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Project GRACE (Guidelines for Resuscitation And Care at End-of-Life) is a statewide initiative based in Tampa, FL. For the past two years, Project GRACE task forces have been reviewing four major areas of EOL care:
Having now presented their reports, the really hard work begins: carrying their message statewide to each individual institution and community. That’s exactly how the task forces are going about it: One community at a time. "What it will take is a combination of education both to the community and to health care institutions and people: nurses, social workers, respiratory care therapists, chaplains, and physicians," says Marty Ratliff, RN, BSN, OCN, executive director.
The model already has been established. Lofty L. Basta, MD, FRCP, FACC, founder of Project GRACE, recently led grand rounds for physicians at St. Petersburg (FL) General. The physicians received CME credit for the hour-long program. "That’s the first layer," explains Ratliff. "Next month we’ll partner with their community outreach program." During that program which, along with a brunch, will be free of charge for the community, both Basta and Ratliff will conduct education programs. Programs then are conducted with the nurses.
"Eventually, all of them will have been educated to the same standards. It’s not the fastest way, but it’s the most effective," adds Ratliff.
Project GRACE also has applied for two program grants. "A group of primary care physicians in the Clearwater area have agreed to be part of a pilot program," Ratliff says. "We’ll go in and educate the physicians and the office staff about making advance directives part of a well-care visit." This education program will be supported with posters in the office, a public education guide, and free copies of advance directives, she adds. "The whole idea is to take the conversation out of the [intensive care unit], the admitting room, and the [emergency room], and put it in the primary doctor’s office," Ratliff explains.
She asserts that quality of care includes following patients’ personal choices. "We need to know what those choices are. The majority of people would tell you they do not want to die in a medical facility, especially a hospital, yet 80% of them do."
• Bernard J. Hammes, PhD, Director of Medical Humanities, Gunderson Lutheran LaCrosse (WI). Telephone: (608) 782-7300. Web site: www.gundluth.org/eolprograms.
• Joanne Lynn, MD, RAND Center to Improve Care of the Dying, 1200 S. Hayes St., Arlington, VA 22202-5050. Telephone: (703) 413-1100, ext. 5451. E-mail: email@example.com. Americans for Better Care of the Dying Web site: www.abcd-caring.org. RAND Center to Improve Care of the Dying Web site: www.medicaring.org.
• Joel Mattison, MD, Physician Advisor to Clinical Resource Management, St. Joseph’s Hospital of Tampa, 3001 W. Dr. Martin Luther King Jr. Blvd., Tampa, FL 33607. Telephone: (813) 870-4933.
• Marty Ratliff, RN, BSN, OCN, Project GRACE, 131 N. Westshore Blvd., Suite 107, Tampa, FL 33607. Telephone: (813) 281-2324. Fax: (813) 281-0295. Toll-free: (877) 990-GRACE. Web site: www.p-grace.org.
• Vicky Weisfeld, MPH, The Robert Wood Johnson Foundation, Route 1 and College Road E., Princeton, NJ 08543. Telephone: (609) 243-5926. E-mail: firstname.lastname@example.org. Last Acts Web site: www.lastacts.org.