Advocacy Alert #5 Reduce Clinician Confusion Regarding Advance Care Planning, Hospital Policies, and State Laws/Clinician Quiz

Clinicians are confused about the rules, protections, and responsibilities concerning state-approved advance directive forms, DNR/DNI policies, and if present, futility policies.  A PCNOW blog post of April 19, 2020, outlined the problems in detail, along with three suggestions:

Step 1. Each hospital should develop a Guide to Advance Directives and End-of-Life Decisions as a collaborative process between key stakeholders.  The Guide should include copies of advance directives promoted by the hospital, relevant state laws, key hospital policies, and a FAQ section to answer the common questions listed above.  The Guide should be reviewed/updated annually.

Step 2. Each hospital should develop a testing process to assess clinician knowledge followed by training in the relevant issues.  The test should be administered both for new hires and at re-credentialing times along with administration at other educational venues.

Step 3. Quality Improvement activities should be developed to track compliance with hospital polices.

This Advocacy Alert is designed to highlight the problem and encourage clinicians to start a dialogue at their institution and implement the three steps.  To facilitate Step 2, PCNOW has developed a generic 10 item-quiz that can be used in all 50 states to a) assess clinician knowledge of relevant state laws and hospital policies and b) serve as a springboard for educating clinicians.

Suggestions for using the quiz include:
1. Include as part of the clinician credentialing and re-credentialing process
2. New orientation for all new clinician hires
3. Use in a clinician training session on advance care planning/medical ethics

Advocacy Steps:
1. Assemble a small group of key stakeholders to work on this project.
2. Assemble the relevant state/local documents and policies.
3. Download the clinician quiz.
4. Administer the quiz to a small group (n=10-20) of clinicians to obtain baseline data; this data may be needed to convince others of the need for a system-wide clinician education project.
5. Develop an testing/education implementation strategy in partnership with hospital/system administration.
6. Work with your quality department to establish a process to assess project impact.

PCNOW Board of Directors