Doctor of Nursing Practice (DNP) Projects

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Doctor of Nursing Practice

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Post Master's DNP Completion

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quality improvement capstone project, improving documentation of advance directives


Terrie M. Black

DNP Project Chair

Terrie M. Black

DNP Project Member Name

Clare Lamontagne

DNP Project Outside Member Name

Linda A. Hurley



Regardless of the Patient Self-Determination Act in 1992, only 15% of Americans have an

advance directive (AD). This will be an even more significant factor by 2030 when the expected elderly population will be 72.1 million people. Purpose: If an individual does not have an AD, they may be subjected to futile, costly and unnecessary suffering at end-of-life. Loved ones may also suffer the emotional burden of not knowing what type of care is wanted if the person is unable to communicate. Primary care providers are first line in caring for patients and are in an ideal position to ensure that their patients have an AD completed. This should not be confined to the elderly, but anyone over the age of 18 as an unexpected illness or tragic event may occur. The literature is consistent concerning the emphasis on this important document but points out that it is not being done due to many constraints such as lack of education on ADs, discomfort with subject, time restraints and difficulty with accessing ADs in electronic medical records (EMR). Method: This quality improvement project seeks to have the AD flagged in the EMR to prompt the provider to have the conversation and easily document the results. One hundred and ten providers and thirty allied staff were involved in the project. Education concentrating on knowledge, comfort and legal aspects of ADs was provided to all staff. A community forum was offered to the public to provide information regarding ADs and its importance. At the start of the project, patients were asked to complete a card with a simple yes or no if their provider discussed completing ADs during their visit. Outcome: This project provided evidence of an increase in documentation due to the “flag “reminder. Education for the community and providers reinforced the importance of ADs. Conclusion: This project will easily be sustainable since the providers were educated on the benefit to their patients, their families and the facility. The flag will have prompted the conversation and documentation with the additional benefit of fulfilling Medicare and Meaningful use requirements.

Keywords: advance directives, end-of-life, primary care, staff education, EMR reminders

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