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

2. 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.

3. 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

4. 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)

5. 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)

6. 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.

7. SCT Findings

8. SCT Findings

9. “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)

12. Moving Forward
Learn more so you can be comfortable discussing this topic!
Go to:
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.

13. 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

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

15. Thank you! Questions?