Effective Decision-Making in Moments of Crisis Requires Support
When is it right for an Elder to go to the Hospital?
In a person-directed care organization, deciding if an Elder should go to the hospital is driven by the individual’s life goals and preferences first, and treatment second. Eden Alternative Principle Seven reminds us that care partner teams need to prioritize decision-making that puts the person first. This grows out of close and continuing relationships, where the Elder is well-known.
On August 20th, INTERACT III Decision Support Tools, the third webinar in a 4-part Eden Alternative series, focused on how person-directed care provides a head start in creating consistent decision making processes for the care partner team.
To support effective clinical decision-making, INTERACT III has created two Decision Support Tools that are based on AMDA Clinical Practice Guidelines. The first involves a set of Change in Condition Cards; the second includes Care Paths for nine common health issues experienced by Elders. To use these tools effectively and move forward with person-directed care, wise leaders understand these key concepts:
- The whole care partner team needs to be engaged and committed to the use of decision support tools (especially physicians, nurses, pharmacist, therapists, nurse practitioners, physician’s assistants). If anyone disagrees with their use, improvement efforts will fail, and the risk of hospitalization increases.
- Each individual experiences chronic and acute medical conditions differently, sometimes outside of accepted normal ranges. When the Elder is well-known, the standard ranges for vital signs and lab values can be adjusted to match her life patterns.
- The care partner team needs to be aware of, and confident in using, all of the resources and skills they have available to meet the Elder’s needs before hospitalization becomes the next step.
- There has to be a balance between clinical standards and optimizing the Elder’s choices during acute changes in condition. How should the care partner team react when an Elder makes a choice that contradicts best practice guidelines?
- Attitudes on the part of team members about the Elder’s age and ability to make decisions, and the need to put safety first, can make treatment the driver during times of crisis. This may result in the Elder losing a sense of identity, autonomy, and/or security.
- Decision support tools are closely connected to effective communication processes. Strong communication skills are vital to the team’s ability to make wise person-directed decisions during acute changes in condition.
When it comes to making consistent decisions when acute changes in condition arise what does your team do well? What could you do better? Where should you begin to make improvements? View the webinar recording with your team and see what ideas come up.