Dear Colleagues,

Welcome to the first edition of New York’s MOLST Update! This eNewsletter is dedicated to providing up-to-date information on MOLST and eMOLST and aims to support shared medical decision-making that is well informed. Frequently asked questions and key educational resources for clinicians, patients, families and caregivers will be highlighted. The eNewsletter provides a platform for recognizing the outstanding work being accomplished by eMOLST Champions statewide and for members of the MOLST Statewide Implementation Team to share their insights.

The MOLST Team set a goal of achieving sustainable MOLST education for all current clinicians and students. Various educational modalities have been used to teach MOLST over the past decade, including conferences, intensive clinician training, webinars, videos etc., however, the ideal modality is unclear. More than a hundred years ago, a German psychologist, Herman Ebbinghaus, used careful experiments to determine how learning and forgetting works. From his experiments, he described the “forgetting curve” in which large amounts of forgetting occur quickly, followed by a slower, steady decline in retention. Research shows that within 20 minutes of learning new information, students recall about 60% of the information they learned. By 9 hours, retention is less than 40%, and 20% by 10 days. Using spaced repetition, a powerful evidence-based study technique, can enhance learning and long-term retention of knowledge. We believe “multiple small feedings of the mind” in eMOLST and these periodic updates will help us achieve sustainable MOLST education.

Many of you read the “Bomba Letter” I started writing in 2001. This eNewsletter was dedicated to raising awareness of palliative care and elder abuse, was used as a vehicle to share information on MOLST and eMOLST, and was sent periodically for more than a decade. To ensure readers’ needs were being met, a survey was conducted. Survey results confirmed accessing this eNewsletter was increasingly from mobile devices. The format was not meeting their needs and a simple way to learn more about MOLST and eMOLST was desired. The Bomba Letter will no longer be published with launch of New York’s MOLST Update eNewsletter.

Thank you for your ongoing support,
Pat
Patricia Bomba, MD, FACP
Chair, MOLST Statewide Implementation Team
eMOLST Program Director

The 2007 MOLST video has been revised and updated to include information about eMOLST and changes in NYS Public Health Law, including the 2010 Family Health Care Decisions Act. In addition, eleven short video clips were produced to support sustainable provider training and community education needed for shared medical decision-making. Several short video clips will be added to eMOLST. View MOLST Videos – Revised 2015!

eMOLST is a web-based application that guides clinicians and patients through a thoughtful discussion. eMOLST also serves as the registry for NY eMOLST forms and is available statewide. eMOLST ensures accurate completion & documentation. Both the MOLST form and the goals for care discussion are available in an emergency and in all settings. Clinicians can print a copy on bright pink paper for the patient. For more information, read 1-page description and visit NYSeMOLSTregistry.com.

As the first long-term care system in New York to use eMOLST, St. Ann’s Community has appropriately been selected as the eMOLST Champion for our inaugural edition of the MOLST Update. Michael McRae, President & CEO, Dr. Diane Kane, CMO, Dr. Kim Petrone, Medical Director, along with the leadership team, the Board of Directors and the entire staff at St. Ann’s, are commended for their recognition of the value of eMOLST in providing the ultimate in resident-centered care for persons near the end of life. Mike McRae reflects on eMOLST:

“When I hear from the medical providers that eMOLST is easy to use and accurate, it gives me confidence that our residents are receiving the highest quality of care. eMOLST is making lives better.”

Under Dr. Kane’s leadership, St. Ann’s was the first nursing home in New York State to embrace MOLST in 2004 and eMOLST in 2012. eMOLST adoption occurred while the organization was still primarily using paper records; St. Ann’s has since transitioned to be fully electronic. According to Dr. Kane:

“Adopting eMOLST was a no-brainer. Being an early adopter allowed us to help shape eMOLST and pave the way for statewide implementation in the long term care continuum.”

Hear Dr. Petrone’s experience with eMOLST in our YouTube video: Advantages of eMOLST: A Nursing Home Physician’s Perspective.

As the first long-term care system to adopt eMOLST, St. Ann’s Community has paved the way for eMOLST implementation in nursing homes statewide.

The 2014 Institute of Medicine (IOM) report, Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life, encourages early advance care planning (ACP) and informed medical decisions based on the values and goals of individuals.

Lessons Learned from NY’s Community Approach to Advance Care Planning & MOLST written by Patricia Bomba and Katie Orem, was published in the Annals of Palliative Medicine in early 2015. The article reviews lessons learned from the development and implementation of New York’s community approach to ACP and key components of two complementary programs: Community Conversations on Compassionate Care (CCCC) and Medical Orders for Life-Sustaining Treatment (MOLST).

Community Conversations on Compassionate Care (CCCC) is an ACP program designed to motivate everyone 18 and older, as well as emancipated minors, to start ACP family discussions; choose the right health care agent; and complete a health care proxy. CCCC combines storytelling and “Five Easy Steps” focused on the individual’s behavioral readiness to complete a health care proxy. CCCC encourages early health care proxy completion and regular review and updates to advance directives along the health-illness continuum.

MOLST is a clinical process that emphasizes discussing the patient’s goals for care and shared medical decision-making between health care professionals and patients who are seriously ill, frail or near the end of life. The result is a set of medical orders that reflect the patient’s current preferences for life-sustaining treatment. MOLST was approved by NYSDOH for use in all settings in 2008. MOLST must be followed by all health care professionals, including EMS. MOLST is the only medical order form approved in NY for both DNR and DNI orders. MOLST is NY’s nationally-endorsed POLST Paradigm program. eMOLST, the electronic version of MOLST, ensures accurate form completion and accessibility across all settings while also serving as NY’s registry. eMOLST is the only statewide electronic completion system of its kind in the country.

Shared, informed medical decision-making is a patient-centered process that is critical to ensuring patient preferences are honored at the end of life. Providers must be trained, qualified, and comfortable with these discussions. Development, implementation, outcomes, lessons learned and sustainability of the CCCC and MOLST programs highlight the success of a healthcare and community collaborative focused on improving end-of-life care. Data support the value of implementing CCCC and New York’s MOLST & eMOLST nationwide.