ACP Status Collection: Difference between revisions

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== Purpose ==
== Purpose ==
We collect ACP status as a quality indicator that reflects documentation (e.g. completed ACP form or Admitting Orders) and discussion of goals of care for all patients  admitted to ICU.
We collect ACP status as a quality indicator that reflects documentation (e.g. completed ACP form or Admitting Orders) and discussion of goals of care for all patients  admitted to ICU or medicine.


== Collection Instructions ==
== Collection Instructions ==
For each record, use the previous documented ACP status in the chart ''prior to '' admission date.
*For each new record, use the last documented ACP status in the chart ''prior to '' admission date, a date and time is NOT required
*After admission, collect the first ACP status documented by a physician
*on admission, collect the first ACP status documented by a physician only
*ACP forms from prior hospitalizations, PCH, health directives can be used to determine the ACP status prior to admission
*At discharge, collect the last ACP status documented by a physician only
   
*Only use ACP forms made during same hospitalization (e.g. ACP status documented by ER, or ward or on prior ICU/ward for transferred patients)
 
===Sources===
*ACP PTA
**ACP forms from previous hospitalizations, PCH, health directives can be used to determine the ACP status prior to admission.  If the last ACP status prior to admission cannot be readily found within the current chart, enter not documented.
*ACP first
**ACP form, orders, notes
**SBGH EPR- go to EPR orders.  Under "transfers and care directives" there should be an order that states, "advanced care planning goals of care"  with the ACP status listed (this also displays in the top of the EPR individual patient demographic information).  If you double click on the order, the ACP electronic form displays (it is exactly the same as the paper form which was previously used). When the physician writes the order, the form automatically is populated with the doctor name and the ACP status also. However, if there are special conditions or comments, the doctor may fill out parts of the form itself separately from the displayed order. 
*ACP Last
**ACP form, order, notes
**SBGH EPR as per above instruction
 
=== Data Entry Instructions ===   
=== Data Entry Instructions ===   
For every new record, the project records with an entry of "not entered" will be automatically generated.   
For every new record, an entry of "not entered" will be automatically generated.   


Update that line to one of the following:  
Update that line to one of the following:  
* '''Project:''' ACP initial
* '''Project:''' ACP PTA
** '''Items''':  
** '''Items''':  
*** ''not yet entered'' (automatic entry)
*** ''not yet entered'' (automatic entry)
Line 28: Line 39:
*** not documented
*** not documented
** Date/Time, Checkbox, Integer, Real: not used
** Date/Time, Checkbox, Integer, Real: not used
{{DT| does the ACP Status PTA need to be documented by a physician or can it be documented by another discipline? [[User:Lkaita|Lisa Kaita]] 16:33, 24 June 2025 (CDT) }}
* '''Project:''' ACP first
** '''Items''':
*** ''not yet entered'' (automatic entry)
*** [[ACP-C]]
*** ACP-M
*** ACP-R
*** not documented
* Date/Time: dttm of the status decision
** if decision was made before admission, use the first service [[Admit DtTm]]
** if a '''time is not available''', Use the best estimate for the time. If there is no estimate at all, use noon, or the closest to noon that the data integrity checks will allow.


* '''Project:''' ACP first change
* '''Project:''' ACP last
** '''Items''':  
** '''Items''':  
*** ''not yet entered'' (automatic entry)
*** ''not yet entered'' (automatic entry)
Line 37: Line 59:
*** not documented
*** not documented
* Date/Time: dttm of the status decision
* Date/Time: dttm of the status decision
** if decision was made before admission, use the first service/admit dttm
** if a '''time is not available''', Use the best estimate for the time. If there is no estimate at all, use noon, or the closest to noon that the data integrity checks will allow.
** if a '''time is not available''', enter 12:00
** if the ACP last status is the same as the ACP first status, enter the same ACP status as the first, and check the checkbox for dttm  
** if the ACP last status is the same as the ACP first status, enter the same ACP status as the first, and use the same dttm as the first ACP.
** if the ACP last status is different than ACP first status, enter the last documented ACP Status and the dttm that it was changed, if there is no time use the best estimate for the time. If there is no estimate at all, use noon, or the closest to noon that the data integrity checks will allow.
** if the ACP last status is different than ACP first status, enter the last documented ACP Status and the dttm that it was changed, you do not need another ACP last entry.   
* If a patient is deteriorating quickly and the ACP status is changed to ACP C,  or is in ICU and they withdraw care, do not document this as ACP last status for this project.  Use the ACP first status and check the checkbox for dttm.   
{{Discuss| IF a patient in this situation continues to live for days, should the ACP status be changed at some point? and if so what timeframe should we use?
*If the ACP form does not have a signature, but an ACP status is checked off, should this be entered as not documented? [[User:Lkaita|Lisa Kaita]] 16:33, 24 June 2025 (CDT) }}
* Comment (optional): If there are multiple ACP status changes/family discussions that are affecting the LOS or seem unusual, leave this as a comment in the "Q" column, NOT the notes section
* Comment (optional): If there are multiple ACP status changes/family discussions that are affecting the LOS or seem unusual, leave this as a comment in the "Q" column, NOT the notes section
* Checkbox, Integer, Real: not used
* Checkbox, Integer, Real: not used
Line 46: Line 70:


===Question  ===
===Question  ===
Moved here from [[ACP Status Collection for LAU]]
*if status is documented as "presumed ACP R" should we capture this as ACP R or not documented?
{{DT|
* many patients are deemed comfort care, with no official change in their status except in the notes and orders, can we use the dttm in orders or notes to reflect ACP last status? I would think yes based on [[ACP-C]] and [[Palliative care]] criteria?  [[User:Lkaita|Lisa Kaita]] 09:53, 11 June 2025 (CDT)
** Interesting. It would depend on the purpose of this field, to some degree. Also, we discussed today that there has been category creep in those over time:
*** [[ACP-C]] content I think was really only ever intended as page intro for what is essentially an index page to make sure we keep in mind all places where the concept is used.
*** APC-C setting qualifies for [[Transfer Ready DtTm tmp entry]]
*** Having ACP-C status qualifies for [[Palliative care]] dx, but other things do as well, so not interchangeable. The page explicitly says they are not the same.
:: I think we are actually looking for properly completed and documented advanced care plans, specifically, but will confirm. [[User:Ttenbergen|Ttenbergen]] 16:30, 11 June 2025 (CDT)
* "note indicating that there was a discussion with patient or care team", a definition similar to that ...
}}
{{DL|
* if date/time is not documented, is a date/time required? would it be date of first service and 1200?
** that might put it before the first service start dttm, which (and needs to) trigger the cross check. The DtTm is important since we will look at this in the context of delays, so even a best guess would be better than a not-filled. So I would say enter best guess. If it is clear the discussion was on the unit and after admission, and there really is no way to figure out when, we could have some sort of standard, eg xhrs after admission. I will confirm. [[User:Ttenbergen|Ttenbergen]] 16:30, 11 June 2025 (CDT)
* How about something like this: Use the best estimate for the time. If there is no estimate at all, use noon (or the closest to noon that the requirement that it has to be within the admission will allow).
}}
 
*if status is documented as "presumed", is this what we should use?
** then you enter "not documented" (but maybe we need to fine-tune the wording)
** then you enter "not documented" (but maybe we need to fine-tune the wording)
{{Discuss| Dan do you agree with this? [[User:Lkaita|Lisa Kaita]] 16:33, 24 June 2025 (CDT) }}


{{DT| meeting with Dr R today where we changed the approach, he would like the ACP status PTA (prior to admission) if documented anywhere, and the first ACP status established by a physician only, this could be found in the orders, the ACP sheet or the progress notes.  It was pointed out the actual ACP form does not have a time entry field it only has a date, he instructed to use our best guess/judgment for the time. He no longer wants the ACP last status
* he also described the situation where a pt is deteriorating quickly and the patient is changed to ACP C or in ICU and they withdraw care, he does not want this captured a a true ACP status.
* on the medicine admission order forms there is a checkbox for "previously established ACP" These patient's sometimes have an ACP status form completed so we are uncertain if the previously established ACP is referring to the form or a PTA ACP status, should we use this as an established first ACP status? 
* I have suspended collection until T & L discuss this further [[User:Lkaita|Lisa Kaita]] 14:07, 16 June 2025 (CDT)
* How about the changes I made above, do they capture the new rules? We can discuss today Wednesday if I can catch you while there. [[User:Ttenbergen|Ttenbergen]] 01:09, 24 June 2025 (CDT)}}


*but if there is no documented ACP status?
== WRHA/SH guidelines / forms ==
** then you enter "not documented"
*[[Media:WRHA ACP form Nov 2013.pdf | Example of WRHA ACP FORM]]
*** yes, but using date & time of first service, date & time of current boarding location service or one of these dates & 12:00?
**** I have removed the date requirement from the initial listing, and updated what to use for the "change" listing. If clear now, pls delete the question. If still not clear, pls explain.
 
{{DT| if we follow the instructions above would this not be a previously established ACP status and not a new one? so we would enter this as PTA and capture the first ACP status established by a medicine doc? [[User:Lkaita|Lisa Kaita]] 14:07, 16 June 2025 (CDT)
* Agreed; in any case, I think this info would belong above with the other when-to-enter-what content rather than here. [[User:Ttenbergen|Ttenbergen]] 09:08, 24 June 2025 (CDT) }}
 
=== If care has been discontinued ===
If the pt has care as been discontinued, do not automatically change the ACP to C. Only add a new pair of records if there is a new '''documented ACP status''' on chart.
 
=== If ACP-M is documented without +/- ===
If ACP M is just written with no qualifiers then one would classify as ACP M-.
 
===ACP from EPR (STB only at this time)===
*To collect the ACP status go to EPR orders.  Under "transfers and care directives" there should be an order that states, "advanced care planning goals of care"  with the ACP status listed (this also displays in the top of the EPR individual patient demographic information).  If you double click on the order, the ACP electronic form displays (it is exactly the same as the paper form which was previously used).
*When the physician writes the order, the form automatically is populated with the doctor name and the ACP status also.  However, if there are special conditions or comments, the doctor may fill out parts of the form itself separately from the displayed order. 
*When putting in the source of ACP, if the order for ACP is written and the form has no additonal information (other than status and dr name) just put source as "order".  If the electronic form is filled out with additional information then put "order and form".  --[[User:LKolesar|LKolesar]] 11:37, 2016 May 26 (CDT)


== WRHA guidelines / forms ==
*[[Media:WRHA ACP form Nov 2013.pdf | Example of WRHA ACP FORM]]
*[[Media:AdmittingOrdersforICU.pdf | Example of Admitting Orders for ICU]]


== Cross Checks ==
== Cross Checks ==

Revision as of 15:33, 24 June 2025

Projects
Active?: planned
Program: CC and Med
Requestor: Dr. Roberts
Collection start: 2026-06-??
Collection end:

This article is about collecting the "ACP Status" (Advanced Care Planning) temp entry. See ACP Status Collection over time for related collections.

Purpose

We collect ACP status as a quality indicator that reflects documentation (e.g. completed ACP form or Admitting Orders) and discussion of goals of care for all patients admitted to ICU or medicine.

Collection Instructions

  • For each new record, use the last documented ACP status in the chart prior to admission date, a date and time is NOT required
  • on admission, collect the first ACP status documented by a physician only
  • At discharge, collect the last ACP status documented by a physician only
  • Only use ACP forms made during same hospitalization (e.g. ACP status documented by ER, or ward or on prior ICU/ward for transferred patients)

Sources

  • ACP PTA
    • ACP forms from previous hospitalizations, PCH, health directives can be used to determine the ACP status prior to admission. If the last ACP status prior to admission cannot be readily found within the current chart, enter not documented.
  • ACP first
    • ACP form, orders, notes
    • SBGH EPR- go to EPR orders. Under "transfers and care directives" there should be an order that states, "advanced care planning goals of care" with the ACP status listed (this also displays in the top of the EPR individual patient demographic information). If you double click on the order, the ACP electronic form displays (it is exactly the same as the paper form which was previously used). When the physician writes the order, the form automatically is populated with the doctor name and the ACP status also. However, if there are special conditions or comments, the doctor may fill out parts of the form itself separately from the displayed order.
  • ACP Last
    • ACP form, order, notes
    • SBGH EPR as per above instruction

Data Entry Instructions

For every new record, an entry of "not entered" will be automatically generated.

Update that line to one of the following:

  • Project: ACP PTA
    • Items:
      • not yet entered (automatic entry)
      • ACP-C
      • ACP-M
      • ACP-R
      • not documented
    • Date/Time, Checkbox, Integer, Real: not used

does the ACP Status PTA need to be documented by a physician or can it be documented by another discipline? Lisa Kaita 16:33, 24 June 2025 (CDT)

  • SMW


  • Cargo


  • Categories
  • Project: ACP first
    • Items:
      • not yet entered (automatic entry)
      • ACP-C
      • ACP-M
      • ACP-R
      • not documented
  • Date/Time: dttm of the status decision
    • if decision was made before admission, use the first service Admit DtTm
    • if a time is not available, Use the best estimate for the time. If there is no estimate at all, use noon, or the closest to noon that the data integrity checks will allow.
  • Project: ACP last
    • Items:
      • not yet entered (automatic entry)
      • ACP-C
      • ACP-M
      • ACP-R
      • not documented
  • Date/Time: dttm of the status decision
    • if a time is not available, Use the best estimate for the time. If there is no estimate at all, use noon, or the closest to noon that the data integrity checks will allow.
    • if the ACP last status is the same as the ACP first status, enter the same ACP status as the first, and check the checkbox for dttm
    • if the ACP last status is different than ACP first status, enter the last documented ACP Status and the dttm that it was changed, if there is no time use the best estimate for the time. If there is no estimate at all, use noon, or the closest to noon that the data integrity checks will allow.
  • If a patient is deteriorating quickly and the ACP status is changed to ACP C, or is in ICU and they withdraw care, do not document this as ACP last status for this project. Use the ACP first status and check the checkbox for dttm.
IF a patient in this situation continues to live for days, should the ACP status be changed at some point? and if so what timeframe should we use?
  • If the ACP form does not have a signature, but an ACP status is checked off, should this be entered as not documented? Lisa Kaita 16:33, 24 June 2025 (CDT)
  • SMW


  • Cargo


  • Categories
  • Comment (optional): If there are multiple ACP status changes/family discussions that are affecting the LOS or seem unusual, leave this as a comment in the "Q" column, NOT the notes section
  • Checkbox, Integer, Real: not used


Question

  • if status is documented as "presumed ACP R" should we capture this as ACP R or not documented?
    • then you enter "not documented" (but maybe we need to fine-tune the wording)
Dan do you agree with this? Lisa Kaita 16:33, 24 June 2025 (CDT)
  • SMW


  • Cargo


  • Categories


WRHA/SH guidelines / forms


Cross Checks

Data use / Reporting and Analysis

  • The Critical Care QI team expects the following data from this project
    • Variables: ACP Status, Date of ACP form/Order and Source of ACP documentation
  • Changes in these over the course of the admission.
  • The expected outcome:
    • % of patient with and without documented ACP during ICU stay
    • Type of timing of ACP documentation
    • The sources of ACP documentation
    • Level of care at both admission and discharge
      • % having ACP R on admission and discharge
    • % of patients with no change in level of care during ICU
    • % of patients with change in level of care during ICU
      • % having ACP status determined during ICU stay
      • % having ACP change with decreased intensity
      • % having ACP change with increased intensity
    • Level of care at the time of ICU death
    • Level of care at the time of discharge for survived patients
  • the data are saved in table L_TmpV2 under projects "ACP at admit / ACP at end / ACP Status / ACP Source" of the centralized_data.mdb
  • the SAS program that reads the data can be found in Template:S:\MED\CCMEDJulie\SAS_CFE\CFE_macros\CFE_CC_ACP.sas

Log

Retrieved from "https://ccmdb.kuality.ca/index.php?title=ACP_Status_Collection&oldid=164322"