An Interim Analysis of an Advance Care Planning Intervention in the Nursing Home Setting
An Interim Analysis of an Advance Care Planning Intervention in the Nursing Home Setting
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DOI：
10.1111/jgs.14463
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发表时间：
2016-11-01
影响因子：
6.3
通讯作者：
Sachs, Greg A.
中科院分区：
文献类型：
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作者：
Hickman, Susan E.;Unroe, Kathleen T.;Sachs, Greg A.
目的描述实施系统性预先护理计划（ACP）的过程和初步结果护理之家环境的干预。设计经过专门培训的项目护士被嵌入到19个护理之家，并参与ACP，作为更大的示范项目的一部分，以减少潜在的可避免的住院。设置护理之家。2013年和2014年12月（n = 2，709）和2015年3月目前登记的居民（n = 1，591）。MeasurementsACP对话与居民，家庭和无行为能力居民的法律的代表进行，使用结构化ACP访谈指南，目标是向所有居民提供ACP。项目护士在2015年3月审查了他们的名册，目前登记的居民，以捕捉障碍，从事ACP.ResultsDuring初始实施阶段，27%（731/2,709）的居民参加了一个或多个ACP对话与项目护士，导致69%（504/731）的记录治疗偏好的变化。最常见的变更（87%）是生成治疗范围医嘱表。最常报告的障碍ACP是缺乏time.ConclusionThe强大的ACP的时间和资源密集型的性质，必须预期系统地实施ACP在养老院设置时。事实上，这些对话导致超过2/3的时间发生变化，这加强了深思熟虑的、系统的ACP的重要性，以确保了解并记录当前的治疗偏好，从而使这些偏好得到尊重。
ObjectivesTo describe processes and preliminary outcomes from the implementation of a systematic advance care planning (ACP) intervention in the nursing home setting.DesignSpecially trained project nurses were embedded in 19 nursing homes and engaged in ACP as part of larger demonstration project to reduce potentially avoidable hospitalizations.SettingNursing homes.ParticipantsResidents enrolled in the demonstration project for a minimum of 30 days between August 2013 and December 2014 (n = 2,709) and residents currently enrolled in March 2015 (n = 1,591).MeasurementsACP conversations were conducted with residents, families, and the legal representatives of incapacitated residents using a structured ACP interview guide with the goal of offering ACP to all residents. Project nurses reviewed their roster of currently enrolled residents in March 2015 to capture barriers to engaging in ACP.ResultsDuring the initial implementation phase, 27% (731/2,709) of residents had participated in one or more ACP conversations with a project nurse, resulting in a change in documented treatment preferences for 69% (504/731). The most common change (87%) was the generation of a Physician Orders for Scope of Treatment form. The most frequently reported barrier to ACP was lack of time.ConclusionThe time- and resource-intensive nature of robust ACP must be anticipated when systematically implementing ACP in the nursing home setting. The fact that these conversations resulted in changes over 2/3 of the time reinforces the importance of deliberate, systematic ACP to ensure that current treatment preferences are known and documented so that these preferences can be honored.