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“Tell Me Who is Important to You” - Opening the Door to End of Life Discussions

by Tamra Minnier, RN, MSN, Chief Quality Officer, University of Pittsburgh Medical Center | Apr 16, 2015


Tamra Minnier, Institute for Innovation Founding Executive Council member, and Chief Quality Officer at the University of Pittsburgh Medical Center submitted this guest blog which is very timely, because today, April 16, is National Healthcare Decisions Day. It’s a day that calls attention to the importance of end of life decision making and completing necessary advance directive documentation. Resources are available at
www.nhdd.org.

During a recent Founding Executive Council discussion, Tamra commented about the practice of asking patients about their emergency contacts and a strategy for expanding that practice to deepen the relationship and trust between clinician and patient.

When patients are admitted, we routinely ask for their emergency contacts. This is an important question and creates an opportunity to take this simple exchange of information a step further. At UPMC, we encourage nurses on the floor to repeat this question – not merely to understand who to call in an emergency, but to understand who is important to the patient. We frame the question a little differently by saying: “Tell me who is important to you.” We explain to the nursing staff that the purpose of this question is to begin to get to know the patient as a person and what matters to them. For the patient, by asking the question, it also demonstrates that their nurse wants to know about their unique circumstances and relationships. Who is important to you doesn’t just elicit a list of names; it gives the patient the opportunity to name the people in their life who are loved, needed and share in their journey. It allows the patient to place him or herself within the context of their own family or chosen community.

It’s interesting to think about how this practice could be expanded to prompt further decision making – and even end of life. What if, after finding out who is important to the patient, we made it a standard practice to follow up with “Is that the person you’d want to make decisions if you couldn’t?”  If the patient says “yes,” it creates a wonderful opportunity to provide an advanced directive choice form such as Five Wishes®. The patient and family can take the form home and discuss at their kitchen table. Can you imagine what could happen?