Combined Assessment Program Summary Report – Evaluation of Advance Directives in Veterans Health Administration Facilities

Report Information

Issue Date
Report Number
16-03960-428
VA Office
Veterans Health Administration (VHA)
Report Author
Office of Healthcare Inspections
Report Type
Comprehensive Healthcare Inspection Program
Recommendations
2
Questioned Costs
$0
Better Use of Funds
$0
Congressionally Mandated
No

Summary

Summary
The VA Office of Inspector General Office of Healthcare Inspections completed an evaluation of advance directives in Veterans Health Administration facilities. The purpose of the review was to determine whether Veterans Health Administration facilities complied with selected requirements for advance care planning and advance directives for veterans. We conducted this review at 48 Veterans Health Administration medical facilities during Combined Assessment Program reviews performed across the country from April 1, 2015, through March 31, 2016. We observed many positive practices, including that facilities had policies addressing advance directive notification, screening, and discussions; employees generally screened inpatients to determine whether they had advance directives; and the advance directive posting in the electronic health record generally reflected patients’ advance directive statuses. However, we identified system weaknesses regarding advance directive discussions and documentation thereof. We made two recommendations.

Open Recommendation Image, SquareOpenClosed and Implemented Recommendation Image, CheckmarkClosed-ImplementedNot Implemented Recommendation Image, X character'Closed-Not Implemented
No. 1
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended that the Under Secretary for Health, in conjunction with Veterans Integrated Service Network and facility senior managers, ensure that employees consistently ask inpatients whether they want to discuss advance directives and that facility managers monitor compliance.
No. 2
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended that the Under Secretary for Health, in conjunction with Veterans Integrated Service Network and facility senior managers, ensure that when inpatients request a discussion about advance directives, clinicians consistently document that the discussion occurred using only the two Veterans Health Administration standardized note titles for advance directive discussions and that facility managers monitor compliance.