Implementation of Advance Directive Screening Education in the Hospital Setting

Abstract

The Patient Self Determination Act of 1991 mandates that Registered Nurses (RNs) must screen patients for advance directives (ADs) during hospital admissions. When ADs are not completed, there is a possibility that unwarranted and costly treatment options will be offered. Unjustified actions create an environment of financial and emotional load for families and our national healthcare system. Over 39 million Americans are hospitalized each year (65 and older years of age). This will exceed 71.2 million by 2030 (182% increase); nationwide, only 33% of U.S. adults have an AD. To increase AD education among Medicine Intensive Care Unit (MICU) RNs at a large, urban hospital located in southeastern United States, a quality improvement (QI) study was conducted. Prior to the initiation of the Doctor of Nursing Practice (DNP) QI initiative, it was identified that a large percentage of patients admitted to the MICU were not being screened, demonstrated by AD screening completion of 57.21%. Institutional policy required 90%. Interventions were intended to address barriers to completion that were identified in a pre-implementation screening survey. The project was designed and introduced to the MICU participants. Various interventions were created and implemented throughout four PDSA cycles over four months. Fifty chart audits were completed each month from April through November, including pre-implementation and post-implementation data. With the implementation of numerous interventions as well as an institutional system change specific to EHR audit requirements, compliance of 90% was achieved. The DNP project site is now equipped to maintain sustainability.