PDSA cycles

Your Clinic Project- Advance Directives/ MOST form Per a study patients prefer discussion: Initiated by MD(thought it’s the physicians responsibility to initiate it) Early in patient-MD relationship In outpatient setting while healthy With diagnosis of life-threatening illness

BACKGROUND Advance directive documentation is a compliant requirement for hospital based clinics by CMS, JACHO. Physicians have no taring to have these difficult conversations. There is no time to have these discussions in clinic Different providers have different documentation rates Every resident physician is required to do a QI project.

Aim statement To increase the completion rate of advance directive documentation in resident led ambulatory clinics (Patient completed package and the file was scanned into EMR) by 10% by April.

What patients to select for the project? Your sickest 5 patients – you all know them . In other words > 65 years of age with multiple comorbidities and /or terminal disease

Plan your own intervention Dedicate a complete clinic visit to discussion Showing them a you tube video of a code Giving them resources to read Be Innovative ……….

Five Patients chosen By the resident Meeting inclusion criteria Resident choses the intervention Write the intervention down in your PDSA sheet Patient comes to clinic Provider Discusses Advance Directives Document why the patient is not willing to sign the form in a Separate PCP note. Document that the form was filled form in a Separate PCP note with advance Directive discussion Title Put the copy in the assigned folder to be scanned Make a copy of the signed MOST form (Needs both yours and patients signature) Patient agrees to fill the MOST form Patient agrees to fill the MOST form Yes No No Patient leaves the clinic with the original form

Scan MOST form and VA form

Outpatient Advance Directive Discussion I discussed advance directives with the patient in clinic today. The MOST(Medical orders for scope of treatment are : ___ Completed and forwarded for scanning ___ Not completed due to a) ___ Patient wants to defer at this time to discuss with family b) ___ Patient does not want to discuss advance directive c) ___ Patient already completed advance directives in another institution. d) ___ Other reasons , Please elaborate ___________________________

STUDY /Measure Number of forms that are scanned.

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