Special Reports
Jump to section:
3 Wishes Project
Nurses on 6SA and 5E have seen growth in compassionate end-of-life care as part of the implementation of the 3 Wishes Project that we began in the Fall of 2022. This program has also grown into a powerful tool to support wellness of all the healthcare team members on these units.
This program was just featured in the American Journal of Critical Care. It was also featured in The Huddle in July 2023.
Since beginning at UWMC-ML in Oct 2022, we have had 268 unique healthcare team members participate in this humanizing work, including 185 RNs, 14 PCTs and MAs, 6 Spiritual Care Providers, 6 Social Workers, 36 Physicians and APPs, and 11 volunteers and hospital administrators.
We have fulfilled 791 wishes for 295 patients. This includes 1,839 individual keepsakes or tangible remembrances.
The 3 Wishes Project (3WP) is a palliative care intervention that started in Ontario, Canada in 2013 that aims to improve the end-of-life experience for patients, families, and healthcare team members by eliciting and attempting to fulfill a set of wishes for a dying patient and their loved ones. With the 3WP, healthcare team members can foster humanizing experiences for patients, loved ones, and themselves. The 3WP is a unique approach to infuse humanity, celebrate a patient’s life and their legacy, and support families and healthcare team members alike.
Being a patient in the hospital can be a dehumanizing experience and dying in the hospital can have profound, long lasting consequences for everyone attendant to the death including the patient’s loved ones and those on the healthcare team. Clinicians who care for dying patients and their family report compassion fatigue, symptoms of depression, and posttraumatic stress disorder. Palliative interventions hold great potential to improve the experience of healthcare team members providing end-of-life care.
The 3WP at UW Medicine began in October 2022 at UWMC-Montlake in the Medical ICU and Oncology/Bone Marrow Transplant ICU (6SA unit) and has since expanded to the Surgical ICU (5E unit).
The goals of the program are:
- For patients: to dignify, honor, and celebrate the patient’s life by personalizing the end-of-life experience
- For families: to humanize the dying experience and foster positive memories
- For healthcare team members: to foster patient and family-centered care, combat caregiver fatigue, and improve healthcare team member well-being by expanding the tools and strategies for caring for patients who are dying.
The 3WP is intended to be inclusive for all of those at the EOL, thus patients are able to participate if it is thought by the healthcare team that they have a >95% chance of dying in the hospital, if a decision has been made to withhold or withdraw life sustaining treatments, if the patient is already receiving exclusively comfort focused treatments, or if the patient is enrolling in Hospice.
Here are some reflections about our program:
Family member referencing keepsakes with her mother’s heart rhythm and locks of hair:
"This is the best gift you could give me. I'm going to cherish this forever. This is something from when she was alive that I will always keep from my Mom."
ICU nurse:
“It was so rewarding seeing the patient's mother's gratitude after receiving her son's heart rhythm strip in a keepsake bottle. Even though I couldn't change her son's situation, at least I could offer some comfort and attention in a different, yet still very meaningful way.I think [the 3 Wishes Project] is really making a difference for both patients and for us.”
ICU physician:
“A young mother selecting a quilt to wrap her children with love after her death…handprints of a dying patient overlaid on their child’s handprint…these types of acts inject humanity and love into the most difficult of circumstances. It’s a gift for our patients, but also for our team members."
ICU nurse:
“I was grateful to have the 3 Wishes Project available to spend some meaningful time with his wife, offer some comfort, and provide small keepsakes for the patient's daughter in case she did not make it in time. It really made a huge difference; this was the best gift I’ve ever given!”
Read the 3 Wishes Project Impact Report
Sepsis Updates
At UWMC we recognize and appreciate the importance of early identification and treatment as best practice for patients with suspected sepsis. Some of our sepsis highlights for 2023 include the new Sepsis Management Policy that acknowledges that sepsis represents a medical emergency that should be assessed and treated emergently to prevent morbidity and mortality. We are committed to timely interventions, interdisciplinary collaboration to identify when sepsis is present, and treat sepsis in accordance with evidence-based protocols. The policy brings value to our practice by creating a consistent sepsis treatment pathway based on evidence-based practice.
Another impactful effort was our updated EPIC Sepsis tools and workflow to support patient-centered care. Within EPIC we empowered the nurse to activate a “Sepsis Huddle” to foster interdisciplinary communication to care for our patients within thirty minutes at the bedside and place Nurse Initiated Orders (NIO) for sepsis to expedite early treatment. We also simplified Sepsis Best Practice Alerts (BPA) for both Inpatient and Emergency Department to make them more meaningful.
We are excited to see what 2024 brings to the care of our special patients and their families that may be impacted by sepsis. We know that the ongoing support and creation of tools that support autonomous nursing practice exemplifies UWMC’s role as the Magnet leader for almost thirty years.
Inpatient Rehabilitation
2023 At a Glance
- Unit operations continue to adapt as the COVID-19 pandemic recedes.
- Expected annual variation in admitting diagnoses, admissions totals, payor mix, and admissions sources.
- Functional gains, overall satisfaction, and discharge setting continue to be a focus area for improvement.
- Opportunities for community engagement remain plentiful.
Read the full 2023 Inpatient Rehabilitation Report