Instruments J and K

Title:California POLST Nursing Home Surveys 1 and 2

Designer: Neil Wenger, MD, MPH. Please cite this article in any future work:

Wenger NS, Citko J, O'Malley K, Diamant A, Lorenz K, Gonzalez V, Tarn DM.Implementation of physician orders for life sustaining treatment in nursing homes in California: evaluation of a novel statewide dissemination mechanism. J Gen Intern Med. 2013 Jan;28(1):51-7.

Suitable for Quality Improvement? Yes, modified to fit your state.

Suitable for research? Yes.

Description of Instrument:These surveys produced research quality data about POLST utilization in skilled nursing facilities to assess the effectiveness of a major grass roots effort promoting POLST use in California. The surveys were not done in isolation, but as follow up to an extensive educational outreach. They are mailed surveys addressed to the nursing home administrator or knowledgeable designee.

How to use:

Step 1: Modify the form to suit your purposes. Versions 1 and 2 are very similar and you should choose which items you want to use from each. Version 2 includes a question ‘does your SNF require completion of POLST as a condition of admission?’ A ‘yes’ response to this identifies an improper practice as POLST completion can be offered but not required as a condition for admission. Decide whether you really need each item and keep items that you have a planned use for or believe may be important to have even though you are not sure what to do with them. Similarly, you may add items that are missing or that address questions that you are trying to answer. You may find items in other instruments elsewhere in the toolkit and want to include them and that is fine.

Step 2: Select which nursing facilities you will survey. You may wish to survey all of them, or just a cross-section. See the FAQ section on ‘Sampling’. In general, as long as you choose facilities in a random fashion (for example, by choosing numbers out of a hat) and get a decent response rate to your survey (30-50%+ for QA and 50-75%+ for research) and survey enough facilities so that you get to 30 usable responses (more for research), that may be enough for most QA purposes. Dr. Wenger’s article describes the sampling strategy they used to ensure that their sample was representative of the entire region—a higher standard needed for research purposes.

Step 3:There is a well described methodology for mailed surveys that is beyond the scope of this toolkit, but you should include a copy of your POLST paradigm form and a self-addressed, stamped envelope and plan on doing more than one mailing. It also helps to have as much institutional support as you can muster to encourage busy people to complete your survey.

Step 4: Analyze the results. Some of the results that you will get from this survey include:

  1. The use of POLST in the facility
  2. POLST education
  3. Barriers to POLST
  4. Confidence in POLST
  5. Some questions about the facility