Public Reporting of Outcomes 2013

Standard 4.8 Quality Improvement

The Cancer Program at Santa Barbara Cottage Hospital provides a broad scope of services, from cancer prevention outreach to cancer detection, treatment, and palliative care. The program receives guidance and leadership from the Cancer Committee, which convenes regularly to ensure that we are meeting the standards outlined by the American College of Surgeons Commission on Cancer. These standards address education, treatment, clinical research, data collection, performance, and quality improvement criteria.

We are pleased to report that Santa Barbara Cottage Hospital was reaccredited in 2013 for a three-year term, with five commendations, by the Commission on Cancer as a community hospital comprehensive cancer program. We are thankful to the physicians, nurses, other healthcare providers and administrators in our community who provide excellent care for individuals living with cancer.

In this report, we would like to highlight a program that exemplifies the dedication and high level of care that is a hallmark of our Cancer Program.

The program is called “Beyond the Final Breath: Nursing Care at the Time of Death”. It was created by several nurses on the inpatient oncology unit who had a vision for providing a more sensitive end of life ritual for the benefit of family members as well as for the nurses who care for these patients.

They established a process to ease the transition for those who are present during the profound juncture of life and death. To show respect and honor, they began a process of bathing deceased patients and wrapping them in white sheets in the presence of family members.

This evolved into a more formalized ceremony with family members invited to participate in ways meaningful to them, including anointing their loved one with lavender oil and offering words of respect. The ceremony seemed to bring more peaceful closure in the separation process, and made it easier for family members to leave the body of their loved one.

With the assistance of Cottage Hospital statistician Jonathan Grotts, a qualitative clinical research study was designed to analyze the bathing and honoring practice as part of nursing care after patient death. Cottage Hospital’s Institutional Review Board approved the study protocol, and the Cancer Committee endorsed this as a quality improvement project for 2013.

Many staff members- including nurses, social workers, palliative care providers, and chaplains – completed a four-hour training to ensure consistent provision of the ceremony. The bathing and honoring ritual was offered to 149 families, of which 89 families accepted and participated. Follow-up interviews with 13 family participants were conducted several months after the death, with a commonly reported outcome of a more comfortable transition to the process of grieving. Nursing staff also completed a survey at the conclusion of the pilot project, and reported that this practice was a positive final experience for them with the patients under their care. The program has been deemed so successful that it has been expanded to other units within Cottage Hospital.

The research was presented at the recent Oncology Nursing Symposium where it was received with enthusiasm, and will be published in early 2014 in a peer-reviewed nursing journal.

In addition, oncology nurses Debra Rodgers, Beth Calmes, and statistician Jonathan Grotts received an award for their work at the 8th Annual Hospital Hero Awards, held Nov. 8, 2013 at the Skirball Cultural Center in Los Angeles.

The Cancer Program at Cottage Hospital is very proud of the work of our staff in providing compassionate quality care.