Respecting Choices - Self Assessment

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“The goals of advance care planning can only be achieved by changing institutional and professional routines. What must be created is an innovative system for advance care planning within healthcare.”

- Bud Hammes, PhD, Director, Respecting Choices

Online Self Assessment

Do you have a good system?

In the Respecting Choices program, success is characterized for each health organization, and the professionals working in them, in terms of developing and maintaining new routines of care. The routines can be described as a list of Five Promises:

We will:
1. Initiate conversations about advance care planning with all adults who need to plan.
2. Skillfully facilitate planning with each individual.
3. Make sure all advance care plans are clear to all involved and specific to each person.
4. Make sure that plans are available when needed.
5. Follow plans in a thoughtful and respectful way.
Since the initiation of the Patient Self Determination Act in 1991, the importance of communicating treatment preferences in a written advance directive is well recognized. In fact, most organizations have some type of program to promote this goal. However, the biggest hurdle has been to provide evidence that these programs are working.
Does the advance care planning program in your organization meet the needs of individuals to plan ahead for their health care needs? Does the advance care planning program address the Five Promises of an effective system?

Use the following questions to assess the quality of your current advance care planning program.

Assessment Questions (Check all that apply)

PROMISE #1: We will initiate the conversation.

1. Who are the conversations being initiated with?

For patients/residents who are admitted to our health care organization (e.g. Do you have an advance directive? admission assessment question)
For all adults who we would not be surprised if they died in the next 12 months
For all adults with chronic, progressive illness
For all adults over the age of 55 as a routine part of their regular physical examination

2. Where are these conversations occurring?

During the admission assessment process
Through regular, ongoing community presentation
In the ambulatory or outpatient health care setting

3. Who initiates these conversations?

Person responsible for admission assessment
Physicians
Nurses, social workers, and/or clergy
All health care professionals
Professionals who have received training in the skills of ACP facilitation

PROMISE #2: We Will Provide Assistance with Advance Care Planning

1. What does "assistance" mean?

Advance care planning typically means completing a written advance directive only
An individual's advance care plan is re-explored with every admission to the organization
An Individual's advance care plan is re-explored with changes in medical condition or response to treatment?
Individuals are well informed of their health care choices

PROMISE #3: We Will Make Sure Plans Are Clear

1. What is the meaning of "clear"?

All written plans are reviewed by a qualified person for legal compliance
All written plans are reviewed by a qualified person for clarity and understanding
Written plans reflect an individuals values and specific preferences

2. Are written plans adequately communicated?

Written plans are understood by the chosen health care decision-maker
Written plans are understood by other family and loved ones
Written plans are understood by the patient's physician

PROMISE #4: We Will Maintain and Retrieve Plans

1. What is the system for making plans available to health care professionals?

Written plans can be entered into the medical record in a consistent and reliable way
Written plans are routinely available to health care professionals to guide medical decision making
Written plans are available within 24 hours of admission to our health care organization
Written plans are transferred with patients when they move to another health care organization

PROMISE #5: We Will Appropriately Follow Plans

1. What is the system for ensuring that written plans are honored?

Systems exist to insure that treatment preferences are transferred to medical orders
Responsibility is taken to follow up on situations where it appears a patient's plan is not being followed
Ethics consultations are regularly made when conflicts or concerns occur about patient preferences
There are ongoing quality improvement processes in place to consistently monitor our advance care planning program