The Common Sense Guide to Improving Palliative Care > Advance Care Planning > 3.5 Measuring Success

Sick To Death book cover This extract from the online edition of The Common Sense Guide to Improving Palliative Care is used with permission.

Advance Care Planning: Measuring Success

Team Delta

To get a baseline, Team Delta reviewed 10 charts for residents who had died recently. No discussion of prognosis or treatment preferences had been documented, and no decisions had been made regarding life­sustaining treatments. Moreover, of the 10, six had died after being transferred to the hospital. The team decided to set a standard of having started a discussion with a resident and/or family member and documented existing decisions in the medical record within 72 hours of admission. The team started identifying "at risk of death" patients and severely cognitively impaired residents. Based on their aims, team members identified which measures they needed to track to best monitor their progress. Over the next few weeks, the team began to implement its changes, tracking whether the patient and family engaged in advance care planning (ACP); educating the facility staff on ACP and documentation of patient wishes; and assuring that their decisions were recorded.

Following are some of the measures other teams have tracked to follow their progress in ACP. The measures may be actual numbers or percentages. Your percentages must have a denominator (e.g., patients eligible for ACP) and a numerator (e.g., patients who complete advance directives). See Chapter 2, "Measuring Success", for more details.

Process Measures

Outcome Measures

Adverse-Effect Measures

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