Operationalizing ACP as Infrastructure Across Care Settings

SESSION DESCRIPTION

Advance care planning (ACP) is often treated as documentation, yet without infrastructure, patient preferences are not consistently available when and where decisions are made. This session reframes ACP as a system-level capability embedded in clinical workflows. Using a real-world implementation example, participants will learn how workflow design and structured documentation improve access to patient goals of care and treatment preferences and support delivery of patient goal-concordant and medical order-concordant care across care settings.

OBJECTIVES

  1. Differentiate advance care planning (ACP) as documentation from ACP as infrastructure that enables access to patient preferences across care settings.
  2. Design a role-based workflow to integrate ACP into routine clinical processes, including delegation beyond physicians, incorporation into standard rooming workflows, and alignment with EHR documentation. 
  3. Assess how access to patient preferences at the point of care supports delivery of goal-concordant and medical order-concordant care across settings.


FACULTY

Jessica Zan, RN, BSN, MAMFC
Vice President, Clinical Implementations & Success, MyDirectives