Nursing Comfort with Advance Care Planning Inquiry and Documentation: An Evidence-Based Quality Improvement Project
Loading...
Date
2022-05
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
The Ohio State University
Abstract
Underuse and lack of documentation of advance care planning (ACP) is a clinical gap area in community
oncology. The Centers for Medicare and Medicaid has identified ACP as a high priority process measure.
The purpose of the evidence-based quality improvement project was to educate nurses on the importance
of ACP. The objectives were to increase nurse and nurse practitioner ACP documentation in the
electronic medical record (EMR) by 30% and to increase the clinical perception of nursing comfort with
this process as evidenced by the scores of the pre-post implementation Kolcaba Advance Directives
Comfort Questionnaire for nurses pre and post education. An educational program on ACP was presented
to the registered nurses in a private oncology practice. The survey was distributed 2 weeks prior to the
education and repeated 6 weeks after the implementation. EMR chart audits for ACP documented were
performed during the same period as the staff survey. Wilcoxon rank-sum tests were used to determine
differences in survey scores pre and post education. Nursing comfort (N=8) with ACP pre-education
mean scores on the Kolcaba survey were 226.6 (max score 288) and 240.8 post education (p=0.14), effect
size d=1.12. ACP documentation increased from 0% pre-education to 63% post-education. Nursing
education increases documentation and comfort level of nurses' assessment of ACP.
Description
Keywords
adults with cancer, advance care planning, early palliative care, advance directives, communication