PCNOW Advocacy Alert #2

Documenting Goal of Care Conversations

As the saying goes, if it isn’t documented, it didn’t occur.  When it comes to documenting goal-of-care conversations for seriously ill patients, there is often a gap between current practice and the ideal.  Failure to adequately document these conversations can lead to over-medicalization of the dying patient, increased patient/family and health professional suffering, unnecessary and prolonged hospital stays, and higher health care costs.  This Advocacy Alert is designed to ensure that all hospitals and long-term care settings have goal of care conversation templates in their Electronic Medical Record.

What is a Goal of Care Conversation (GOCC)?   The GOCC is when discussion takes place between the patient or surrogate and health care team to define patient goals—physical, social, spiritual or other patient-centered goals—that arise following an informed discussion of the current disease(s), prognosis, and treatment options.  These conversations should include:

• Who was present
• What was discussed
• What was decided
• What are the next steps

Supporting features that should also be documented include:

• Presence or absence of an advance care planning document
• Whether the patient has decision making capacity; if not, who is making decisions and with what legal authority
• Clinician prognostic estimate (time and function)

For patients in whom a decision is made to withdraw life sustaining treatments, additional key information can include:

• Recommendation for hospice referral
• Role of current/future artificial nutrition/hydration
• Decisions regarding re-hospitalization
• DNR status
• Disposition plan

What can you do?

• Learn if your facility has an EMR or paper GOC template
• Review PCNOW sample templates: https://drive.google.com/open?id=0BylFEWCSwGsUMlFwOUhqeUxIQVU
• Learn the process at your site to develop and standardize a documentation tool
• Convene key stakeholders: ICU, ED, Palliative Care, Hospitalist program, Nursing, Social Work, Discharge Planning, EMR team
• Share your tools and experiences with PCNOW