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A need for change was identified by clinic management, as Physician Orders for Life-Sustaining Treatment (POLST)/Advanced Directive (AD) completion rates at the primary care center were low. Participants in the study were selected by clinic management and included primary care providers and certified medical assistants (CMA) of two primary care teams within the clinic. For two months, the selected teams participated in the project, which included having CMAs check if patients 65 and older on any given day had POLST or Advanced directives on file. For those without completed forms on file, a POLST was put in the treatment room as a visual cue for the provider to initiate the conversation. Completion rates were tracked over two months with a completion rate of 50% set as significant. An increase in completion rates was seen over a 2-month period, except for the last 2 weeks when a provider returned from leave and had issue with the project, which may have led to skewed data. Prompting providers to have conversations in regards to POLST/Advanced directives was shown to improve completion rates, but proper communication amongst all providers is key to success.

Author Supplied Keywords

POLST, Advanced directive, End-of-life care planning, Primary care, Practice improvement project


Advance directives (Medical care); Terminal care

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Copyright for this work is retained by the authors.

NRS 597: Practice Improvement Project



Document Type

Doctoral Project

Included in

Nursing Commons