Implementation of a Facilitated Advance Care Planning Process in an Assisted Living Facility

Nancy A. Hall, MS, RN

Additional Authors
Carole Jenson, DNP, RN, ACNS-BC, CCRN

Winona State University

Background
Fifty percent of people are incapable of making decisions about treatment when they reach the end of life, leaving others to decide. When uncertainty exists, healthcare professionals default to aggressive treatment, often resulting in less quality of life for patients and the experience of regret and depression for caregivers following the death. The Patient Self Determination Act and advance directives have not successfully provided for consistently available information about well-informed preferences for care at the end of life.

Significance
Patient centered advance care planning and Provider Orders for Life Sustaining Treatment have evolved as methods to provide for thoughtfully considered and well-informed preferences available to guide care decisions at the end of life.

Purpose/objective
The purpose of this project was to implement the Respecting Choices® model of Provider Orders for Life-Sustaining Treatment (POLST)-type advance care planning in an assisted living facility. POLST-type advance care planning results in a document that communicates care preferences as a provider’s order, actionable in local healthcare settings.

Methods/project
This evidence based project, completed in the context of a community-wide implementation effort, focused on implementation of an evidence-based intervention (POLST-type advance care planning) among residents of an assisted living facility.

Results
Eight residents and their healthcare agents participated in POLST-type advance care planning; POLST documents were signed by the physician. Follow-up chart review indicated that residents who experienced POLST-type advance care planning had more provider orders addressing life-sustaining treatments than were previously present. Ninety-four percent of participants who completed a satisfaction survey rated the overall quality of the discussion as excellent.

Clinical implications
Residents’ end-of-life medical care will be consistent with stated, well-considered preferences. Health care agents will be involved in ensuring residents’ preferences are honored. Health care providers will have clear, reliable documentation to inform care at the end of life.