Table 3 Thematic analysis of staff response to enquiries on ACD and GOC storage, implementation, and consenting process
Question | Theme (frequency) | Theme Group | Related quote |
|---|---|---|---|
How can we improve the ACD and GOC documentation electronic storage location and access? | Connecting alert/Icon in EMR front page (5) | C002 | “I think it’s now on first net? But still not sure. Would be great if there was a first net icon that could link you straight to the last GOC discussion. I usually spend some time clinking around in SMR until I find it.” |
Dedicate section in main EMR (15) | D015 | “Needs a dedicated section in EMR to locate ACD and GoC documentation all together, and ensure the most recent is accessed. Some way to have detailed ACD plans uploaded to EMR to capture exact wording on ACD, if some info is on Cerner and some on SMR this can be confusing for which one to look at.” | |
Recurrent update every admission (9) | R004 | “Make sure that firstnet keeps records up to date, and that doctors, both ED and inpatient, are making sure to document goals of care at the earliest opportune moment. Often it seems ED doctors disregard this, waiting for inpatient teams, and it creates issues for nursing staff” | |
Educate staff on completing/filing (2) | E002 | “Education sessions regarding where to find documentation, who can make decisions, who can speak with patient around decisions” | |
QuestionTheme (frequency) Theme groupRelated quote | |||
How can we improve the implementation of existing ACDs and GCCs? | Pop-up trigger notification (13) | PT003 | “Can FirstNet/CERNER have a trigger built into it to alert when someone does not have a GOC documented? I continue to be astounded by the frequency with which mainly haem and onc patients present to ED in extremis; they are suffering from an incurable illness for which they are receiving palliative / symptom directed management and NOONE in the home treating team has ever had a GOC discussion with the person and/or significant others. Surely for this particular subset of clients and others with chronic incurable illness, a GOC discussion should be mandatory?” |
Staff Education (5) | SE003 | “Often they (GOC) are written in the medical / surgical admission notes but may not be verbally communicated or updated in First net so you don’t realise until you are handing over. So better documentation, maybe decisions discussed with patients earlier by ED team. Written ACD brought in by ambulance may not get updated onto our GOC so can be confusing, pretty sure to follow the written instructions, but would be good to have it documented by our team.” | |
Clarity and consistency of records (11) | CC001 | “Clarity on the interventions that are offered and should not be considered needs to be more explicit and simpler. Carry forward GoC on one admission automatically to the next.” | |
Question Theme (frequency) Theme group Related quote | |||
How can we streamline obtaining consent for patients with cognitive impairment and with no ACD? | System or staff guide (3) | SG001 | “have a section for it that is more visible and easier to find in either ED Summary or MTDM/Patient information on FirstNet that stays there from previous admissions - as the alert goes away after each admission” |
MTDM contact maintained (11) | MTD009 | “I’m not sure except to suggest that directives are in place on entering any facility. I understand not everyone has an enduring power of attorney. Perhaps there needs to be hospital policy of how best to care for a patient by considering best outcome for patient” | |
Unsure (14) | U004 | unsure. I think we need to get better at our cognitively intact patients before we try harder tasks. | |