ACP Status Collection

Projects
Active?:	in planning"in planning" is not in the list (active, planned, legacy, aborted in planning) of allowed values for the "ProjectActive" property.
Program:	CC
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.

This is a starting point, all below needs to be updated.

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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.

Collection Instructions

For each record, use the last documented ACP status in the chart prior to admission date. After admission, collect the first ACP status documented by a physician

• ACP forms from prior hospitalizations, PCH, health directives can be used to determine the ACP status prior to admission

An initial ACP Status entry will be automatically added.

• for each ACP documentation, change
  • Project ACP Status
    • Item one of the following
      • ACP R - full resuscitation
      • ACP M+ - all medical care given except cardiac resuscitation; intubation either happened or allowed
      • ACP M- - all medical care given except cardiac resuscitation and intubation; also if ACP M is written without +/-
      • ACP-C - comfort care
      • not documented - should be paired with same in ACP Status
  • Project ACP Source
    • Item one of the following:
      • Form
      • Orders
      • Form and Orders
        • choose this item if the ACP status and Date are the same on both the ACP Form and the ICU Admitting Orders (see below for sample forms). Otherwise, enter a new ACP documentation with different ACP status or date.
      • Other - with this option only, put in tmp comment what other place you obtain ACP status and date
      • not documented - should be paired with same in ACP Source
  • for both Source and Status:
    • Date: Same date filled out for both Project ACP and ACP Source
      • No Date: check the checkbox for source and status if there is no date
    • Integer (column "N"): used to pair status and source entries; put a number; use the same number for the status and source entry for the same form. e.g. put a "1" for the status and source for the first tmp entry pair, then put a "2" for each of the second. This allows us to pair up entries even if there are more than one for the same date.

Question

Moved here from ACP Status Collection for LAU

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? 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. Ttenbergen 16:30, 11 June 2025 (CDT) "note indicating that there was a discussion with patient or care team", a definition similar to that ...

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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. 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).

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• 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)

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 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. Ttenbergen 01:09, 24 June 2025 (CDT)

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• but if there is no documented ACP status?
  • then you enter "not documented"
    • 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.

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? 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. Ttenbergen 09:08, 24 June 2025 (CDT)

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Examples

Some EXAMPLES of pairing ACP status and Source in CCMDB_TMP: CLICK HERE to see table of examples.

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". --LKolesar 11:37, 2016 May 26 (CDT)

WRHA guidelines / forms

• Example of WRHA ACP FORM
• Example of Admitting Orders for ICU

Cross Checks

• Query s tmp ACP

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

• 2025-06-24 TT split this page off from ACP Status Collection for LAU and reverted that one when it became apparent that it will be substantially different, and edited the S_tmp table
• 2025-06-16 LK, TT, DR met and discussed; LK updated ACP Status Collection for LAU page