The Effect of a Palliative Care Consultation during the Admission Process in a Skilled Nursing Facility
Jennifer S Zelen
Published: March 07, 2022
Abstract
A palliative care (PC) consultation in a skilled nursing facility’s (SNF) admission procedure confers multiple benefits, including clarification of patients’ care preferences. However, many SNFs do not offer PC consultations, and rates of advance directive (AD) and power of attorney (POA) completion are low. In a quality improvement intervention to increase AD–POA completion rates, SNF patients were offered, upon admission, a PC consultation and an opportunity to complete ADs–POAs. AD–POA completion rates during the 12-week intervention period were compared with completion rates during a 12-week period absent PC consultation. Lewin’s change theory was used to develop policy–practice guidelines. During intervention, AD–POA completion rates (100%) substantially exceeded the target, 60% (control, 0%). By intervention end, all intervention participants’ (n = 57) medical records contained ADs–POAs; by control period end, only 49% of control participants’ (n = 61) medical records contained ADs–POAs. Project outcomes supported the premise of the PICOT question, “In patients admitted to a SNF during a 12-week period, how will a PC consultation affect the AD–POA completion rate (i.e., how will the intervention group’s rate compare with the rate seen in standard practice)?” Following these outcomes, the SNF’s policy now mandates that all incoming patients be offered a PC consultation. The intervention’s outcome suggests that including, during patient admission, a PC consultation and opportunity to complete documents can improve AD–POA completion rates and is likely to generate for a SNF and its patients the benefits that these documents can confer.
Keywords: Advance directives; Skilled nursing facility; Palliative care