Evaluation of Quality Improvement Initiatives to Improve and Sustain Advance Care Planning Completion and Documentation

Abstract

Despite the established benefit of advance care planning (ACP), achieving and sustaining high rates of ACP completion continue to be a challenge in many health care settings. A palliative care champions committee has targeted improving the ACP process through quality improvement initiatives at an academic medical center. To understand the impact of multiyear efforts to improve ACP, surveys of registered nurses, care coordinators, and medical assistants from inpatient and outpatient settings were conducted in 2013 and 2017 to explore comfort level with ACP, barriers preventing completion of ACP in daily practice, and suggestions for overcoming these barriers. The findings suggest strategies to further integrate ACP through interdisciplinary teams, including outpatient staff education, inpatient and outpatient quality improvement initiatives, and dedicated staff for ACP.

Systematic Approach to Selecting and Preparing a Medical Power of Attorney in the Gynecologic Oncology Center

“…[15][16][17][18][19][20] The high prevalence of accessible AD and Physician Orders for Life Sustaining Treatment in decedents where initially pioneered, 20 and to a lesser extent, in a large health care system using a heart failure model, are indicators of its success. 16 ACP pilots in a variety of outpatient and hospital settings show more variable penetration and challenges with sustainability, [21][22][23][24][25] as did an intensive ACP intervention at a sister cancer center similar to our own. 26,27 Future plans to promote patient, family, and clinician engagement include coaching registered nurses to ask PNS AD questions from a culture of yes, viewing of a brief English-or Spanish-language video explaining the importance of selecting a prepared MDM, incorporating simple definitions of ADs into the PNS process, and providing metrics to clinicians, enhancing practice awareness.…”

Measuring Goal-Concordant Care in Palliative Care Research

“…Clinical and administrative initiatives are increasingly common to improve consistency of documentation of goals-of-care discussions. 39,40 More frequent and thorough documentation and updating of patient goals and advance care planning not only improves data available to the care team for clinical decision making, but improves researchers' ability to map goals to treatments. Longitudinal measurement in real time will support accurate mapping of goals and treatment when using that method (Method 3), thereby increasing the likelihood of accurate assessment when determining whether care was concordant or discordant at the time it was delivered.…”

Increasing Medical Power of Attorney Completion for Hospitalized Patients During the COVID Pandemic: A Social Work Led Quality Improvement Intervention

“…A previously conducted survey of 732 bedside nurses, 125 medical assistants, and 52 care coordinators at our institution revealed that time constraints, logistical issues (i.e., locating ACP documents and uploading them into the EMR), and patient clinical condition (nonverbal or altered mental status) were the three main barriers to ACP completion for hospitalized patients. 10 In thinking about how to redesign this process, we engaged partners who brought diverse relevant perspectives and front-line experience about how the hospital was changing in the midst of the COVID pandemic. It was critical that the stakeholders we engaged also had the resources to sustain costs of a proposed intervention.…”