A Process Improvement Project to Increase the Utilization of Advance Care Directives in Primary Care

Abstract

Background/Purpose: The Patient Self-Determination Act passed in 1990 brought great attention to the need of advance care directives (ACDs). In the United States, 18-36% of adults have an ACD and less than half of adults with chronic and life threatening illnesses have completed ACDs. The purpose of this scholarly project was to increase the utilization of ACDs in a primary care clinic through staff education. The goal this project was to increase the rate of completion of ACDs. Methods: A Plan-Do-Study-Act (PDSA) model was used to initiate “Advanced Care Directives for Patients in Primary Care". This project was implemented using the Diffusion of Innovation Theory (Rogers, 2003). A retrospective chart review was conducted on 100 charts to determine percentage of ACDs completion in a primary care clinic. An education session was organized to assist staff with initiating end-of-life care discussions. A pre/post education survey was administered to all participants. A second retrospective chart review was conducted sixty days after implementation. Conclusion: There was a 3.5 fold increase in the completion of ACDs. Implication for Practice: Clinical education can increase the utilization of ACDS in primary care.