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    Patient ICM Experiences

    A diabetic patient was admitted following the amputation of the last toe on his right foot. His personal goal was to be able to work in his garden again. We began to use self-management coaching techniques, and he accepted the challenge to take control of his health. His blood sugar was controlled, his diet was changed, his wound healed, and because of this he avoided the amputation of his foot. This amazing turnaround occurred in less than a month. When we discharged him he was excited about meeting his personal goal and getting back to his gardening.

    I recently saw a heart transplant patient, who is also diabetic. A telehealth monitor was installed that transmitted vital signs twice daily to our office. This enabled our telehealth nurse to detect a needed change in medication, which she was able to coordinate with the physician. The telemedicine program helped us see the problem early, get the changes in the medication the patient needed, and prevent an unnecessary rehospitalization. Each visit I covered a different topic with the patient to educate and empower her. She stated her goal was to get her strength back, and we worked toward that objective. I watched as the patient was transformed from very anxious to very confident that she could manage her condition.

    I asked the patient to set her own goals for managing her diabetes. She said her goal would be that her children would learn about her disease. They were present and heard her say this, and they were willing to learn. Amazingly, as the patient watched her family learn more about diabetes, she became motivated to learn herself. Their desire to learn actually motivated her to learn! When we added the telehealth unit, and could show her the impact her diet had on her blood glucose reading, she was able to ‘connect the dots’ for the first time. The change in her life has been phenomenal!

    One our hospice patients, 78‐year‐old female patient with a diagnosis of ovarian cancer with liver metastases, had a goal to be able to have enough energy to enjoy her grandchildren.

    She was resistant at first to take morphine at bedtime to control dyspnea and to control pain to help her sleep. She experienced tiredness during the day because of not sleeping well at night. She was also resistant to taking dexamethasone in the morning for pain management. Her case manager suggested she try small doses of morphine at night as a trial. The patient found she slept better and was less tired during the day. As the patient’s trust in her case manager increased, she decided to take the dexamethasone in the morning. Between the morphine and the dezamethasone our patient said she had increased energy, her appetite improved and she had her pain under control. Because she was feeling so much better she was able to meet her goal and she was able to enjoy her grandchildren over the holidays.

    The patient’s case manager helped the patient by “connecting the dots” that taking her pain medications helped her meet her desire to have enough energy to enjoy her grandchildren. The Hospice Performance Improvement Manager said: “I’m wondering before ICM, if we would have labeled this patient “difficult,” “non‐compliant,” or “choosing to not take her medications.” Since ICM, we have learned how to find out what is really important to our patients. It is very fulfilling and such a joy to know we have helped our patients reach their goals and desires at the end of life!”

    One of our Hospice Social Workers related this story: “At my eval visit, I encountered a tremendously anxious daughter. Every subject I introduced brought on increased anxiety. Even encouragement and support interjections ended up producing more anxiety. I thought about the use of open ended questions and reflective listening that we’d been taught at the ICM training. I must admit my initial thought was the last thing I wanted to do was ask at the end of my visit, “What questions do you have? I have time.” However, after I asked this question, I took a very deep breath and remained silent. This was the one thing I could do for this anxious daughter. I wanted her to know I was a witness to her anxiety and I was hanging in there with her; not trying to get away from her. She was on the fence about her mother being on hospice. When I left, I asked her, “So, Hospice is a go?” She replied, “Yes.” By telling her I had time for her, asking her if she had any more questions and then listening to her specific concerns, I felt I had accomplished reassuring her that I genuinely cared about her and could hang in there with her anxiety in this difficult time.

    In 2017 the SCIC team worked with the subject matter expert sepsis team at Sutter Health to develop a sepsis stoplight tool. The green, yellow and red colors of the SCIC stoplight tools help patients quickly assess the seriousness of their symptoms and guide what actions they should take to stay well. The goal of this particular stoplight tool is to provide “at risk” patients with written health literate education about how to identify early signs of infection and sepsis, so that timely interventions can be implemented to reduce unnecessary healthcare utilization. The back of the tool includes measures patients can take to prevent infection and sepsis. This tool has the potential to reduce mortality from a sepsis event.

    When developing our stoplight tools the SCIC team partners with patients to review and test tool content to ensure it was easy to follow. Staff from a Sutter Health hospital reported that one patient came into their ER waving the sepsis tool in hand stating “I think I may have sepsis.” In fact she did need treatment for an infection and due to timely treatment was able to be discharged to home that same day. The SCIC stoplight tools have won awards from the Center for Plain Language and the Institute for Healthcare Advancement for tool quality by meeting health literacy standards.