.
Tammy gave you all of this great information
and you probably will ask, if you see it,
you say when you're ready to apply for the certification.
The next steps would be,
as we say, you would do a Gap Analysis in the program.
And all that is, like it says, it's a self-assessment
against the standards and the clinical practice guidelines,
as Tammy mentioned.
You would take a look to see what you already have in place
versus our standards and the clinical practice guideline.
And once you determine that you are ready to start the process,
then you do have to submit an application.
For some of you that might not have any certifications,
you do have to submit an application,
and I'll show you where you do that in a second.
But what we ask that you do is that you kind of determine
when you want to be certified.
We ask that you give us at least four to six months from that date.
And so if you're looking right now,
if you're saying, "Well, I'd like to be certified sometime in April of 2024,"
then what you would do is you would gather your information,
you would submit your application at least in December
if you're looking to have an April 2024 review.
And then it says, "contact the Business Development person,"
which would be me.
I walk you through the application and help you complete it.
And I also have some templates
to give to you to help you complete
the CMIP section of the application.
And I'll talk about that on the next slide.
Next slide, please.
In the application, there are two sections to the application.
This first section is what we call the E-Application.
Basically, we just want basic information about the program.
Again, we ask for your review date, we want the volume of patients.
And then the second section is what we call the CMIP,
and that's the Certification Measure Information Process,
and this is where you would put your clinical practice guidelines
when it was published,
your performance measures that Tammy just went through,
they will be preloaded.
And then, we do ask that you give us four months of that data
when you have your on-site review.
And in addition to-- On the CMIP section of the application,
there are five of six questions,
five or six performance improvement questions.
And what I normally do is, I can send you a template
so you can start looking at those questions,
or when you do get access to the application,
what I ask is that you can take
and copy and paste that page to a Word document
and then type out the description of, you know, answer the questions,
you know, in a Word document
and then you can copy and paste them into this CMIP section of the application.
Next slide, please.
And, again,
for organizations that are accredited,
and if you already have a certification,
this is the Certification Tab.
This is where the palliative care application is housed.
You would go to your Certification Tab,
you would click on that you're interested in the palliative care,
and all of the E-Application information
for the palliative care certification would open up.
It's pretty, you know, simple
because a lot of the information is already transferred
from your accreditation application.
All we ask on the E-app section is basically your review date
and then the number of patients that you serve.
Next slide, please.
As you just heard from Tammy, you know, our reviewers,
and as she said, she is the main palliative care reviewer.
She is a subject matter expert,
and you can be assured that when she comes on site,
she can inspire to improve
your quality of patient care for this certification.
Next slide, please.
As Tammy had mentioned,
preparing for the on-site review,
she already went through what she does
for the opening conference and orientation.
And she went through your team members, what you need to have.
She went through your tracer activities.
She talked about your clinical practice guidelines,
and your policies,
and your data that you need to use,
the orientation, and your competency, credentialing,
and then she will give you a closing report.
In addition, you do get a review process guide
once you decide that you're ready to start the process,
and this is what you would get from your Account Executive.
And then it's also available
on your Connect site in your Connect portal as well.
Next slide, please.
Here are some other resources.
Joint Commission Business Development,
that would be me.
You are always assigned an Account Executive for certification.
If you already have certifications,
that would be the same Account Executive.
If this will be your first certification,
you would be assigned a Certification Account Executive
in addition to your Accreditation Account Executive.
And we also have the Palliative Care standards manual.
You can get that electronically.
Once you let me know,
I can give you a trial, a free 90-day trial.
We also have a hard copy, a PDF that I can send to you as well.
Then as I mentioned,
you do have access to the Review Process Guide,
and that is on the Connect Portal as well.
And then there are some webpages
on our website for the Palliative Care Certification.
Next slide, please.
We have some additional resources,
like I said, we have the Measures manual.
These are the places on Joint Commission where you can get the manual from,
and the measure specification that Tammy just went through,
the manual goes into the details of those measures.
And then you will be able to get access to this webinar as well
once it's uploaded to our website.
Next slide, please.
Once you become certified,
you can advertise your achievement on your website,
you can display the Gold Seal.
I know I've gone to some, not a lot,
but some hospital organizations
and I see that they have the Gold Seal there
for their certifications when you walk into the lobby,
and I think that's real neat how some hospitals do display that.
And the next slide.
If you have any questions,
this is the certification port, this is the certification email address.
And then, below is my information, you can contact me directly,
that's my email and my direct phone number.
And the last, I think that the last slide, please.
I will open it up for any questions.
If you don't have anything in the chat, if you have any questions,
you can let us know.
I'm going to turn it back over to Amanda.
(Amanda) Thank you so much, Francine.
And also thank you, Tammy, for the great presentation.
We do have a couple of questions that came in the chat.
The first one is,
how long does the certification process take?
And feel free, Francine or Tammy, either one of you to respond.
(Francine) Yep. This is Francine.
From the time you feel that you're ready
to have the certification,
ready to apply for the certification, like I said earlier,
we do ask that you give us at least four to six months.
So, again, if you're looking to have,
you should go back to see when you want to be certified.
If that's in April of 2024,
then you probably need to apply in December.
If you want to do it in March,
if you're looking to be certified sometime in March,
then you might want to start getting your application ready now.
It really depends on you,
but we do ask that you give us
at least four to six months lead time for the certification.
(Amanda) Awesome. Thank you.
And then the next question here is,
which I think this was covered, but we can cover it again,
how can I access the standards to review them?
(Francine) Okay, excuse me.
You can send me an email or you can go to the--
you can send me an email
and then I can give you a 90-day free trial.
And then also what I do is,
I can send you a PDF copy as well
if that's what you want.
You can just email me
and my email again is ftopps@jointcommission.org.
(Amanda) Thank you. And then a couple more questions here
before we wrap up.
How do you determine the cost for an organization
and what are the benefits
of having Advanced Certification for Palliative Care?
(Francine) Okay, so you're saying, okay, so can you read,
you said what are the costs? Is that the question?
(Amanda) It was twofold. There's two parts.
The first one was, how do you determine the cost for an organization?
And then, what are the benefits of having this certification?
(Francine) Okay. We have basically one--
We have a basic cost for the certification.
The cost that I'm giving to you now is just for one site, one day review.
And so, there's an annual fee. The annual fee is $3,600.
And then the onsite visit fee is $2,185.
And that's basically for one site, one day, one reviewer.
If you have additional sites,
then, we can determine what those costs would be
and how we would bill you for those costs.
And what was the second part of the question?
(Amanda) What are the benefits of the certification?
(Francine) Well, I mean, like any of our certifications,
we can't give you an ROI right now in terms of the benefit
but, of course, the benefits are
that you have, like I said earlier,
you have shown that it helps in your processes and procedures.
It helps in your community, it shows that you have gone through,
like I said, the processes with Joint Commission
and that you are looking for quality
for patient safety,
and it kind of--
you stand out apart from any of your competition in your area
that might not have this,
the Palliative Care Certification, or any of our other certifications.
(Tammy) And I would just like to add from the palliative care standpoint,
a lot of organizations that are palliative care certified
are wanting to get the word out,
because you bring up a good point,
why, what's-- you know, because one palliative care program
is not the same as the next.
And so, many know
that the 4th Edition National Consensus Guidelines
for Palliative Care
require the highest level of quality in palliative care,
which is to have a core team.
You're not just going to have a physician, or a nurse, or any other.
You're going to have the core team, and the core team is,
you have physician, you have nursing,
you have social work, you have chaplain, you have that holistic approach
to palliative care.
And I think the more that word gets out there,
which many who are certified are trying to get out there,
is that you are the bomb.
You are the premier program,
because the way you do palliative care is different
than say the hospital down the road, because you have an approach to it
that is organized, and you have a solid foundation.
And many, many programs are trying to push for this
so that it is a totally different program.
A lot to be proud of.
That's all.
(Francine) Okay, thank you, Tammy. That was great. Thank you.
(Amanda) Thank you both.
And then, one final question here before we dismiss.
How long is the certification good for or how often do we need to renew?
(Francine) Okay. The certification is a two-year rolling certification.
You have your review your first year
and then, like the end of the second year
and beginning of the third year.
It is a two-year rolling certification.
(Tammy) And we also have an inter-cycle call in between.
And you have that touchpoint with the actual reviewer.
We make a phone call mid-cycle between the two years,
and at that point, you have the opportunity to ask questions.
We also go through your measures,
we can see them that you've uploaded.
Any issues you're having, we try to help you with those.
There is, although we're not on site, we're by--
Whoa, I said by phone, but now we're by web.
So, we actually can look at each other and everything.
But I think that's a benefit that many programs like as well.
So every two years, but also not to forget our inter-cycle call touchpoint.
- (Francine) Yes, thank you, Tammy. - (Tammy) You're very welcome.
(Amanda) Perfect. Again, thank you so much, Francine and Tammy.
And if you do have any additional questions,
you can reach out to Francine.
Her contact information is in the slide deck
that you will receive after via email with a recording of today's presentation.
And with that, we will wrap for today.
Thank you so much for everyone that joined
and thank you again, Francine and Tammy. Have a good day.
(Tammy) It's a pleasure.
(Francine) Okay, thank you all. Thank you.
(Amanda) Bye, everyone.
(Francine) Bye.