National Healthcare Decisions Day 2015

Alvin L. Reaves, III, M.D., FACPMedical Director

Palliative Medicine and Supportive CareRegional Medical CenterOrangeburg, SC 29118

RMC Palliative Care

• Reasons for consultation:– Pain management– Non-pain symptom management– Hospice appropriateness– Withdrawal/withholding of life-sustaining

therapies– Goals of care discussions– Advance care planning

Types of Advance Directives (AD)

• Living Will• South Carolina Durable Healthcare Power of

Attorney• Five Wishes• Other

Who assists with it?

• Pastoral Care• Customer Service section of Care Planning– A cadre of hospital volunteers who can serve as

witnesses– Notarized on site at the time of completion– Free service to all patients and the community– Availability 7 days of week (weekends done by

nursing supervisors who are also notaries)

Why have an AD?

• Promotes autonomy in one’s medical decision making

• Reduces burden of decision making on family survivors

• Allows improved communication and guidance of one’s healthcare by the medical team

What is our experience?

RMC PC QI project

• Prospective chart review• Comparing EMR advance directive

documentation with scanned medical record or paper chart for the actual advance directive– accuracy in congruence– directive has been printed and placed on the

paper chart– awareness of the directive, its contents by the

physicians and medical staff

Results

• Small study of patients referred for PC consultation 1/1/2015 – 3/4/2015

• On-going, prospective study– admitting staff asks about AD at time of admission– 22% new palliative care consults had AD per admitting

EMR documentation (verified and unverifed)– only 36% with documented AD in the EMR had a

verified copy available on the chart (electronic or paper) during the time of hospitalization

– most attendings were unaware of the directive

Barriers

• Often the AD is scanned into the old chart prior to implementation of the EMR

• Requires that medical staff asks and look for the AD• Verification of the EMR is not often followed up

post-admission• Importance of asking is not always on the radar of

the medical team• Patient barriers – lack of understanding; fear;

mistrust; cultural differences – personal vs family autonomy

RMC NHDD 2015• Thursday April 16, 2015• Orangeburg-Calhoun Technical College• 5-730pm• Community-wide symposium• Speakers to include:

– past Director of Chaplaincy/Pastoral Care, Emory University Hospital Midtown

– Local elder law attorney– RMC Case Management/Customer Service– RMC Palliative Care– RMC Pastoral Care– Several local hospice agencies to serve as vendors– PACE program, Orangeburg

Future NHDD 2016

• Leading by example• Hospital-wide drive for RMC employees to

complete their own AD

Thank you