Nurse Practitioner-Led Education: Improving Advance Care Planning in the Skilled Nursing Facility

Abstract

The Advance Care Planning (ACP) note is a critical component for guiding the care of patients in the Skilled Nursing Facility (SNF). Although ACP documentation is essential, it often is not completed in the SNF. The purpose of the project was to increase the number of ACP notes for patients admitted to 13 SNFs in Southeastern Minnesota. Prior to intervention, the ACP note was not consistently completed by the Nurse Practitioner (NP) or Physician Assistant (PA) in the SNF. The aim of the Quality Improvement (QI) project was to increase ACP note completion rates by 50% and increase satisfaction and knowledge with the ACP process amongst NPs and PAs over a 12-week period after the administration of a one-hour ACP education session. By improving the ACP process, patients can participate in a positive end-of-life experience and receive medical care that is consistent with their values, goals and preferences. The hypothesis for this project was that a structured ACP process would increase the number of ACP notes completed compared to current processes. A secondary outcome was that structured ACP process would increase NP and PA satisfaction and knowledge with completing ACP notes. The design was a QI project that addressed the ACP process in 13 SNFs in Southeastern Minnesota. A convenience sample (N=10) of NP/PA providers completed a pre and post ACP education intervention survey. On all six survey questions, a general increase in mean value was demonstrated. Question two, seven and eight demonstrated the greatest increase in mean value score of (0.7, 1.2, and 0.9) respectively. A Wilcoxon signed-rank test elicited significant change in knowledge (p=0.037), understanding of ACP note billing (p ≤ 0.001), and satisfaction with ACP note documentation (p=0.004). Unfortunately, the QI project demonstrated a 2% decrease in ACP note documentation in the post-intervention phase. Although there was not a significant change in the ACP note completion rates, an improvement in NP/PA knowledge and satisfaction was demonstrated through ACP education session.