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ETHICS IN CLINICAL PRACTICE COMMITTEE
Overview | Responsibilities | 2015 Accomplishments | CG Ethics Champions

Current Work:

  1. Dr. Ellen Robinson, nurse ethicist at MGH was invited to present at the April 4th EICPC meeting. Dr. Robinson discussed the ethical issues often associated with cases where there is disagreement between the interdisciplinary healthcare team and patients or families when the patient wishes to continue receiving life-sustaining treatment (LST) in situations where the burden of suffering outweighs the benefit of treatment.
  2. The role of surrogate can be difficult and burdensome and frequently impacted by feelings of anger-associated grief. The goals and intent of CPR as outlined by the American Heart Association were reviewed as well as a proposed model for clinical decision-making based upon the ethical principles of beneficence and non-maleficence, understanding the patient’s values and beliefs as well as prognosis, and the use of shared decision-making in delineating goals of care and appropriate treatment options. Section 3.6 of the MGH LST Policy: Do No Harm was also discussed. This section includes statements of intent and language related to the needs of patient who are imminently dying where continuing such treatment would be futile and only serve to prolong the patient’s suffering and those who are not imminently dying but with no reasonable chance of surviving CPR to the point of leaving the hospital. Transparency is essential. The responsible physician should inform patients and surrogates of the decision not to perform CPR and the rationale for this while assuring that the patient will continue to receive the highest possible quality of care.
  3. The role of the Optimum Care Committee in ethics consultation and how to process an OCC consult was also reviewed. Employees, patients, and families may request an OCC consult based upon Joint Commission standards and institutional policy. Consults may be processed by accessing the Partners’ Directory and entering the word, “ethics” which will identify the appropriate pager number for the responding consultant.
  4. Data was also shared regarding the gradual increase in the number of OCC consults that has been seen over the past 2-3 years. Prior to this, the average number of consults was approximately 60 cases annually. There were 167 consults in 2016, 204 in 2017, and thus far there has been 74 in 2018 necessitating an expansion in the OCC ethics consultation team to manage the increased number of consults.
  5. The 2018 EICPC Annual Advanced Care Planning Information Booth for patients, families, visitors, and staff was held on Wednesday, April 25th in the White Lobby near Coffee Central. There was a variety of written materials available for distribution which included copies of the MA Health Care Proxy form in English and Spanish, MOLST forms, the MGH Patient Education handout entitled, Preparing in Advance for Your Healthcare, and information on organ donation. A proclamation from Mayor Martin Walsh was obtained in recognition of advance care planning as an important aspect of care and the patient’s right to self-determination regarding his/her treatment preferences, and National Health Care Decisions Day (NHDD) as a significant initiative to raise awareness of ACP nationwide.
  6. Dr. Erica Wilson presented an overview of The Continuum Project in Palliative Care and an update regarding recent enhancements made to the EPIC ACP Module. The use of Serious Illness Conversations Guide is being rolled out across all clinical services across MGH as the primary focus of The Continuum Project. The main goal of this Guide is to assist providers and other clinical staff in conducting meaningful conversations with patients who have serious illnesses and their families regarding goals of care predicated on the patient’s wishes and perspectives regarding quality of life.
  7. The ACP report and module in EPIC is designed to be the source of truth for advance care planning for patients.  Code status history, serious illness conversations conducted over time, and links to scanned Health Care Proxies and MOLST forms are all accessible via the ACP report.  The ACP report can be accessed by clicking the yellow "code status" or "MOLST" button in the patient header of EPIC.  Detailed information and instructions about this resource are available in the following short healthstream: http://www.healthstream.com/HSAPP/CourseDetails?courseInstanceId=fd6d8ca4-ed52-e811-8f51-005056b10528
  8. Plans for the annual SAFER Fair are underway.  The EICPC is again planning to organize a charitable collection to compliment the themes of resource allocation and collaboration.  Committee champions Christine Marmen and Jackie Havey will be reaching out to MGH SW as well as Boston Health Care for the Homeless to assess the feasibility of a clothing and/or sock drive. We will open participation in this collection to all collaborative governance committees once details are finalized.  Susan Warchal, former chaplaincy fellow, has volunteered to provide The Blessing of the Hands at our annual SAFER fair table as part of the theme of collaboration. We will also be considering the possibility of creating an ID badge tag with information about available organizational ethics resources to give away at the fair. 

Accomplishments 2017

  • The EICPC again participated in the annual Collaborative Governance SAFER Fair on 10/11/17.  Three champion co-chairs organized our annual booth around the over-arching theme of communication. Many champions on the committee participated in creating a poster showcasing the ethical resources available at MGH. Another champion crafted a “Tree of Life” quilt that was raffled off to one of the fair-goers. Visitors at the booth were encouraged to think about, what gives their life meaning, and then were asked “who have you told.” This segued into information and education about accurately completing a health care proxy form. Additionally, the committee collected used cell-phones which were donated to the “Cell Phones for Soldiers” Organization.

  • The EICPC collaborated with the Diversity and Inclusion Committee twice this year to discuss timely questions and concerns about race, bias, diversity, inclusion, immigration, and ethical care for our patients.  This collaboration came at the request of our champions, stemming from a case presentation that troubled clinical staff that were working with parents of an injured child who were undocumented. At our April meeting, the Diversity and Inclusion CG Committee leaders led the EICPC champions through a presentation, conversation, and exercises related to the issues of diversity and inclusion, especially focused on unconscious bias. Resources that are available to staff to help with concerns that champions are experiencing regarding issues related to diversity and inclusion were also shared. Additionally, at our December meeting, champions from both committees participated in our annual book discussion on Small Great Things by Jodi Picoult. Led by EICPC champion, Tara Logan, committee champions shared their individual perspectives on the book and their thoughts on race, privilege, prejudice, justice, and compassion. Champions agreed having both committees engage in the discussion was valuable.
  • With the guidance of the EICPC leaders, five champions presented case studies at our monthly meetings on topics such as: ICDs at the end of life, tube feeding in advanced dementia, challenges associated with addressing questions and concerns from pediatric patients, and challenges associated with futile care and high expectations of hope of patients coming to MGH. In addition to discussing details of the individual cases and ethical resources utilized, champions this year also incorporated evidence based practice into their presentations by including current research articles about these topics.
  • The EICPC presented their mission, goals, accomplishments, and impact to a Magnet Appraisers at a dynamic meeting in November. 

Goals 2018

  • Serve as a resource to the MGH community regarding the advance care planning (ACP) process through education, consultation, and programmatic activities.
  • Maintain the EICPC EED portal page to ensure that this resource supports the educational needs of committee champions, MGH staff, and the public. 
  • Educate clinical staff concerning current ethical issues that impact practice and resources available to address ethically challenging situations utilizing an evidence based framework.
  • Create opportunities for professional growth, development, and participation for committee champions.

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Meets:

1st Wednesday monthly
1pm - 3pm
Trustees
Conference Room

Committee Contacts:

Co-Chairs
Brian Cyr, RN
Staff Nurse Bigelow 11

Jennifer Mantia,
RN, Staff Nurse Blake 7 MICU

Coach
Gail Alexander, RNBlum Patient and Family Learning Center

Advisor
Cynthia LaSala, RN, CNS- Phillips 20

Recorder
Jenny Crampe, Perioperative Services

CG Ethics Champions

ETHICS IN CLINICAL PRACTICE COMMITTEE OVERVIEW
The Patient Care Services Ethics in Clinical Practice (EICP) Committee is a multidisciplinary committee, which was formed to develop and implement activities and programs to further clinicians’ understanding of ethical aspects of patient care. The work of this committee involves identifying strategies to integrate ethical judgment into professional practice and consultation at unit and organizational levels related to ethical issues in patient care. return to top

Responsibilities:
  • Design and implement activities and programs to support the development of staff in Patient Care Services in the area of health care ethics.
  • Promote culturally competent care and staff education.
  • Employ strategies to educate EICP champions the area of health care ethics.
  • Student outreach.
  • Identify and address ethical issues and conflicts faced by clinicians in Patient Care Services.
  • Provide consultation to the organization regarding policies, procedures and programs with ethical implications.
  • Expand the impact of EICP through collaboration with other Collaborative Governance Committees, links with the organizational initiatives, and professional conference participation.
  • Engage in joint projects with other Collaborative Governance committees.
  • Align the work of the committee with PCS strategic goals. return to top
Membership:
  • All Patient Care Services professional staff are eligible to apply during the annual application process.
  • Annually, committee leaders recommend applicants to the Senior Vice President and Chief Nurse based upon the committee’s needs.
  • Applications are occasionally accepted from professional staff outside of PCS and will be recommended based upon the needs of the committee.
  • Committee meetings and events are open to the PCS community. return to top

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