Promoting communication and documentation of advance care planning in long-term care facilities.

This paper describes the findings of Phase I of an advance care planning (ACP) demonstration project, undertaken collaboratively between the Texas Partnership on End-of-Life Care and the North Texas Alliance of Nursing Homes. The goal of the project, designed as a continuous quality improvement program for the nine volunteer nursing facilities (NFs), was to increase the systematic implementation of ACP Phase I consisted of baseline data collection of ACP documentation from the nine NFs. This was followed by a pre-intervention train-the-trainer educational program for facility coordinators and other interested staff who subsequently would implement the procedures in their NFs, to increase the use of advance directives (ADs). Following the Phase II implementation, a model will be developed for replication in other Texas facilities. Reported here are the pre-intervention baseline chart review findings documenting ACP and various AD documents. Based on the experience of this chart review, recommendations are outlined for improving the quality of ACP communication and documentation.