Use of Multimodality Simulations to Improve Self-Reported Competence in Palliative Care Skills Among Veterans Administration Healthcare System of Ohio (VISN 10) Primary Care Providers and Nurses

May 17, 2016 9:45 AM – 11:15 AM

Rosalyn Scott1, MD, Mary Davidson1, RN, Cathy Graham1, PhD, Kira King2, PhD, Terri Benjamin3, RN, MS
1VHA, 2Kynectiv, 3The Salus Group

The VA’s Hospice and Palliative Care Program is committed to building a culture and practice of excellence for seriously ill Veterans and their families.  The Bereaved Family Survey (BFS) has been used as a national indicator of the quality of end-of-life care provided Veterans.  Improvement in scores may be possible by initiating effective medical goals of care discussions upstream of the Veteran’s terminal hospitalization. However, to be effective primary care providers and nurses need basic skills in palliative care to align with patient's goals and basic symptom management.  Response to didactic training was, “I still do not know what to do.”  To enhance basic palliative care competence of non-palliative care providers and nurses, virtual patient cases (VP) were developed to model meaningful goals of care conversations for providers and comprehensive pain assessment for nurses.  Skills were reinforced with facilitated standardized patient experiences.  Twenty-seven providers and 134 nurses participated. Provider response to the training was very positive, with 81% reporting enhanced skill.  Although 63% of nurses initially reporting high levels of competence in pain assessment 61% selected the suboptimal choices in the VP case.  Pre- and post-assessment data and key decisions within the VP will be presented.  Use of multi-modality simulation as the training model has been successful and represents a critical enhancement to didactic training alone.