What You Need to Know
BWH’s next site survey from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is slated for January 2004. To help prepare nurses for the impending survey, BWH Nurse will continue to publish regular articles on appropriate processes and standards that apply to Nursing. All nurses, who have not yet been through a JCAHO Survey, should work with their nurse managers to ensure understanding and expectations of the process.
Part II: Advanced Directives
Nursing Assessment of Patients
As mentioned in last month’s BWH Nurse, nurse managers on inpatient units conduct monthly audits of medical records to measure compliance with JCAHO standards. One of the indicators measured in this audit is the nursing assessment of a patient’s advance care directive status. BWH’s overall compliance in regard to properly documenting the completion of this assessment is at 55 percent. Nurses’ assistance is needed in improving compliance by assuring that ACD status of every patient admitted is assessed. BWH’s goal is to achieve a compliance score of 90 percent or better.
JCAHO requires that there is documentation in the medical record of whether a patient does or does not have an Advance Care Directive. BWH recognizes the right of individuals to make decisions about their treatment, including decisions to withhold or withdraw life support measures.
There are two (2) types of Advance Care Directives which assure that patients’ wishes are carried out, in the event that they become unable to make decisions:
1. Health Care Proxy –
In Massachusetts, this legal document allows patients to appoint someone they trust to make health care decisions for them, in the event that they become unable to make or convey those decisions for themselves.
2) Living Will –
This document allows patients to specify their wishes related to the type of medical care they would want if they become terminally ill or were not expected to recover from physical or mental disability or disease.
Expectations of Nursing Staff:
The Pre-admission/ Admission Assessment Form completed on every in-patient has three questions addressing Advance Care Directives (ACD). The first question asks if the patient has an ACD. If the response to this question is “NO”, the patient must be asked if s/he would like additional information.
If additional information is requested, the nurse should indicate what actions were
taken (i.e. Guide to Advance Care Directive given to patient or Social Worker/Care Coordination notified). In the event the patient has an ACD, it is essential that a copy be obtained and placed in the patient’s medical record. The document should be labeled with a pink ACD sticker in the top right corner of the document. A pink ACD sticker should also be placed on the front of the medical record. The Advance Care Directive should be filed in the patient’s medical record, in front of the face sheet.
The Pre-admission staff will screen patients who are scheduled for elective surgery. For those patients who have an ACD, they will be asked to bring a copy of the document with them the day of their surgery. In the event that patients are unable to provide a copy of their ACD, we would encourage staff to provide them with an ACD form so that they can
complete it at that time. These forms are available on all nursing units.
Please note:
Ambulatory care services are currently evaluating how ACD assessment of ambulatory patients can be addressed. As these plans progress, we will share them with you.
For additional information on Advance Care Directives: contact the Care Coordination.