ADVANCE CARE PLANNING W HA T W HY W HEN & HO W WHAT IS ADVANCE - - PowerPoint PPT Presentation
ADVANCE CARE PLANNING W HA T W HY W HEN & HO W WHAT IS ADVANCE CARE PLANNING Ad va nc e Ca re Pla nning : Fac ilitate d c o nve rsatio ns be twe e n patie nts, lo ve d o ne s and he althc are ag e nts Re fle c ts o n g o als,
W HA T W HY W HEN & HO W
minatio n A c t 1991
L T C -§483.10(c )(6), (c )(8), (g ) (12)-”A dvanc e C ar e planning ” is a pr
c o mmunic atio n be twe en individuals and the ir he althc ar e ag e nts to unde r stand, r e fle c t o n, disc uss, and plan fo r futur e he althc ar e de c isio ns fo r a time whe n individuals ar e no t able to make the ir
e de c isio ns.
e planning is an inte g r al aspe c t o f the fac ility's c o mpr e he nsive c ar e planning pr
e s a r e -e valuatio n o f the r e side nt’s de sir e s o n a r
basis and whe n the r e is a sig nific ant c hang e in the r e side nt’s c o ndition.
e side nt must r e c e ive a c o mpr e he nsive asse ssment to pr
dir e c tio n fo r the de ve lo pme nt o f the r e side nt’s c ar e plan to addr e ss the c ho ic e s and pr e fe r e nc es o f the r e side nt who is ne ar ing e nd o f life … initia te
disc ussio ns/ co nsider a tio ns re g a r ding a dva nce c a re pla nning a nd re side nt c ho ice s to c la rify g o a ls a nd pre fe re nce re g arding tre a tment inc luding pa in ma na g ement a nd sympto m c o ntro l, tre a tment o f a c ute illne ss, a nd c ho ic e s re g a r ding ho spita liza tio n.
a nd a dv a nc e dire c tiv e s, if a ny.
AC
Surve y(natio nal survey se nt o ut fro m a ll 7 c e nsus b ure a us) fo und 26.3% 18 & o ld e r o f the re sp o nd e nts ha d a n Ad vanc e Dire c tive -of tho se with a n AD, 51.2% we re 65 o r o ld e r a nd o nly 11.8% o f tho se 18-34 ha d a n AD
vie wed w/ in 30 d a ys o f d e a th, o nly 31% o f p a tients a nd 52% o f c a re give rs b elieved the p a tie nt ha d le ss tha n o ne ye a r to live.
tant, o nly 25% ha ve re c ord ed the ir wishe s
Re fe re nc e s 1,2,3,4
Referenc es 1,2,3,4
Referenc es 1,2,3,4
“ F
T he risk o f ha rm is e le va te d a nd mo re a ppa re nt in pa tie nts with se rio us illne ss o r o lde r a g e . As a c o nse q ue nc e o f the ir c o nditio ns, suc h pa tie nts ha ve a n inc re a se d risk o f de a th, a nd ma y a lso ha ve a n inc re a se d risk o f po te ntia lly ha rmful e ve nts suc h a s ho spita liza tio ns, lo ss o f c a pa c ity, lo ss o f inde pe nde nc e ,
b e c o nside re d ne g lig e nt, re sulting in unne c e ssa ry suffe ring a nd ha rm.” (fo r b o th re side nts a nd fa milie s) Alle rg y Ana lo g y: “ Pro viding c a re w/ o e ng a g ing in c o nve rsa tio ns a b o ut E OL c a re wishe s & de live ring c a re inc o nsiste nt w/ pa tie nts’ sta te d wishe s we re o n pa r with me dic a l e rro rs.”
(Dr . L a c hla n F
r
e c to r
e , Be th Isr a e l De a c o ne ss Me d ic a l Ce nte r ) Re fe r e nc e 4
96 y/ o fe ma le with a pa st me dic a l histo ry o f: de me ntia , ma c ula r de g e ne ra tio n, sync o pe , G E RD a nd a rthritis. Re side s a t a nursing fa c ility fo r the la st ye a r a fte r tra nsitio ning fro m a n a ssiste d liv ing fo llo wing a fra c ture . She is a le rt- no inc a pa c ity no te d. So n is inv o lve d in he r c a re . He no te s tha t he r me nta l sta te is up a nd do wn, b ut she wa s re c e ntly a b le to pla y a b o a rd g a me a nd wa s fa irly c o nv e rsa nt. Co de Sta tus o n a dmit is “ no c o de ” a nd ha s b e e n tha t fo r q uite so me time prio r to a dmissio n. T he re ha ve b e e n no c o nv e rsa tio ns re : g o a ls o f c a re o the r tha n c o de sta tus disc ussio n. Re side nt fa lls o ut o f b e d a nd e L T C ha s b e e n c o nta c te d. Nurse re po rts tha t re side nt ha s b e e n de c lining a nd ha ving multiple fa lls la te ly. She susta ine d a skin te a r, a b ra sio n/ he ma to ma to fo re he a d a nd no se b le e d. She is typic a lly mo re re spo nsiv e tha n she is a t the time o f the c a ll. Due to c ha ng e in a lte re d me nta l sta tus a nd no prio r g o a ls o f c a re c o nv e rsa tio ns, she is se nt to E D v ia a mb ula nc e . In the E R, re side nt ha s kne e pa in a nd is so mno le nt. Physic ia n spe a ks to so n who wa nts to “ limit te sting to o nly e me rg e ntly ne c e ssa ry te sts.” He is e a g e r to g e t he r b a c k to fa milia r se tting s a nd she is se nt b a c k to fa c ility. 1. Ho w wo uld ha v e a n ACP disc ussio n he lpe d in this situa tio n? 2. Ho w/ whe n wo uld yo u ha ve sta rte d this c o nv e rsa tio n?
Pre - re quisite :
Who Sho uld Be Invo lve d In T he C o nve rsatio n?
(who will be the c hampio n in yo ur fac ility)
e so me o ne in the family that ne e ds to be the r e e ve n if the y ar e n’t the DPO A?
itual/ C ultur al L e ade r
ac titio ne r
(Be ing invo lve d c an be do ne via pho ne )
fo r billing )
n the ro o m ha s a c ha i r- SIT DOWN- No DOORWAY DISCUSSIONS
E le me nts o f an AC P C o nve rsatio n: C -A-R/ R-E
e nt's p e rsp e c ti ve , no t me re ly d isp e nsing info rma tio n a nd a c quiri ng a d e c isio n. First a sk fo r, the n L I ST EN to the p a tie nt’ s p e rc e ptio n o f the ir me d ic a l situa tio n a s we ll a s the ir va lues a nd go a ls o f c a re .
E OARS
xe c ute :
lli ng re q ui re me nts a nd c o mmuni c a ti
IVING WIL L / POL ST ;MOST / CODE ST AT US
7
85 y/ o fe m ale with m ild de m e ntia re c e ntly diag no se d with panc re atic c anc e r with m e tsto the live r. T he c o nve rsatio n with the o nc o lo g ist inc lude d: a disc ussio n o f the natural c o urse o f the illne ss; pro g no sis and tre atm e nt o ptio ns, inc luding ho spic e c are . Risk and be ne fits o f c he mo we re also disc usse d and e xplaine d that survival with no furthe r the rapy is le ss than 3 m o nths and at be st a ye ar with c he mo the rapy. Surg e ry and RXT are no t an o ptio n. C o m fo rt c are was e nc o urag e d m ultiple tim e s, but she wante d to pro c e e d with c he mo the rapy. She is full c o de . He r husband was pre se nt at the c o nve rsatio n with the physic ian. She was ho spitalize d sho rtly afte r he r first ro und o f tre atm e nt fo r we akne ss, nause a and no w is c o m ing to yo ur fac ility fo r stre ng the ning . What are ne xt ste ps? What is im po rtant to find o ut?
1. Ra o JK , Ande rso n L A, L in FC, L a ux JP. Co mple tio n o f a dva nc e dire c tive s a mo ng u.s. c o nsume rs. AM J Pre v Me d. Ja nua ry 2014; 46(1):64-70. do i:10.1016/ j.a me pre .2013.09.008. 2. Ha rdy JE, Hilme r SN. De pre sc rib ing in the la st ye a r o f life . J
and Re se arc h. 2011; 41(2). 3. Adva nc e Ca re Pla nning : a g uide fo r he a lthc a re pro fe ssio na ls. The Ca lifo rnia Sta te Unive rsity Institute fo r Pa llia tive Ca re & Co a litio n fo r Co mpa ssio na te Ca re o f Ca lifo rnia . https:/ / c supa llia tive c a re .o rg / pro g ra ms/ a dva nc e -c a re -pla nning / e b o o k-2017/ . Ac c e sse d 12/ 20/ 17. 4. Mc Cutc he o n Ada ms K , K a b c e ne ll A, L ittle K , So ko l-He ssne r L . “Co nve rsat io n Re ady”: A Fram e wo rk fo r im pro ving End-o f-L ife Care . IHI White Pa pe r. Ca mb ridg e , Ma ssa c huse tts: Institute fo r He a lthc a re Impro ve me nt; 2015. (a va ila b le a t ihi.o rg ) 5. Ra mb o tto m K & K e lle y ML . De ve lo ping stra te g ie s to impro ve a dva nc e c a re pla nning in lo ng te rm c a re ho me s: g iving vo ic e to re side nts a nd the ir fa mily me mb e rs. Int e rnatio nal J
http:/ / dx.do i.o rg / 10.1155/ 2014/ 358457. 6. NASW, ASWB, CSWE, & CSWA Sta nda rds fo r Te c hno lo g y in So c ia l Wo rk Pra c tic e . 2017. https:/ / www.so c ia lwo rke rs.o rg / inc lude s/ ne wInc lude s/ ho me pa g e / PRA-BRO- 33617.Te c hSta nda rds_FINAL _POSTING.pdf 7. A 17- A pra c titio ne r’ s g uide to a dva nc e c a re pla nning disc ussio ns in the PA/ L TC se tting . Ma rc h 18, 2018. https:/ / pa ltc .o rg / a mda -white -pa pe rs-a nd -re so lutio n-po sitio n- sta te me nts/ a 17-pra c titio ne r%E2%80%99s-g uide -a dva nc e -c a re -pla nning . Ac c e sse d Ma y 22, 2018