Date of Award

2024

Document Type

Dissertation

Degree Name

Doctor of Nursing (ND)

First Advisor

Dr. Lindsay Kemp

Abstract

Code status assessment is an essential component in the acute hospital setting and a vital of the hospital admission process. If inadequately addressed, it can lead to costly length of stays and unwanted life-prolonging measures. Under the Patient Self-Determination Act of 1990, healthcare organizations must inform patients of their rights to healthcare, assess and document in the medical record whether the patient has an advance directive, and educate staff and communities on issues concerning advance directives (Patient Self-Determination Act, 1990). The purpose of the project was to assess current provider practices regarding code status assessment in the acute hospital setting, implement practice change interventions to improve consistency of code status identification, and reassess change in provider practices regarding code status assessment. Provider practices were assessed with an initial survey. Educational sessions were held regarding EMR modifications for code status order prompting, development of hyperlinks to advance directives, and utilization of SPIKES and REMAP goals of care communication tools. Participants were given two months to implement changes into clinical practice. A follow-up survey was utilized to reassess change in provider practice. Descriptive and inferential statistics were used for data analysis. While data analysis did not show any statistically significant changes, practical differences in provider practice were recognized following the second survey. Participants reported an increase in the frequency of assessment in the post-test, incorporated recommended screening tools, and reported an increase in their confidence screening for code status. Participants also validated that EMR prompts were useful in recognizing the need for code status 7 assessment. Furthermore, this project supports the need for continued education of healthcare providers regarding code status assessment and reconciliation.

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