Canadas complex and sometimes-siloed health system can present a real challenge for sharing and understanding goals of care, especially when decisions need to be made on behalf of incapacitated individuals. At the Regina QuAppelle Health Region, new documentation and processes have resulted in a streamlined approach to advance care planning that puts patients at the center of the conversation.
Regina QuAppelle Health Region serves a diverse population in southern Saskatchewan, caring for more than 260,000 residents living in cities, towns and villages in an area of over 26,000 kilometers. The Region has a commitment to patient-centered care and has designed advance care planning processes that fit within that model.
Our approach is to create a culture where the focus is on the person and on discussions, says
Margaret Walraven, a Senior Health Educator at Regina QuAppelle. We want the public to understand their right to be involved in those discussions and we want our health teams to ensure that these important conversations occur.
Primary among Regina QuAppelles efforts to ensure a patient centered process is a transition away from the Physicians Order to a Person Order, through the My Voice for Life-Sustaining Treatment (MVLST) Order, a condensed, one-page form that allows patients to simply and clearly communicate their wishes regarding their goals of care to the health care team and their proxy. The Order is filled out with the help of a qualified health professional, who guides the patient and family members through the document. Its then strategically placed in the patient chart in a clearly identified greensleeve at the front of the chart.
Walraven and her colleagues were initially concerned that the public might respond negatively to the prospect of having such sensitive conversations with their healthcareproviders, however, they continue to receive positive feedback at regular public information sessions and within various care settings.
Health professionals have also been receptive to the new process –along with training over
2200 urban and rural staff in Regina QuAppelle Health Region, Walraven regularly receives requests for training from various professional groups. “They understand that it may take a bit more time to have the conversation, but that it’s also critical to caring for our community members,” she says.
In addition to increased training, the Health Educators for Advance Care Planning have conducted over 1600 chart audits and are regularly in demand to take on individual case studies. A new Aboriginal guide has also been developed, and the team has also begun working on specific documentation for use in pediatrics and mental health.