Breathing life back into a medical ethics committee

Organizations pursuing Magnet® recognition must ensure the evidence supports the structures in place for frontline nurses to address ethical issues. What’s more, the organization’s nurses need to have a strong understanding of the American Nurses Association’s Code of Ethics for Nurses.

In 2012, the chief nursing officer (CNO) of the University of Pittsburgh Medical Center (UPMC) Passavant, a 400-bed community hospital in Pittsburgh, Pennsylvania, asked the director of nursing (DON) to assess the hospital’s ethics committee. The goal: to evaluate the role and value of the current committee and determine how the team contributed to patient care and the nursing and medical staffs. The DON’s assessment confirmed that our medical ethics committee wasn’t operating at a level that matched the organization’s mission, vision, and values. Meeting attendance was low, members showed little energy or enthusiasm for the work, and the committee lacked a purpose and vision. Committee members’ consults focused primarily on risk-management issues. Although the literature shows many hospital ethics committees have periods of ebb and flow, our ethics team clearly needed a transformation to become purposeful and high functioning.

Appointed by the CNO to oversee a committee redesign, the DON devised a plan to build an interdisciplinary committee consisting of physicians, nurses, care managers, palliative care staff, and members of the quality and risk department. The literature supports a multidisciplinary team approach. (See UPMC ethics committee members.)

Members of the newly developing committee knew they had to acquire strong leadership and build a solid foundation that would allow it to grow. After implementation of the redesign plan, our newly transformed ethics committee was born.

Acquiring capable leadership

One key to building a strong team is dedicated, capable, and knowledgeable leadership. The director of anesthesia, who was well versed in medicine, medical ethics, business, and law, agreed to serve as the committee’s lead physician. The DON, also well educated and knowledgeable in the foundations of medical ethics, was appointed committee chair.

To build a high-quality medical ethics committee, we needed to explore why the committee had been functioning at a suboptimal level. Before the January 2013 inaugural meeting of the new committee, several newly appointed members were asked to conduct a literature search of regulatory requirements to help determine best practices for a medical ethics committee. One of the first needs they identified was for each committee member to define the term ethics, both literally and personally.

We also became aware of other needs, such as:

education of committee members regarding their role, the foundation of medical ethics, and the role of healthcare providers in providing ethical care and interventions

education of the healthcare team regarding the role of healthcare providers in providing ethical care and interventions

• selection of a small team of consultants to respond to ethical concerns of patients, families, and the healthcare team

• review of types and frequencies of consults (such as ethics consults) to track their frequency and category. Ethics consults may address such issues as end-of-life care, power of attorney, second-victim concerns, difficult families, and controversial concerns regarding a patient’s care.

Early on, the newly configured team needed to create a vision and determine what the ethics committee would signify. They set out to answer many questions, including:

• How many members should the committee have?

• Do we have the right members?

• Do we need additional education?

• Whom would we serve?

• What avenues of communication should we employ?

• Where should we start?

During the discovery phase of restructuring, we learned our organization was a member of the Consortium Ethics Program (CEP), a regional healthcare ethics network in western Pennsylvania. This network educates nurses, physicians, social workers, and others from participating healthcare organizations in the methods, language, and literature of healthcare ethics. Immediately, our team reached out to CEP to discuss an ethics educational plan that would include onsite education on the function of ethics committees, how to conduct ethics consults, law and ethics, and advance directives.

Ethics committee co-chairs also sought the expertise of Elizabeth Chaitin, DHCE, MSW, Director of Quality and Ethics at the UPMC Palliative and Support Institute. She agreed to serve as the committee’s mentor.

Reviving ethics consults

In 2012, our medical ethics team conducted only six consults. After the restructured committee’s first meeting in January 2013, members decided to meet monthly to establish goals and develop guidelines for consults. CEP members and Dr. Chaitin proved to be invaluable resources, providing educational opportunities and mentoring committee members through this journey.

Seven committee members were chosen to serve as ethics consultants. They received focused education to ensure they possessed the knowledge and tools to perform consults. In April and November 2013, the entire team took part in a simulation exercise. Patient simulators attended a special 2-hour meeting to replicate ethically challenging scenarios. Team members were tasked to simulate a consult so they could better understand the consults they might encounter and the tools they’d need for consulting. From the time of restructuring through December 2015, team members conducted 76 consults, averaging 26 per year.

Awareness campaign

When the committee realized many nursing and medical staff members at UPMC Passavant didn’t know our committee existed, we decided to launch an awareness campaign with all stakeholders. Not only did staff need to be aware of the services available (such as consults on end-of-life issues), but they also needed to know the committee was revitalized and now included seven newly trained consultants ready to perform consults.

We used various media to communicate the news of our transformed medical ethics committee. In the spring of 2013, the news was delivered to the medical executive team, announced at a department heads meeting, and presented at the hospital’s professional practice council and patient care leadership council. In August 2013, many nurses attended a nursing grand rounds with an hourlong presentation titled “UPMC ethics committee: What it can do for patients, families, and staff.”

Advice for other organizations

If your organization is considering developing a medical ethics committee or rejuvenating its existing one, we suggest you engage enthusiastic staff to create an interprofessional team that can bring knowledge from all areas of health care. A highfunctioning committee has the right experience and knowledge—and a passion for doing what’s right. These qualities are especially important in providing ethics consults, which cover a multitude of challenging issues. Finally, establish a relationship with ethics experts who can provide education to help your committee mature into a robust, highly credible team.

Jill A. Kelley is the patient safety specialist at UPMC Shadyside Hospital in Pittsburgh, Pennsylvania. Melanie M. Heuston is the director of nursing at UPMC Passavant Hospital in Pittsburgh, Pennsylvania.

Selected references

Andereck WS, McGaughey JW, Jonsen AR. The clinical ethics consultant: verifying the qualifications of a new type of practitioner in a community hospital. J Healthc Manag. 2012;57(4):264-73.

Judicial Council. Guidelines for ethics committees in health care institutions. JAMA. 1985;253(18):2698-9.

Lachman VD. Clinical ethics committees: organizational support for ethical practice. Medsurg Nurs. 2010;19(6):351-3.

McGee G, Spanogle JP, Caplan AL, et al. Successes and failures of hospital ethics committees: a national survey of ethics committee chairs. Camb Q Healthc Ethics. 2002;11(1):87-93.

McGowan CM. Legal aspects of end-of-life care. Crit Care Nurse. 2011;31(5):64-9.

University of Pittsburgh. Consortium Ethics Program. 2015.

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