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Depending on a team's aims and its information system, changes to the system itself can be worth trying. Some teams have created important changes just by modifying their usual forms. And since health care providers are used to keeping and seeing many records, they expect to contribute to them. One move that teams can try for a wide variety of aims is to change something about the information being recorded. If a standard history and physical form has space for "pain and symptoms," "preferred decision makers," or "spiritual issues," those things are much more likely to be recorded - and to be brought up with patients and loved ones.
One very popular change is to alter the bedside chart for hospital patients so that pain is recorded every time vital signs are taken (see chapter 3 on ways to improve pain management). One nursing home made a similar and effective change by using the last line of the "problem list" for a synopsis of advance care plans. Having a space to be completed made quick reference easy and ensured that the issues were addressed.
The record system itself can be the basis for innovation. Statewide, Oregon uses a hot-pink form called the POLST, Physician's Orders for Life-Sustaining Treatment, to communicate plans about resuscitation and other important aspects of rescue treatment. The form is valid in every treatment setting in the state - home, ambulance, nursing home, and hospital (see chapter 7 for more details).
The possibilities for using automated patient record systems as quality improvement tools are numerous. Automated systems can provide prompts or follow-up inquiries. One team is trying a query that pops up whenever an ICU patient is discharged. The query asks, "Do we know what this patient would want if he/she were ever so sick again?"
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This online version of the book Improving Care for the End of Life: A Sourcebook for Health Care Managers and Clinicians is provided with permission of Americans for Better Care of the Dying [ www.abcd-caring.org ] and Oxford University Press. All rights reserved. For further information on quality improvement in end-of-life care visit The Palliative Care Policy Center [ www.medicaring.org ]. |
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