Can we incorporate advance care planning into our facility?

Advance care planning is a collaborative process between healthcare providers, patients and family members, where all parties come together to discuss future healthcare, including end-of-life decisions. Eliciting and documenting patients’ wishes ensures that, even if they become incapacitated, their preferences are known. This honors residents’ voice and choice and reduces stress on family members. 

Advance care planning encompasses more than just CPR; it also addresses topics such as ventilator use, artificial feeding, artificial hydration through intravenous fluids, and other emergency treatments. This is an opportunity for the patient to express care decisions based on their values and preferences. 

Staff often avoid these crucial conversations because the subject can be difficult; education does a lot to help ease these fears. 

Consider appointing a staff member to serve as an advance directives advocate and educator for patients and staff alike. This person should be able to share materials that help patients and family members understand various options. 

To incorporate advance care planning into care delivery, address it upon admission and during every care conference. Begin by asking patients what kind of treatment they would or would not want in a few emergency scenarios. For example, if they have a stroke, cannot move, and their heart stops, would they want CPR?

Documentation can take place in an advance directive or living will. Be sure to check your state’s laws to ensure advance directives are valid. 

Keep copies of the directive in both the medical record and the patient’s plan of care.