NICAP Initiative: Advance Directives Starting the conversation & uploading into MyUFHealth

The Problem Disconnect between patient’s end-of-life wishes and family/caregivers/healthcare team awareness 53% of physicians did not know that patients did not want CPR 50% of patients experienced (unaddressed) moderate or severe pain at least half of the time within their last few days You have the right to make decisions about your own medical treatment. These decisions become more difficult if, due to illness or a change in mental condition, you are unable to tell your doctor and loved ones what kind of treatments you want.

Advance Directive Is a document or series of documents that lets you state exactly how you wish to be treated if you become seriously ill and cannot speak for yourself (also called living will). Lets you indicate who you would want to make decisions for you if you were unable to make them for yourself (also called healthcare surrogate designation, power of attorney). Empowers patient to set own goals and priorities that help guide care Takes stress off of patient, family, and healthcare providers

Importance of Completing AD 90% of people say talking with their loved ones about end-of-life care is important. 27% have actually done so. 60% of people say making sure their family is not burdened by tough decisions is extremely important. 56% have not communicated their end-of life wishes. 80% of people say that if seriously ill, they would want to talk to their doctor about wishes for medical treatment toward the end of their life. 7% report having had this conversation with their doctor. 82% of people say it’s important to put their wishes in writing. 23% have actually done it. Source: Survey of Californians by the California HealthCare Foundation (2012)

Examples of Preferences Life-support treatment (cardiopulmonary resuscitation (CPR), major surgery, ventilator, feeding tube, blood transfusion, etc.)) Medication if you are in pain Religious or personal beliefs/practices Where/how you might want to spend your final days (home, hospital, nursing home, etc.) Designated healthcare surrogate (someone who will make health decisions on your behalf IF you are unable to)

NICAP Initiative: Supportive Care Team NICAP formed a Supportive Care Team (SCT) to discuss importance of Advance Directives with patients, assist them, and ultimately increase the rates of AD completion. Volunteers through Haven Hospice Visit the Neurosurgery and Movement Disorders clinics Wednesdays 9AM- 3PM See as many patients as they can during this time, provide them with Advance Directive packets and help them fill theirs out.

SCT Findings

SCT Findings

“I Have an AD, Now What?” It does patients no good if the AD is locked up in a safe at home!!! It must be in their medical record where providers can access it. 3 easy ways patients can get their AD added to their EMR Give it to their doctor at the next visit Mail it to UF Health Information Management Department (address provided on form) Scan in, upload from home into their MyUFHealth account (see next)

Moving Forward Learn more so you can be comfortable discussing this topic! Go to: https://www.my-emmi.com/SelfReg/ADVANCEDIRECTIVES Enter your Name and DOB under ‘patient information’ and select: Advance Directives (20 Min) REQUIRED Palliative Care (15 Min) Recommended Considering Hospice Care (25 Min) Recommended This training is required if you are on QI rotations! Following training, a quiz will test your comprehension of the material.

Moving Forward NICAP interns on QI rotations MUST shadow SCT volunteers at least 1 hour (Wednesday between 9AM-3PM) If shift not on Wednesday, make every effort to adjust schedule and shadow for 1 hour If shadowing is impossible for documented reasons, let QI director and grad lead know QI interns will call patients approached by the SCT to follow-up/assist with AD upload/mailing/etc. A Q&A sheet will be provided to facilitate the conversation

AD Forms and More Information Remember, AD forms and requirements are state-specific More info about Florida AD https://ufhealth.org/advance-directives/overview Here you can find a health care surrogate form, living will, starter kit to get you thinking about what decisions you want

Thank you! Questions?