Browsing "Advance Directives"

Advance Directives – Entry 2

Dear Diary:

Based on a conversation I had with Carol, Hattie’s daughter, as well as conversations with our team related to our work to reduce avoidable hospitalizations, our QAPI team decided to review our systems around advance directives.  We do a great job completing advance directives upon admission and reviewing them annually, but we don’t have a good system in place to ensure that:

  • Residents and their families have good information to help make these important decisions, and
  • Advance directives are always current and easy to find in the health record.

Rhonda, our social worker,  has agreed to lead a team to work on these areas. Since we use a lot of the INTERACT tools, we thought this would be a good time to look at the INTERACT Advance Care Planning tools to see if they can help us out. As we reviewed the tools, we all agreed that the place to start is to make sure staff are comfortable having end-of-life conversations with residents and families. The INTERACT Advance Care Planning Communication Guide is a great tool to help with this.

Rhonda volunteered to lead educational sessions using this tool with all of our nurses on the Elm neighborhood. She has a wonderful idea of role playing these conversations as part of the training. Some volunteers from our QAPI team even agreed to help her out! Once everyone is trained on how to use the communication guide, we’ll introduce the rest of the INTERACT Advance Care Planning tools to the Elm neighborhood.

Rhonda’s team will be involved with the training and then work on systems to assure the advance directives are current and everyone knows where to find them.  She’ll report the progress back to the QAPI team. Our plan is to empower the staff on Elm neighborhood and test the education and strategies there. Once we figure out what works best, we’ll move ahead with the other neighborhoods. I’m excited about the possibilities here!

I wonder what other homes are doing to facilitate discussion and assure current advance directives are in place?

Signed, Donna

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Advance Directives – Entry 1

Dear Diary:

This morning while making rounds, I ran into Hattie’s daughter Carol.  Unfortunately, since Hattie came to live here things haven’t gone so well for her. She had increased lethargy and confusion related to antipsychotic drug use. She fell, broke her hip and needed to be hospitalized. After returning to River View, she experienced quite a bit of pain after her hip surgery and then she developed a catheter-acquired urinary tract infection that almost landed her back in the hospital.  Carol told me she’s relieved that despite some worsening dementia, Hattie seems to be getting back to “her old self.” Carol is pleased that her mom is participating in activities she’s always liked to do—cooking, knitting, and going to church. She’s even getting involved in the quilting club that meets at one of our neighborhoods on Tuesdays.

Apparently Carol, Hattie, and the rest of her family have been having some end-of-life conversations, as they’ve been observing what she’s been through in the past few months. They all agree that at this point they are more concerned about Hattie’s quality of life, rather than the length of her life. She’s suffered a lot in the last few months, and Hattie has told her family that she doesn’t want to go through that again. She says she’s ready to die and doesn’t want to be sent back to the hospital.  She’s adjusted to her new home here and would prefer to stay and remain comfortable where people know her and her routines. With that in mind, Carol has asked me to note in her mom’s chart that as long as we are able to keep her comfortable here at River View, she should stay here rather than being transferred her to the hospital.

I talked with Anna, one of Hattie’s nurses, and she’s working with Carol to update Hattie’s advanced directives. Made me think that we need to make sure we are regularly having these kinds of conversations with all of the residents and their families. How can we make sure this happens?

Signed, Donna

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