Date of Graduation

Summer 8-5-2020

Document Type

Project/Capstone

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

Abstract

Problem: The DNR No POLST project aims to increase the number of physician orders for life-sustaining treatment (POLST) forms completed on hospitalized patients who are designated DNR status. Currently, there is no process for ensuring completion of advanced care planning (ACP) materials, including the POLST form, on designated DNR patients throughout the hospital. Ensuring patients receive a complete and accurate POLST prior to discharge decreases the chance of unwanted overtreatment.

Context: This quality improvement project utilizes regionally trained life care plan (LCP) facilitators to initiate and assist patients and families in the completion of the POLST form. Approximately 70% of the patient population is over the age of 65 years, with two or more chronic conditions, making them ideal candidates for discussions about healthcare wishes. The top three common diagnoses of this patient population are congestive heart failure, chronic obstructive pulmonary disease, and chronic kidney disease.

Intervention: This project implemented direct LCP facilitator engagement with hospital-based physicians to complete accurate, quality POLST forms on all hospitalized DNR patients. A process map was developed by the team, with input from senior leadership and physician champion. The process for POLST completion is followed each day to maximize the number of POLST forms completed prior to patient discharge.

Measures: Measures for the DNR No POLST project are designed to capture the daily census of DNR patients admitted to the hospital without a POLST in place. The outcome measure for this project is the percent of patients with a completed POLST form prior to discharge.

Results: The DNR No POLST project revealed successful results over the last seven months. An average of 92% completion rate of POLST forms on DNR designated patients was maintained during the project timeline. The current results of this project were above the set 65% aim in all instances. It is expected this project will continue to produce these exceptional results.

Conclusions: The DNR No POLST project is significant. The objective of the DNR No POLST project is to ensure that patients receive medical care that aligns with their values. This project encourages patients and families to have crucial conversations with their healthcare providers. It also facilitates proper documentation of patient preferences regarding code status and medical treatment. The POLST form provides a critical platform for end-of-life discussions in which patient preferences can be converted into medical orders. The POLST allows for the communication of patient preferences when patients are unable speak for themselves. It is expected this project will increase awareness about the importance of POLST completion to understand and honor patients’ medical wishes.

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