Programmes such as Respecting Choices in the USA and Respecting Patient Choices in Australia have been developed to address the need for improved advance care planning. Numerous guidelines, policies and pieces of legislation exist to provide guidance on requirements for developing and documenting advance care plans. However the problem of sub-optimal advance care planning in hospitals persists.
Problems have been identified in having ‘difficult’ conversations, documenting decisions made, the accessibility of advance care directives and applying advance care directives in practice.
One of the approaches that can support better use of advance care plans in hospitals is the use of standards and accreditation processes. In Australia, new National Safety and Quality Health Service Standards include items regarding the need for systems to receive or prepare advance care plans in partnership with patients and families, and to document these in the clinical record.
These National Safety and Quality Health Service Standards provide explicit statements of the expected level of safety and quality of care to be delivered to patients. The Standards are mandatory and hospitals need to be assessed against them from January 2013.
The Standards provide an opportunity to embed systems that support effective advanced care planning in practice through a system-wide approach to quality improvement. These high-level standards complement the more detailed policy and educational programmes that already exist, and provide a focus for efforts to improve the safety and quality of end of life care for patients in hospitals.
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