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

Abstract

Background The high risk of mechanical ventilation with COVID hospitalizations requires health-care systems to rapidly innovate advance care planning (ACP) delivery for hospitalized patients to promote goal-concordant care. Measures Assess the impact of a social work and care management intervention on the proportion of admitted patients each week with a Medical Durable Power of Attorney (MDPOA). Intervention Social workers were consulted to assist with identification of a surrogate decision maker and completion of MDPOA forms for hospitalized patients. This intervention utilized change management strategies and was implemented between April and June 2020. Outcomes From a baseline average of 30.1%, the weekly percentage of admitted patients with MDPOA forms rose to 42.8% with correlating evidence of nonrandom special cause variation. Lessons Learned Use of change management strategies resulted in rapid implementation of an effective ACP initiative. Ongoing needs include focusing on intervention sustainability and education of interprofessional providers about ACP processes.

Advanced Care Planning (ACP) in the early phase of COVID-19: A rapid review of the practice and policy lessons learned

“…In some jurisdictions, only medical staff may initiate ACP conversations, with limited/no input from other multidisciplinary team members (Raftery et al, 2020; Singh et al, 2021). A large cohort study conducted in the US, found engaging social workers in ACP resulted in a 13% increase in patients nominating a medical POA (Singh et al, 2021). .…”

“…In some jurisdictions, only medical staff may initiate ACP conversations, with limited/no input from other multidisciplinary team members (Raftery et al, 2020;Singh et al, 2021). A large cohort study conducted in the US, found engaging social workers in ACP resulted in a 13% increase in patients nominating a medical POA (Singh et al, 2021).. A Taiwanese study noted local legal obligations to have two witnesses and associated costs might impede ACP (Lin et al, 2021). A narrative review during the pandemic (Gilissen et al, 2020) identified seven documents that described core ACP issues to be discussed with nursing home residents: POA (Enduring Guardian equivalent ), cardiopulmonary resuscitation (CPR), admission to hospital, intubation, non-invasive ventilation, fluids, antibiotics, etc.…”

“…Difficulties range from accessing lawyers (Chan, 2020), to differing legal terminology (Block, Smith, et al, 2020), to identifying who is entitled to initiate conversations. In some jurisdictions, only medical staff may initiate ACP conversations, with limited/no input from other multidisciplinary team members (Raftery et al, 2020;Singh et al, 2021). A large cohort study conducted in the US, found engaging social workers in ACP resulted in a 13% increase in patients nominating a medical POA (Singh et al, 2021).. A Taiwanese study noted local legal obligations to have two witnesses and associated costs might impede ACP (Lin et al, 2021).…”

Implementation of advance care planning amid the COVID‐19 crisis: A narrative review and synthesis

“…In total, 20 articles were included, of which eight were primary studies incorporating 5542 participants. The design of the primary studies was retrospective observational ( n = 4), 17–20 comparative cross‐sectional ( n = 1), 21 design process ( n = 2), 22,23 quality improvement intervention ( n = 1), 24 case report/study ( n = 2) 25,26 and virtual workshop ( n = 1) 27 . The rest of the articles were perspective papers ( n = 5), 3,28–31 letters to the editor ( n = 2), 32,33 newspaper analysis ( n = 1) 34 and guideline review ( n = 1) 35 .…”

Application of the power of attorney in the law of guarantee against fixed objects in Indonesia

“…SKMHT is a deed of agreement that is classified as a power of attorney in the form of lastgeving (volmacht), where SKMHT is a special letter that is only allowed by law to contain certain legal acts that are related to the imposition of dependent rights and is an irrevocable power and will not expire for any reason, therefore, SKMHT can be classified as an absolute power of attorney for material guarantees. If SKMHT has absolute power of attorney relating to material guarantees what about the regulations relating to the period of SKMHT if reviewed from the rules of the power of attorney in the Civil Code (Singh et al, 2021MacKay, 1992.…”