Improving the use of advance care planning in assisted living facilities

Abstract

<p>Ensuring patients receive care in the fashion they so choose at the end of life should be considered and addressed upon any admission process. The project site noted many unnecessary, repeated emergency room (ER) visits for residents so an evidence-based solution was sought. The purpose of this quantitative, quality improvement project was to determine if the implementation of the Carolina Caring Hospice Agency ACP (CCHAACP) toolkit would impact ACP implementation and reduce ER visits among residents in an assisted living facility (ALF) in Western North Carolina over four weeks. Orem&rsquo;s selfcare theory was the framework of the project. Data was obtained from the electronic health record for the number of ACPs and the quality department provided the ER visits data among the sample of 31 residents of an ALF. A Chi-square test indicated a clinical and statistically significant improvement in the implementation of ACP between the comparative (<em>n</em>=0, 0%) and the implementation group (<em>n</em>=3, 30%), <em>X²</em> (1, <em>N</em>=31) = 6.98, <em>p</em>= .008. A chi-square analysis indicated there was no statistically significant reduction in ER visits (<em>X²</em>(1, <em>N</em> = 62) = .295, <em>p</em> = .587). However clinical significance was noted in reducing readmissions by 6.5%. Therefore, the implementation of the CCHA-ACP toolkit may improve ACP implementation but additional data analysis is needed on reducing readmission rates. Recommendation are to sustain the project and reanalyze data after six months to determine if the short project timeline impacted the statistical analysis.</p>