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Editor’s note: This is the third article in a multipart series about advance care planning and how to operationalize an effective program in nursing homes. Find the first article explaining the basics of what it is and why it matters here and the second article explaining how to use advance care planning for maximum effectiveness in providing person-centered care here.
Advance care planning involves more than completing documents, such as advance directives and POLST (Physician Orders for Life-Sustaining Treatment) forms, says Shigeko (Seiko) Izumi, PhD, RN, FPCN, associate professor in the School of Nursing at Oregon Health & Science University in Portland, OR; presenter of the April 22 webinar “COVID Conversations: Team Approach To Assisting Patients With Advance Care Planning” from the Coalition for Compassionate Care of California; and co-author of “A Model to Promote Clinicians' Understanding of the Continuum of Advance Care Planning” in the Journal of Palliative Medicine (2017; 20(3):220-22).
“It’s a mistake to fixate on the paper documents. Without conversation, the documents alone don’t help much because they can be overlooked in times of crisis,” stresses Izumi. “The most important part of advance care planning is having the conversation to learn the resident’s values, goals, and treatment preferences—and making sure the people around that resident also know what is important to them so that even without documentation, they can advocate for the resident when the resident cannot express their own wishes.”
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Editor’s note: This is the first article in a multipart series about advance care planning and how to operationalize an effective program in nursing homes.
The surveyor guidance under F578 (Request/Refuse/Discontinue Treatment; Formulate Advance Directives) in Appendix PP of the State Operations Manual defines and discusses advance care planning as follows:
“Advance care planning” is a process of communication between individuals and their healthcare agents to understand, reflect on, discuss, and plan for future healthcare decisions for a time when individuals are not able to make their own healthcare decisions. …
The ability of a dying person to control decisions about medical care and daily routines has been identified as one of the key elements of quality care at the end of life. The process of advance care planning is ongoing and affords the resident, family, and others on the resident’s interdisciplinary health care team an opportunity to reassess the resident’s goals and wishes as the resident’s medical condition changes. Advance care planning is an integral aspect of the facility’s comprehensive care planning process and assures re-evaluation of the resident’s desires on a routine basis and when there is a significant change in the resident’s condition. The process can help the resident, family and interdisciplinary team prepare for the time when a resident becomes unable to make decisions or is actively dying.
But what exactly does that mean? “The commonly used definition of advance care planning is that it is a process to support a person in understanding and ensuring their values, goals, and preferences regarding future medical care,” says Shigeko (Seiko) Izumi, PhD, RN, FPCN, associate professor in the School of Nursing at Oregon Health & Science University in Portland, OR; presenter of the April 22 webinar “COVID Conversations: Team Approach To Assisting Patients With Advance Care Planning” from the Coalition for Compassionate Care of California; and co-author of “A Model to Promote Clinicians' Understanding of the Continuum of Advance Care Planning” in the Journal of Palliative Medicine (2017; 20(3):220-22).
“It’s very important to know the resident’s values, goals, and preferences of future care and then to share that information with families and other healthcare providers so they understand what kinds of care the resident wants when that resident is unable to make their own decisions or cannot express their wishes,” she explains.
Advance Care Planning: An Exploration of the Beliefs, Self-Efficacy, Education, and Practices of RNs and LPNs.
Objective: This study compared the advance care planning (ACP)-related beliefs, sense of self-efficacy, education, and practices of RNs and LPNs.
Advance Care Planning in Skilled Nursing Facilities: A Multisite Examination of Professional Judgments.
BACKGROUND AND OBJECTIVES: Lack of advance care planning (ACP) may increase hospitalizations and impact the quality of life for skilled nursing facility (SNF) residents, especially African American residents who may be less likely to receive ACP discussions. We examined the professional judgments of SNF providers to see if race of SNF residents and providers, and risk for hospitalization for residents influenced professional judgments as to when ACP was needed and feelings of responsibility for ensuring ACP discussions.
Princeton Place Did Not Always Comply With Care Plans for Residents Who Were Diagnosed With Urinary Tract Infections (A-06-17-02002)
Princeton Place did not always provide services to Medicaid-eligible residents diagnosed with UTIs in accordance with their care plans, as required by Federal regulations. Specifically, Princeton Place staff did not always document that they monitored the residents' urine appearance at the frequencies specified in their care plans. Princeton Place did not have policies and procedures to ensure that its staff provided services in accordance with its residents' care plans. As a result of Princeton Place not following residents' care plans, the residents were at increased risk for contracting UTIs and for incurring complications from UTIs, including requiring hospitalization.
It’s that time of year. The turkey has been carved and eaten, and the holiday decorations are beginning to appear. To most people, that means holiday season has officially arrived.
But to directors of nursing services (DNSs) across the country, it means something else entirely: the full implementation of Phase 2 of the Mega Rule—and with it, the new survey process to monitor compliance with infection control and prevention standards.
Is your facility ready for the surveyors? Here's how to get started to make sure that you meet the infection prevention requirements, and enjoy your holidays too.
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