Enhancing Advance Care Planning in a Geriatric Clinic.
We sought to increase advance care planning advance care planning discussions at an academic primary care geriatric clinic
utilizing the electronic medical record. The measure was the number of documented ACP discussions.
Two plan-do-study-act quality improvement cycles. Phase 1: engagement of physicians and development of a patient
information sheet with advanced directive forms for inclusion in the patient take-home clinic summary. Phase 2: engagement of clinic staff to screen for patient readiness for ACP discussions and to remind physicians.
At baseline, 47.7% of patients had advanced directive documents in their EMR, and there was an 11.1% advance directive document completion following ACP discussions. Over a 3 month intervention, the rate of ACP discussions remain unchanged at 3.4% of patients during Phase 1 but increased to 7.63% during Phase 2.
A team-based approach targeting patients prepared for ACP discussions was able to double incident new ACP discussions. Physicians identified several barriers to ACP discussions including patient readiness, time constraints, EMR constraints, and regulatory factors.
Advance care planning documents the details of patient’s wishes with respect to the choice of life-sustaining treatment and/or surrogate decision-maker, when they are unable to communicate on their own behalf.
ACP documents include: 1) a living will which indicates care preferences, 2) appointment of healthcare agent which includes the medical power of attorney for medical decisions when the patient is not able to, and 3) the portable directive or medical order which provides documentation to all healthcare providers and emergency personnel regarding the patient’s wishes.
Palliat Med Hosp Care Open J. 2018; 4(1): 1-6. doi: 10.17140/PMHCOJ-4-126
