Improving the Accuracy of Code Status Documentation in Home Care.

Area of Science:

• Palliative Care
• Healthcare Quality Improvement
• Nursing Education

Background:

• Advance care planning (ACP) discussions are crucial for patients with life-limiting illnesses, requiring specialized skills.
• Advance care planning documents (e.g., Health Care Proxies, MOLST, POLST) are vital for care continuity but often lost during care transitions.
• Home care clinicians must ensure awareness of patient code status and goals of care among all providers.

Purpose of the Study:

• To guide home care nurses in reviewing and reaffirming code status orders and advance care documentation at the start of home care.
• To enhance the consistency and accuracy of code status documentation during care transitions.
• To improve patient care goal alignment through effective advance care planning.

Main Methods:

• A quality improvement project involving three interventions: reminders for code status review, brief educational huddles/emails, and primary palliative care education classes.
• Focus on empowering home care clinicians with the necessary skills and knowledge for ACP.
• Systematic implementation of educational and reminder strategies over a 10-month period.

Main Results:

• Compliance with reviewing and reaffirming code status orders and advance care documentation improved dramatically.
• Code status documentation compliance increased from an initial 8% to 100% within 10 months.
• The interventions successfully addressed the gap in documentation continuity between hospital and home settings.

Conclusions:

• Targeted education and consistent reminders are effective in improving advance care planning documentation for home care patients.
• Enhancing home care clinician's role in advance care planning supports patient goals and improves care transitions.
• Quality improvement initiatives can significantly boost adherence to critical documentation standards in healthcare settings.