Bellhouse-King, Mathew2019-05-282019-05-282018-05http://hdl.handle.net/10125/62618Introduction Advanced care planning (ACP) is a dynamic process by which patients, their family and healthcare providers establish the values and goals of medical care and document these in the event a patient cannot communicate for themselves. The purpose of this DNP project was to expand the use of ACP education videos at Adventist Health Castle (AHC) to increase the documentation of end-of-life (EOL) decisions with the goal of aligning care to patient’s explicit wishes. A literature review was conducted synthesizing available ACP research into five major themes; ACP effectiveness, decision aids, screening, video intervention and cost effectiveness. The Iowa Framework of Evidence-Based Practice to Promote Quality Care was selected to guide this DNP project (Titler et al., 2001). Methods The clinical question for this project was: will expanded use of evidence-based patient education ACP videos improve Providers Orders for Life-Sustaining Treatment (POLST) and advanced directive (AD) completion by 15% for adult inpatients at AHC over 4 months? The project aimed to answer the clinical question by utilizing an impact (summative) and process (formative) evaluation design. The practice change aimed to expand the use of the ACP education videos by engaging a multi-disciplinary team of health professionals. The sample population was all patients on the Laulima/telemetry unit of AHC who were screened and met criteria for ACP discussions per facility protocol. Results The expected outcome was to increase AD and POLST completion by 15%. Actual outcomes were a 19.8% increase in AD completion and a 7.9% increase in POLST completion. Process evaluation results indicate staff concerns regarding the initiation of ACP conversations, including feelings of anxiety and discomfort, were sufficiently addressed during project implementation. Discussion The expected outcome to increase AD and POLST completion by 15% was an ambitious goal. The 19.8% increase in AD completion exceeded expectations. POLST completion increase of 7.9% was a modest but meaningful improvement. A limited implementation phase may not have provided adequate time for staff to acclimate to the psycho-social and cultural aspects involved in ACP discussions and for a sustained practice change to be demonstrated.Advanced directives (Medical care)Terminal care--Decision makingPatient education--Audio-visual aidsLiving willsThesis