IMPROVING THE USE OF POLST AND AHCD IN LONG-TERM CARE THROUGH A COMMUNITY PARTNERSHIP

Abstract

Background: In 1990 Congress passed the Patient Self-Determination Act, which requires any facilities receiving Medicare or Medicaid payment to inquire if the patient has an advance directive and to provide information if the patient does not have one (IOM, 2015). Advance Care Planning (ACP) for end-of-life care emerged in the mid-1970s to address the need for tools, such as the Advanced Health Care Directives (AHCD), to guide medical decision-making among seriously ill patients, their families, and healthcare providers (Nedjat-Haiem, Cadet, Amtaya, & Mishra, 2019). End-of-life care planning has evolved and currently tools available include Providers Orders for Life-Sustaining Treatment (POLST) and Advance Health Care Directives (AHCD). Objective: The goal of this evidence-based quality improvement project was to improve healthcare staffs’ (registered nurses, certified nursing assistants, admission staff and social work) knowledge and comfort level with discussing Providers Orders for Life-Sustaining Treatment (POLST) and Advanced Health Care Directives (AHCD) with newly admitted patients in a long-term care facility through a four-part interactive education workshop. Methods: A four-series 30-minute staff educational workshop was conducted over a month period. Each workshop explored different avenues of advance care planning and utilization of POLST and AHCD in a long-term care facility. Five point-Likert scale pre and post-survey completed by staff to assess self-reported confidence and knowledge. A pre and post knowledge quiz (true or false) evaluating knowledge about POLST and AHCD. Results: Overall staff average on knowledge quiz after completion of workshop series improved by 8%. Conclusion: Staff education workshops seem to improve knowledge and comfort, however the limited time for the project did not allow for observed improvements in conversations with patients about POLST and AHCD.