Assessing advance directive (AD) completion rate in inpatient hematology unit.

Abstract

42 Background: Advance Directive (AD) completion is particularly more important in patients with cancer given the higher mortality associated with the diagnoses as well as the treatments that patients receive. In reality AD discussion and completion rate is influenced by patient characteristics and disease status. We undertook a Quality improvement project to improve AD discussion and completion in inpatient hematology unit at our institution. Methods: Plan-Do-Study-Act (PDSA) methodology was used and the team consisted of residents and case managers. Each morning electronic medical record (EMR) was reviewed and new patients admitted to hematology unit were identified for a period of 1 month. Patients without an AD on file were educated by a designated resident and were given forms to file AD. Based on the patient’s willingness, the case manager was alerted with daily communication email to follow-up and assist in completion and filing of AD into EMRs. Results: AD on discharge on a randomly chosen pre-intervention month was 6.97% which improved to 42% post intervention. Conclusions: Compared to Oncology patients, Hematology patients have a lower rate of AD completion in general. Hematology patients are usually younger, have a higher chance of achieving remission, and usually have improved survival with stem cell transplant due to which AD discussion does not happen very often. The notion of having AD discussion only for patients with poor prognosis should change and must be offered to everyone. We found an improvement in AD filing rate by increasing physician involvement and streamlining the process with designated roles. It is the responsibility of physicians to discuss Advance Care Planning (ACP) with their patients and readdress them at appropriate intervals as disease status can change. [Table: see text]

Completion of electronic nursing documentation of inpatient admission assessment: insights from Australian metropolitan hospitals

“…Variations in healthcare form completion relating to age, sex, and clinical specialty have been reported. [13][14][15] Younger patient age has been shown to be linked to lower completion. 14,15 These studies explored factors relating to completion of a form, however the results related mostly to advanced care directives, rather than admission forms.…”

“…[13][14][15] Younger patient age has been shown to be linked to lower completion. 14,15 These studies explored factors relating to completion of a form, however the results related mostly to advanced care directives, rather than admission forms. [14][15][16] Research on form completion has focused on physician practices, paper-based processes and electronic documentation of nursing tasks as a whole, as opposed to a single foundational process such as admission.…”