Fundamental to the care we provide at Providence is respect for our patients, residents and clients, and a desire to ensure that their preferences about how they want to be treated govern everything we do. Central to this is asking the people we care for what is important to them, especially in conversations about advance care planning and serious illness. We as health care providers have expertise in diagnosis, prognosis and treatment, while patients, residents and clients are the experts in what is most meaningful and important to them.
On behalf of the Advance Care Planning/Serious Illness Conversation Steering Committee, we are happy to announce the following improvements to help facilitate advance care planning/serious illness conversations with patients, residents and clients, and to support better communication about their goals, fears and preferences for care within Providence. The following changes will come into effect Tuesday, April 4, 2017, unless otherwise indicated.
1) OPTIONS FOR CARE AND RESUSCITATION / DNAR ORDERS (PH254) has been updated to facilitate the following improvements (please refer to Figure 1):
- Break out from 4 options to 5 to align with the VCH Medical Orders for Scope of Treatment (MOST) form in number and type of care level designations for uniformity and in anticipation of CST amalgamation.
- An elevated ‘Additional Information’ section to add clarifications about the care plan if needed.
- Sections for details of the advance care planning/serious illness conversation.
- Simplification of information on the reverse.
2) ADVANCE CARE PLANNING RECORD (MR101) has been revised to include a section to document components from the serious illness conversation guide (please refer to Figure 2):
- The ACP Record is used to document serious illness and other ACP conversations that are not otherwise documented on the Options for Care/DNAR form. This form is frequently used by allied staff to document their conversations with patients/substitute decision makers (SDMs), and frequently used in outpatient/chronic disease clinics
3) OPTIONS FOR CARE/DNAR folder in Chartscan/Softmed has been elevated to the Patient Level with the ADVANCE CARE PLANNING (OTHER) folder (please refer to Figure 3):
- All Options for Care/DNAR forms will be scanned into one elevated folder for easy review of previous orders and discussions with patient/SDMs.
- Beside the Options for Care/DNAR folder will appear the Advance Care Planning (other) folder, when any patient related ACP documents (eg Representation Agreement, Advance Directive, informal written wishes, external MOST forms) and the ACP RECORD MR101 have been received and are scanned.
- This co-locates in two companion folders at the easily accessible Patient Level, previous discussions, orders and wishes regarding ACP, serious illness and end of life wishes.
4) ADVANCE CARE PLANNING alert in SCM. A similar alert has existed, but at a lower and less visible profile. The new ACP alert will appear on the patient header at the same level as the ‘Violence Risk’ or ‘INFECTION ALERT VRE MRSA’ (please refer to Figure 4):
- The ACP alert is requested by the health care provider by a note in Prescribers Orders, or by notifying the unit coordinator.
- The ACP alert will appear for current and future admissions, and a notification is printed with the patient’s admission chart pack.
5) ADVANCE CARE PLANNING/SERIOUS ILLNESS CONVERSATIONS POLICY is an update to our existing ACP policy to outline expectations of physicians and other health care providers for engaging in ACP and serious illness conversations. This policy will be formally announced in the coming weeks.
6) SERIOUS ILLNESS CONVERSATION EDUCATION AND PROJECTS are being planned across the organization throughout 2017-18. Programs are currently being identified in chronic and acute care, as well as an ACP/SI pilot with residents living in the downtown eastside, where there is willingness to improve conversations utilizing the tools, education and program developed by Dr Atul Gawande, Dr Rachelle Bernacki, and their associates at the Ariadne Labs/Harvard University.
For more information on advance care planning and serious illness conversations at Providence Health Care, please contact Wallace Robinson, leader, Advance Care Planning at Wrobinson@providencehealth.bc.ca.