Massachusetts
Medical Orders for
Life-Sustaining
Treatment
MOLST in Massachusetts: Overview and Expansion Update
Following the Patient in the Healthcare Journey
MOLST Implementation STAAR/MassPRO Conference
Christine McCluskey, RN, MPH
Director for MOLST Expansion
October 30, 2012
The Massachusetts MOLST project is a collaboration of the:
•
Massachusetts Department of Public Health
•
Massachusetts Executive Office of Elder Affairs and
•
Commonwealth Medicine at UMass Medical School
2
Objectives
• Describe MOLST and its place along the advance care planning
continuum
• Name steps involved in MA MOLST implementation in health
care facilities
• List resources for learning more about Medical Orders for LifeSustaining Treatment
3
MOLST is…
 A standardized hot pink-colored form* that contains a patient’s
preferences about life-sustaining medical treatments.
 Valid medical orders that can be honored across all health care settings.
 A clinical standard of practice for documenting and communicating
patient preferences about life-sustaining medical treatments.
 A dynamic form, meant to be updated along with changes in a patient’s
health status or treatment preferences.
* Original MOLST forms are created on hot pink-colored paper to maximize visibility
and portability. Electronic, faxed and non-pink forms are also valid.
4
MOLST in the Advance Care Planning Continuum
Everyone age 18 and older
Fill out health care proxy form to
appoint Health Care Agent
C
O
N
Review/update proxy form periodically
V
E
R
Only if diagnosed with an advanced
Illness (any age)
S
A
T
Fill out a MOLST Form
I
O
N
S
End-of-Life Preferences
Communicated and Honored 5
Which patients are suitable for MOLST?
Patients of any age with an advanced illness including, but not
limited to:
– Life-threatening diseases
– Chronic progressive diseases
– Life-threatening injuries
– Medical frailty
– Any patient suitable for considering DNR orders
6
MOLST Takeaway Messages
• MOLST is not an advance directive.
• MOLST is a medical form containing medical orders created by
clinicians, based on a patient’s current health condition and effective
immediately when signed.
• All adults aged 18 and older should still complete a health care proxy
form to appoint a health care agent to make decisions for them in
the event of loss of capacity.
7
MOLST Expansion in Massachusetts
June
Spring
2011-12
2010
MOLST
Demonstration
Project in
Worcester area
Planning for
statewide
expansion
2012
Pilot
implementation
training with acute
care institutions
2012
MOLST
Implementation
Tool Kit available
at www.molstma.org
Goal:
2014
Statewide
MOLST use
2012-13
Self-paced
MOLST
implementation
at institutions
throughout MA
2008 – 2009
Acts of 2008 mandate and
Planning for “POLST” pilot project
8
To launch MOLST in Clinical Care Institutions:
1.
Review MOLST information and resources at www.molst-ma.org.
2.
Identify a “MOLST Clinical Champion” within the institution.
3.
Access the MOLST Implementation Tool Kit at: www.molst-ma.org.
4.
Begin the self-paced MOLST implementation process.
5.
Set or estimate a MOLST launch date and access MOLST forms on
line at www.molst-ma.org.
9
Visit the Massachusetts MOLST Website for:
• More information about MOLST
• Answers to Frequently Asked Questions
• MOLST training materials for health professionals
• Registration for conference calls and events
• Patient and family information and materials
• Informative video about MOLST in Massachusetts
www.molst-ma.org
10
MOLST Website:
molst-ma.org
11
MOLST Video
12
Self Directed Trainings
13
Self Directed Trainings
14
Other Resources
POLST website:
http://www.ohsu.edu/polst/index.htm
MA End of Life Expert Panel: Final Report - Patient Centered Care
and Human Mortality
http://www.mass.gov/hqcc/the-hcqcc-council/about-thehcqcc-council/meeting-schedule-and-materials/expertpanel-on-end-of-life-care/
15
Northeast Health System
MOLST Implementation STAAR/MassPRO Conference
Breakout session
October 30, 2012
Shirley Conway, RN, Director of Geriatric Initiatives
Fay Curtis, RN, Director of Acute Care Services
Gregory Bird, RN, Sr. VP for Patient Care Services & CNO
16
Northeast Hospitals
Advance Care Planning Framework
Interrelated Initiatives
STAAR
Advance Care Planning
Life Prolonging Care*
Palliative Care*
Patient’s Right
to SelfDetermination
Hospice
Care*
5 Wishes MOLST
NICHE (Nurses Improving Care for Healthsystem Elders)
Geriatric Initiatives:
Elder Friendly Hospital
Preventing Geriatric Syndromes
Older Patient Bill of Rights
Massachusetts End-of-Life Expert Panel Gap Analysis
* Copyright 2008 Center to Advance
Palliative Care.
17
Objectives
• Practical implications for implementing MOLST at the
hospital level by incorporating MOLST into related
activities & goals (e.g., Advance Care Planning)
• Discussion will include how to:
– Take Action steps needed for success
– Identify key stakeholders
– Utilize MA MOLST resources
– Incorporate education strategies
18
Blueprint for Action
One of the Nursing Division Goals for FY12:
Continue to improve the care and health of hospitalized
older adults by advancing Nurses Improving Care for
Healthsystem Elders (NICHE) principals.
• Spread access to the Five Wishes document within the hospitals and
primary care practices.
• Perform a gap analysis of NHC practice compared to the
Massachusetts Expert Panel on End of Life Care Report September
30, 2012.
• Develop and present for approval a Bill of Rights for Hospitalized
Older Adults by September 30, 2012.
• Establish a pilot Inpatient Palliative Care Consultation service and
evaluate effectiveness by May 1, 2012.
• Participate in Phase 2 of the Massachusetts Medical Orders for Life
Sustaining Treatment (MOLST) Program by May 1, 2012.
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Project Initiation
• Senior Leadership Support – Critical to Success
• Identification of initial project Team
– Key internal and external stakeholders
• MOLST work incorporated into STAAR Cross
Continuum Team
20
Project Scope Development
• Utilizing MOLST resources
–
–
–
–
–
Tool Kit
Webinars
Conference Calls
Web Site
Working with MOLST Leadership Team
21
Project Stakeholders
Identification of Key Internal & External
Stakeholders
• Planning Meetings
• Narrowing down the focus to basic operations
with targeted agendas: MOLST Mini-Meetings
22
Workflow
• Process flow diagrams were developed to identify
MOLST workflow
23
Education & Training
• Education:
– Access/Registration staff
– Medical Records staff
– Medical Staff
•
•
•
•
Medical Executive Committee
Hospitalists
Primary Care Physicians
PHO
– Nursing staff
• Staff meetings
• Content incorporated into Skills Days Training Session
• Case Managers
– Social Workers
24
Questions?
25