Advisory no: A15/02 | Advance care directive assessment requirements in low risk environments

Advisory no: A15/02

TITLE / Advance care directive assessment requirements in low risk environments
VERSION / 2.0
DATE OF PUBLICATION / 22 May 2017
REPLACES / Version 1.0 issued 8 September 2015
STATUS / ACTIVE
COMPLIANCE WITH THIS ADVISORY / Mandatory for accrediting agencies
APPROVED FOR DISTRIBUTION BY / Chief Operating Officer
REVIEW DUE DATE / 31 December 2018
INFORMATION IN THIS ADVISORY APPLIES TO /
  • All approved accrediting agencies
  • Health service organisations including day procedure services, rehabilitation and mental health services

KEY RELATIONSHIP /
  • NSQHS Standard 1: Governance for safety and quality in health service organisations
  • NSQHS Standard 9: Recognising and responding to clinical deterioration in acute health care

RESPONSIBLE OFFICER / Margaret Banks
Senior Program Director
CONTACT DETAILS / Phone:1800 304 056
Email:
TRIM NO. / D14-15499
LINKAGES TO OTHER ADVISORIES and/or DOCUMENTATION / Advisory A13/07: Advice provided to accrediting agencies on non-applicable actions
ATTACHMENT / n/a
NOTES
(if applicable) / n/a

Version 2.0|22 May 20171

Advisory no: A15/02 | Advance care directive assessment requirements in low risk environments

Advisory no: A15/02

Advance care directive assessment requirements in low risk environments

PURPOSE:

To clarify the implementation requirements for advance care directives (ACDs) in health service organisations where the risk of harm to patients is consistently low because of the patient selection criteria and/or the treatment provided is low risk.

ISSUE:

The Australian Commission on Safety and Quality in Health Care (the Commission) has been advised that the implementation requirements for ACDs in low risk environments require clarification. Three actions relate to ACDs, they are:

Action 1.18.4 / Patients and carers are supported to document clear advance care directives and/or treatment-limiting orders
Action 9.8.1 / A system is in place for preparing and/or receiving advance care plans in partnership with patients, families and carers
Action 9.8.2 / Advance care plans and other treatment-limiting orders are documented in the patient clinical record.

A low risk environment is one in which the care is uncomplicated and the likelihood that clinical deterioration resulting in death or harm is very low, and where the health service organisation can demonstrate there have been no or very few incidents of patients requiring treatment for clinical deterioration.

Advisory A13/07 Advice provided to accrediting agencies on non-applicable actions states that Action 1.18.4 could be ‘non-applicable’ if the health service organisation can demonstrate there is a low risk of patient harm from care provided by that service. Similarly, for health service organisations operating in a low risk environment, Actions 9.8.1 and 9.8.2 could be ‘non-applicable’ where there is evidence of minimal or no risk that their patients’ clinical condition will deteriorate.

A patient’s health condition or their co-morbidities may place them at high risk of clinical deterioration. Pre-admission screening processes and patient assessment should be used to determine if a patient is suitable for care in a low risk health service organisation.

REQUIREMENTS:

It is not intended that every patient admitted to a health service organisation operating in a low risk environment will be asked to provide a copy of an ACD on admission. However, to implement Actions 1.18.4, 9.8.1 and 9.8.2, the Commission expects the organisation will have a policy and supporting protocols and procedures that:

  • describe the mechanism for accepting and documenting an ACD and/or treatment limiting orders when a patient is admitted who voluntarily provides this information
  • notify the treating doctor that an ACD has been received
  • expect the treating doctor to discuss with their patient the risks of the procedure and actions that may be taken should an adverse incident or clinical deterioration occur
  • ensure the ACD is included in the clinical handover information should a patient’s clinical condition deteriorate and there is a need for care to be transferred to another health service organisation.

In addition, health service organisations that can provide evidence that they work in a low risk environment and can demonstrate that seeking an ACD from patients is inappropriate in their care setting, will fully meet Actions 1.18.4, 9.8.1 and 9.8.2 where they comply with these requirements.

Version 2.0|22 May 20171