Implementation of an Advanced Directive Protocol among Hospitalized Patients

Abstract

Abstract An initiative was implemented to increase advance directives (ADs) for employees of a community hospital in Southeastern North Carolina. Due to the Patient Self Determination Act (PSDA) of 1991, Registered Nurses (RNs) were required to screen patients for ADs on admission to the hospital; however, no protocol was enforced to ensure inpatients were completing ADs and having them documented in the electronic health record (EHR). A standardized protocol was created that utilizes an interdisciplinary approach to discuss advance care planning (ACP) and increase completed ADs documented in the EHR. The EHR was streamlined to allow increased accessibility of AD documents and efficiency of ACP documentation. A pre and post implementation chart review determined there was not an increase in the percentage of admitted patients with documented ADs in the EHR. There was an increase in the percentage of ADs documented in the streamlined location within the EHR.