March 30, 2012True Auditorium

in the District, Maryland, and Virginia (DMV) Region

} }Good End

of Life Care }}

Conference Program

}Center for EthicsThe Center for Ethics program at Washington Hospital Center was created in 1982 by Dr. John J. Lynch. The program grew from an ethics committee to a bioethics program in the Department of Pastoral Care. As the role of the ethics committee increased and the need for an organized department became clear, the department separated from pastoral care. The Center was separated from the Department of Pastoral Care in 1992 and its founding director was Janicemarie K. Vinicky, PhD.

The Center for Ethics is currently staffed by:

Nneka O. Mokwunye, PhD, DirectorEvan G. DeRenzo, PhD, Senior Clinical EthicistVirginia A. Brown, MA, Clinical Ethics Educator and EditorJohn J. Lynch, MD, Medical Director

MissionThe mission of the Center for Ethics at Washington Hospital Center is to help clinicians and other hospital professionals meet a standard of excellence in the care of our patients through education, training, consultation, policy development, and research in clinical bioethics. Additionally, when appropriate, we address the ethical concerns of our patients and families directly.

Current Status of Bioethics at Washington Hospital CenterCurrently, the Center is a resource to the members of the medical and dental staff, house staff, nursing, hospital employees, MedStar Health Research Institute Committee, and Institutional Reviews Boards, and the community at-large. The department’s responsibilities include: consultation in clinical and research practice, coordination of continuing education programs in bioethics, development and critique of institutional hospital policy, and the development and implementation of independent research on biomedical issues.

The Center administers a 35-member multidisciplinary Bioethics committee which has 3 subcommittees; policy, education, and consultation. A comprehensive consultation service is in place with a team on-call 24 hours a day, seven days a week, chaired by John J. Lynch, MD and Norine McGrath, MD.

The Center provides training courses for residents and other health care practitioners at Washington Hospital Center. The Center’s staff has served as consultants for establishing Bioethics programs at NRH (National Rehabilitation Hospital), NIH (National Institutes of Health), VNA (Visiting Nurses Association), Greater Southeast Hospital, MedLink Nursing Care Facility, and other institutions both locally in Washington DC and the greater metropolitan area, as well as other institutions in the United States. The Center for Ethics with the support of its Policy subcommittee, has helped to develop several key bioethics related standard practices and guidelines for Washington Hospital Center. A few of these practices include but are not limited to: Advance Directives, Guidelines for the Implementation of Do Not Resuscitate Orders, Withholding or Withdrawing Treatment; Refusal of Blood/Blood product transfusions; Guidelines and Protocols for the Management of potentially Viable Mid-Trimester fetus/Infant and Statements on the Management of Handicapped Infants.

Good End of Life Care in the District, Maryland, and Virginia (DMV) Region

}Conference AgendaFriday, March 30, 2012 True Auditorium

9:00am to 10:00am Registration and Continental Breakfast

10:00 am to 10:30 am Welcome and Opening Remarks

10:30am to 12:00pm Keynote Addresses:

Hunter Groninger, MD Staff Physician, Pain and Palliative Care, Clinical Center, National Institutes of Health “Good End of Life Care in the District, Maryland and Virginia Region”

*Questions and Answers

12:00 pm to 1:00 pm Lunch (provided)

1:00pm to 1:30pm Instructions for Break Out Sessions

1:30 pm to 4:00 pm Break Out Sessions: (locations assigned to group)

Group 1 – POB A Gap Analysis Question 1

Group 2 – POB B Gap Analysis Question 2

Group 3 – POB C Gap Analysis Question 3

Group 4 – East Building Boardroom (Bioethics Committee Chairs Only)

4:30 pm to 5:30 pm *True Auditorium

Presentation from Break Out Groups

Closing remarks

Hunter Groninger, MDHunter Groninger completed his medical degree and training in internal medicine at the University of Virginia. After this, he completed a fellowship in hospice and palliative medicine at Capital Hospice, and joined its faculty from 2006 to 2010. In 2009, Dr. Groninger became the founding Medical Director for Palliative Care at the Washington Hospital Center, the District of Columbia’s largest tertiary

care center. In 2011, he joined the National Institutes of Health Pain and Palliative Care Division.

As a clinician-educator in Dr. Groninger currently serves as a core faculty member for the National Institutes of Health-Capital Hospice Physician Fellowship Program and is also a Master Facilitator with the Education for Palliative and End-of-Life Care (EPEC) Program at Northwestern University. He has been a faculty member of the University of Virginia Center for Biomedical Ethics and Medical Humanities since 2005. His professional interests include communication skills, mindfulness training, and the medical humanities. He lives with his wife, Catherine, and their daughter, Anna, in Arlington, Virginia.

Group 1:

I. Best practice is that all members of an ethics committee can Identify the nature of the value uncertainty or conflict of clinical consultations related to end-of-life (EOL) care problems in their own institution.

II. Current practice is only a few members of most committees are able to identify these issues in an EOL consultation.

III. Resulting gap: Too many ethics committee members are unable to identify the ethical issue(s) at the center of values uncertainty or conflict in their hospital’s practice of EOL care.

IV. Learning objective: At the end of this activity the conference participant will have designed a self- education program for his/her hospital’s ethics committee to assure that all members are able to identify the key problems and/or barriers to improving EOL care in their own hospital.

Group 2:

I. Best practice is that hospital ethics committees review and evaluate all of a hospital’s policies that have explicit ethics implications, such as a hospital’s policy on Allow Natural Death/Do Not Resuscitate, management, including deactivation, of inserted life-extending technologies (eg. Left Ventricular Assist Devices, LVADS), and operations of the hospital’s ethics committee.

II. Current practice: There is variability across hospitals concerning the degree to which any particular hospital is integrated into its own institutional policy activities.

III. Resulting gap: Some hospitals could benefit from greater ethics committee contribution to policy review and development.

IV. Learning Objective: At the end of this activity the conference participant will be able to formulate an appropriate review process for his/her own hospital that will address that hospital’s policies for adequacy.

Break out groups to work on the gaps:

Good End of Life Care in the District, Maryland, and Virginia (DMV) Region

Group 3:

I. Best practice is the where there is moral distress among clinicians related to EOL issues for patients, this moral distress is diagnosed and reduced.

II. Current practice: There is much moral distress in hospitals today that goes unaddressed.

III. Resulting gap: Unaddressed moral distress in nursing negatively impacts retention and physician moral distress results in burnout.

IV. Learning Objective: At the end of this activity the conference participant will be able to identify at least 3 areas in his/her own hospital where an ethics committee sponsored ethics educational activity would be usefully deployed to begin reducing clinican moral distress.

Group 4: Bioethics Committee Chairs

I. Best practice is that ethics committees regularly plan and provide much of the training needs in clinical ethics for its hospital’s clinicians related to EOL care.

II. Current practice: Nationally, data indicate that practice is weak as a result of few opportunities for education and training in clinical ethics. Locally, there are no data available to ascertain if District, Maryland, and Virginia hospital ethics committees are providing necessary EOL education and training to their respective hospital clinicians.

III. Resulting gap: Locally, this variability, if confirmed, will illustrate internal educational needs and explain and clarify a source of cross regional variability in that some physicians have privileges at more than one local hospital, the implication being that whatever education on EOL issues a physician may have will be transferred to all hospitals where that physician practices. Therefore, a planned outcome of identifying the gap in training will be to involve the participants of this conference in developing an education process that will combine hospital resources regionally to training across multiple regional hospitals.

IV. Learning objective: At the end of this activity the ethics committee chairpersons will have started to design a common, anonymous electronic survey to administer at each’s own institution, to estimate the EOL clinical ethics education needs of its own clinicians (which clinicians to be surveyed to be left to the individual institutions). This survey will be comprised of a list of questions intended to address training needs in each hospital related to end-of-life care. It is anticipated that this survey will be exempt from IRB review at all institutions, but a common letter requesting exemption will be drafted and agreed to jointly, and then submitted to each administering hospital’s IRB of Record. That way, the data obtained will be used to guide the efforts of the specific institution’s ethics committee. This method of individual hospital assessment will allow for systematic collection of data so that the data can be studied comparatively at a later date, if any of the administering hospitals would like.

Course Description

There are over 50 hospitals in DC, MD, VA region which are expected to have an ethics or patient care committee. Each ethics committee has essentially the same roles and responsibilities those within other institutions. There is great variability, however, across these ethics committees related to their level of utility to their home institutions. This conference is designed to begin creating a local network of ethics committee chairpersons and members to improve individual ethics committee function as well as improving resource utilization by encouraging cross-hospital sharing of education and training responsibilities about all ethics committee functions, particularly as they influence and improve the end-of-life care of each hospital’s patients and families.

This one-day conference on clinical ethics is focused on hospital clinicians and other professionals throughout the DC, MD, and VA (DMV) metropolitan region. Most hospitals have ethics committees made up of physicians, nurses, social workers, chaplains, clinical ethicists and other clinicians and administrators who address the clinical ethics needs of their own institution. This conference is designed to be the first in a series of annual meetings to bring together members of these hospital ethics committees and other health professionals to establish a regional network of hospital professionals dedicated to elevating the quality of clinical care within each institution, to work together to develop solutions to common ethical problems and to determine whether such a network will improve the ethical quality of healthcare . This inaugural DMV Regional Hospital Clinical Ethics Conference will be focused on how hospital ethics committees can contribute to improving end-of-life (EOL) care for patients at each participant’s own hospital.

Learning Objectives

n Design a self-education program for their hospital’s ethics committee to assure that all members are able to identify the values uncertainty or conflict issues as well as barriers to improving end-of-life care in their own hospital.

n Evaluate the current EOL education programs at each institution and design an evidence-based educational intervention to address the EOL clinical ethics education needs of its own clinicians.

n Identify at least 3 areas in each hospital where an ethics committee sponsored educational activity could be usefully deployed to reduce clinicians’ moral distress.

n Evaluate the hospital’s policies that have explicit EOL ethics implications and either create or revise the policies to improve EOL practices.

CME Information

Good End of Life Care in the District, Maryland, and Virginia (DMV) Region

Target Audience

This conference is intended for intensivists, internists, surgeons, pulmonologists, geriatric and palliative care physicians, residents, fellows, nurses, social workers, chaplains, clinical ethicists, medical directors, chief medical officers, administrators and those who serve on these hospitals’ ethics committees.

CME Accreditation

MedStar Washington Hospital Center is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation

MedStar Washington Hospital Center designates this live activity for a maximum of 6 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Disclosure of Financial Relationships with any Commercial Interest

As a sponsor accredited by the ACCME, it is the policy of MedStar Washington Hospital Center to require that everyone who is in a position to control the content of an educational activity disclose all relevant financial relationships with any commercial interest prior to the educational activity.

The ACCME considers relationships of the person involved in the CME activity to include financial relationships of a spouse or partner. Any individual who refuses to disclose relevant financial relationships will be disqualified from participating in the CME activity. For an individual with no relevant financial relationship(s), the participants must be informed that no conflicts of interest or financial relationships exist.

Special Assistance (optional)

MedStar Washington Hospital Center wishes to ensure that no individual with a disability is excluded, denied services, segregated or otherwise treated differently from other individuals because of the absence of auxiliary aids or services identified in the Americans with Disabilities Act. Please call (202) 877-0246 to notify us of your needs.

MedStar Washington Hospital Center is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Further details regarding Credit Designation and Disclosure of Financial Relationships with any Commercial Interest, are available on http://cme.whcenter.org or the program/registration website [www.enterwebsite.xyz]

Registration FeePhysicians $75 Other Clinicians $40 Students (w / ID) $30

Registrant Contact InformationFirst Name: _______________________________________________ Last Name: ______________________________________

Title: _________________________________________________ Institution: __________________________________________

Address: ___________________________________________________________________________________________________

Phone Number: ___________________________________________ E-mail: __________________________________________

Method of Payment1) To pay by credit card, please long on to http://sitelms.org/conference/WHCEOLCON and use the following group code for payment:

n Physician Group Code — DOCCME n Other Clinicians Group Code — OTHCME n Student Group Code — STUCME

OR

Fax your credit card information to 202-877-3898.

Please charge my contribution for The Regional Clinical Ethics Conference to:

o VISA o MASTER CARD o AMEX o DISCOVER CARD

Number: _________________________________________________________________ Sec. Code: _______________________

Exp. Date: ___________________________ Name on Card: ________________________________________________________

Signature: __________________________________________________________________________________________________

2) Please make checks payable to Center for Ethics and include “Regional” in the memo line. Mail to 110 Irving Street, NW, EB3108, Washington, DC 20010

Thank you!* ThisprogramwillbeCMEaccreditedandparticipantswhorequestcreditwillreceive6CMEunits. ParkingProvided.

Good End of Life Care in the District, Maryland, and Virginia (DMV) Region

Tear at perferation.