Improving Advance Care Planning Among Providers in a Long-Term Care Setting

Abstract

A quality improvement (QI) initiative was implemented to increase Advance Care Planning (ACP) conversations and documentation by healthcare providers in two southeastern skilled nursing facilities (SNF) in North Carolina. An evidence-based practice (EBP) algorithm initiative was developed based on literature review and identification of the problem. The research demonstrated a lack of ACP conversations among providers and documentation into the electronic medical record (EMR). These SNFs lacked both a standardized process for screening patients and protocol for initiating or completing ACP forms, especially the Medical Orders for Scope of Treatment (MOST). The algorithm was created to utilize an interdisciplinary approach to promoting ACP conversations among providers and increasing completion of the ACP forms. There was a total of 193 EMRs reviewed, pre-project n=90, post project n=103. Of the reviewed charts there was demonstrated an increase in the percentage of SNF residents with documented ACP forms in the EMR, with a growth rate greater than 30% for all forms combined post project completion. The MOST form had the greatest increase and potentially offers the highest level of benefit for the SNF resident. Some of the implications discovered include the need to increase advocacy for utilization of all ACP forms within the SNF setting and promotion of provider initiation of ACP conversations. Some recommendations include the promotion of collaboration between healthcare disciplines to promote higher quality patient outcomes and initiation of MOST forms during admission to a SNF.