Background An Advance Care Plan (ACPlan) that is ambiguous, contradictory or difficult to interpret can undermine confidence in the ACP process, lead clinicians to question the value of ACP and reduce the likelihood a person’s ACP wishes will be honoured.
In Canterbury, a quality process has been developed to ensure ACPlans published to the electronic medical record (EMR) are clinically interpretable and any advance directives (AD) contained within the document meets NZs criteria for validity.
Methods a two-step process has been developed
Step 1 - Administration review to ensure the plan has been entered onto the EMR; the signed scanned copy matches the EMR version; there are two signatures – that of the person creating the ACPlan and the health care professional (HCP) supporting them.
Step 2 - Clinical review to ensure the content of the ACPlan is consistent with any ADs contained in the document and the plan is clinically interpretable.
If an ACPlan does not meet the quality parameters, it is returned for review and amendment. This process enables the ACP team to engage with the HCP leading the process, provide individual feedback and support them to improve the quality of plans submitted in the future.
Results Numbers of ACPlans published continue to grow (2014 n=118; 2015 n=354; 2016 n=519; 2017 n=772). While the percentage of plans requiring support from the ACP team to meet publishable criteria is falling (2014=31%; 2015=32%; 2016=27%; 2017=20%).
Conclusion(s) The quality review process established in Canterbury supports the creation of clinically interpretable ACPlans.
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