Promise 4: We will assure that plans will be available
This promise involves the implementation of necessary organization/community structures and practices that insure plans are entered into the medical record, are available when needed, follow the patient upon transfer to another organization and designate accountability to personnel for monitoring this outcome.
To evaluate whether an organization or community is meeting this promise, the following questions could be asked:
- What is the system for entering the written plans into the medical record? Are written plans entered through local attorney offices, outpatient settings, community settings or other local health care organizations? Are written plans entered in a timely fashion? Are physicians notified of an entered advance directive? Are written plans available when decisions are needed; upon transfer to another organization or within 48 hours of admission?
- What is the system for honoring oral treatment preferences? Are oral directives routinely documented?
- What is the system for identifying problems with maintaining or retrieving written plans? Is there a quality improement program that routinely assesses the ability of the system to maintain and retrieve plans?
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This content is provided by Gundersen Lutheran Medical Foundation. Citation: Hammes, Bernard J., Briggs, Linda, "Respecting Choices Advance Care Planning Facilitators Manual," Gundersen Lutheran Programs for Improving
End-of-Life Care, Gundersen Lutheran Medical Foundation, 2000. http://www.gundluth.org/eolprograms