ICU Wishing Well Allana LeBlanc, CNS Intensive Care and High Acuity, allana.leblanc@vch.ca Julie Lockington, RN Intensive Care/Emergency, julie.lockington@vch.ca Vancouver General Hospital

Acknowledgments

•We thank Dr. Deborah Cook, France Clark, Neala Hoad, and the 3 Wishes Project Team from St. Joseph’s Healthcare in Hamilton, ON for their generous support of this project.

Background

• You’re visiting your dying family member… What’s missing from this picture?

3 Wishes Demonstration Project St Joseph’s Healthcare, Hamilton ON

• Objective: “To bring peace to the final days of a patient’s life and to ease the dying process.”

• ICU setting can interfere with humanizing death and dying for patients, families, and caregivers.

• Simple wishes helped promote a sense of peace and helped dignify the dying process.

• Engaging patients and their families in an organized and collaborative way helped to personalize the dying process.

Cook D et al. Personalizing Death in the Intensive Care Unit: The 3 Wishes Project. Ann Intern Med 2015; 163:271-279

What Kind Of Wishes?

Categories • Bringing together family and friends o Organizing skype/facetime call

• Humanizing the environment o Allowing flowers, LED candles, music

• Religious rituals/ceremonies o Special reading/prayers prior to removal of life support

• Other ceremonies/experiences o Toasting the patient at the bedside, visit from pet o Personal care (ie hair wash, shave, mani/pedi)

• Memorials and tributes o Word cloud, donations

Cook D. et al. 2015

Growing An Idea…

• Julie Lockington/Allana LeBlanc took the idea forward

• Enthusiastic early buy-in from entire team

• Connected with Dr. Cook and team from Ontario

• Test case/first wish

• Fundraising

• Developing Resources and the Wishing Well Network

Initial Team

Julie RN Allana CNS Jackson ICU Manager Denise RN Research Coordinator, Critical Care George Intensivist Vinay Intensivist

1st Wishing Well

How To Wishing Well

• Step 1 – decision made to change to comfort care

• Step 2 – reach out to Wishing Well network/use Wishing Well binder

• Step 3 – family and patient are approached and a plan is created

• Step 4 – make the plan happen

• Step 5 – documentation and

follow up

Nur$e For A Day!

Outcomes

• “Dr. Dhingra, he told everyone about the doughnuts you bought him.

You left quite an impression on this quiet man and his family. Thank you

again.” - Family member

• “The compassion and personal time put into honoring those patients

with this program is exceptional!! It meant a lot to my family.” – Family

member

• “She purchased a little stuffed monkey [to represent our infant

daughter] in the ICU when my husband passed…My daughter has

become extremely attached to it...It’s Daddy essentially.” – Family

member

Word Clouds

Word Clouds

“Allows the person to return to focus, eclipsing the patient”

www.wordclouds.com www.wordle.net

BCPSQC Quality Award

•Wishing Well program won an award in the category of Coping with End of Life

• $2500 to support and grow our current program

• https://bcpsqc.ca/quality-awards/2017-quality-awards/coping-with-end-of-life/

Wishing Well Network

RNs MDs Social Work

Julie Lockington George Isac Sophia Goksoyr

Allana LeBlanc Vinay Dhingra Spiritual Care

Denise Foster Bill Henderson Michael Pasche

Marlies Ernst PCA PSM

Susan Elliot Simon Wills Jackson Lam

Tak Chan RTs Admin

Julie Kyle Maddie Laberge Any Palomino

Jenny Latcko Kelsey Hambrook

Jess Donald Kaitlyn Price

Jamie Allison

Future Directions

• Plan for sustainability

• Grow the team

• Scalability and transferability to other units

• Data measures

• Research collaborations

Resources

• Cook D et al. Personalizing Death in the Intensive Care Unit: The 3 Wishes Project. Ann Intern Med 2015; 163:271-279.

• Davidson J et al. Guidelines for Family-Centered Care in the Neonatal, Pediatric, and Adult ICU. Critical Care Medicine 2017; 45:103-128.

• Downar J et al. Guidelines for the Withdrawal of Life-sustaining Measures. Intensive Care Med 2016; 42:1003-1017.

• Vanstone M et al. Narrative Medicine and Death in the ICU: Word Clouds as a Visual Legacy. BMJ Support Palliat Care; 2016.