| Description |
Advanced care planning (ACP) has been linked to an increase in patient autonomy and the utilization of palliative care, while decreasing costly end of life treatment, hospitalization, family distress and decision-making burden (Carr & Luth, 2017; Detering & Silveira, 2018). One of the crucial components of ACP are advanced directives (AD) which are documents (Living Will, Durable Power of Attorney for Health Care, Combined Directives, Physician Orders for Life Sustaining Treatment ), that a person completes while in decisional capacity about possible treatment options, if at some point the ability to communicate their desires is no longer an option (Detering & Silveira, 2018) . Despite the significant impact, there is inconsistent data regarding completion (Detering & Silveira, 2018; Yadav, et al,. 2017) with some studies showing only thirty to fifty percent completion rates (Detering & Silveira 2018; Walker, et al., 2018; Yadav, et al., 2018). The electronic health record (EHR) has improved documentation efficiency, but in some instances, has also increased variability in documentation, contributing to difficult data retrieval and fragmentated information (Chao, 2016). Stage two of the Meaningful Use Requirements aim to use the EHR for continuous quality improvement and to exchange information in the most structured format possible (Centers for Disease Control and Prevention, 2019). The University of Utah Healthcare (UHealth) Nursing Quality team uses Software Requirement Specifications (SRS) to design dashboards to track quality measures. SRS are done during the development stage of a project to translate stakeholder needs, expectations, and any constraints into a set of software requirements (Schmidt, 2013). This process allows for specifications regarding software, computing environment, and post-development to be designed (Schmidt, 2013). A dashboard is a clinical decision support (CDS) tool that provides visual representation of performance measures in a single report (Livernois, 2019). Dashboards integrate evidence-based quality indicators and have been shown to decrease time and effort to gather information, reduce error rates, and improve quality of care, patient safety, situational awareness, usability and navigation. (Livernois, 2019;Schall, et al., 2017; Stadler, Donlon, Siewert, Franken, & Lewis, 2016). Dashboards also allow for standardization of analysis, ensuring the same metrics and processes are used for comparison among healthcare facilities (Schall, et al., 2017).The current compliance evaluation process at the UHealth has many locations where information can be entered, making it difficult to track quality metrics. There are also multiple places within the EHR that managers have to navigate to see the various quality measures. The goal at the UHealth is to have all of this information presented in one place to ensure increased accessibility and use. The objective of this project will be to improve the current SRS and dashboard for advance directives so that nursing leadership is able to track the completion of AD assessments as a quality measurement. This will allow for the identification of processes that need improvement to increase compliance for the institution. |
