Q: How will the existing paper MOSTs on inpatient charts get in to PowerChart following the change?
A: Dedicated project staff will transfer patients’ MOST records from paper to electronic form on cutover day. Depending on the size of your site, this will take place in one of two ways. For Lady Minto, Port Hardy and Port McNeill hospitals, the unit NUA will fax the paper MOST to the designated fax line, 250-740-2687, where staff will transfer them to electronic format. At Campbell River and Comox Valley hospitals, project staff will be onsite, going from unit to unit, stamping the charts and entering them into the electronic health record (EHR) on location.
Q: Will there be clear communication/dissemination of responsibility to remove the paper MOST forms at each site?
A: Project staff will remove the paper MOST forms and will provide a reminder in green sleeves at the front of patient charts to use the eMOST tools from now on.
Q: Will there be a prompt built into the EHR if a patient doesn’t have a current eMOST?
A: There is no prompt/pop-up, but a patient’s MOST status is always visible in the Banner Bar.
Q: Will physicians in the community need to go into PowerChart to fill the eMOST?
A: Community physicians seeing patients in the community have the option of filling out a paper MOST form and faxing it to 250-740-2687 (you can find this number at the bottom of the paper MOST form). Staff will input the MOST into electronic format by noon the next business day. Medical staff caring for inpatients may log in to PowerChart remotely to enter an eMOST.
Q: Are agency nurses required to do the training?
A: We recommend that all clinical staff complete the 30-minute training modules, Introduction to Advance Care Planning and Medical Orders for Scope of Treatment (MOST) in the EHR – Clinicians.
Q: I completed the training and quiz in Learning Hub but my training says I’m still “in progress” in the LMS. Why is that?
A: Island Health’s learning management system takes 24 hours to be updated. If more than a day passes, please let your CNE know. We rely on educators, so if something seems amiss, we will take their word.
Q: Is an eMOST from a previous encounter valid upon a new admission? In particular, what are my legal obligations in caring for the patient if they decompensate or experience a code blue?
A: The patient’s last documented MOST will be your best guidance for the new admission, as these are patient’s last known wishes. Both MOST and ACP information in the EHR crosses encounters and remains valid until the patient expresses differently. Unless the care team hears from the patient that he/she does not want certain resuscitation options (CPR, intubation etc.), the care team will follow the patient’s last known documented wishes. If an ACP/MOST conversation does take place: 1) the physician / nurse practitioner will enter a new eMOST order or 2) it can be documented and communicated to the provider appropriately. This will result in a new eMOST/ACP to guide your team’s care. It is the provider’s responsibility to review the MOST within 24 hours of patient’s admission.
If you find the patient unresponsive and in need of CPR, you are obligated to resuscitate them if their last known MOST calls for it. You can legally act on the the patient’s behalf using the previously documented MOST, and decide not to initiate this care, if the last known MOST does not call for it.
Q: Will there be opportunity to have staff ask ethical questions about the advance care planning and the use of MOST about this when the team is on site, or will the rollout be specific to the transition from paper to electronic only?
A: We have experts in Advance Care Planning and completing MOST orders on the project team, and they are available on an ongoing basis to take your questions that extend beyond the technical change and get into the ethical issues. You can use the email firstname.lastname@example.org to send your questions.
Q: In the event a patient has an eMost temporarily changed for a surgical procedure, our policy states that they will resume their pre-surgical eMost after leaving PACU. How will this be reflected in the EHR?
A: Current Island Health policy still applies. Medical Orders for Scope of Treatment (MOST) and Advance Care Planning document 12.6.26P, Section 2.2, says: “A new MOST is not required when any change in resuscitation status and scope of medical interventions applies only to the period in the operating/procedure and recovery room. The patient’s documented MOST status will resume after leaving the recovery or procedure room.”
Q: Outside of ED/ICU, nurses do not frequently use CareCompass. Do we need to start teaching ward staff to use this platform with the roll-out of eMOST?
A: Use of CareCompass for viewing eMOST orders is covered in the clinical training module: Medical Orders for Scope of Treatment (MOST) in the EHR – Clinicians.
eMOST status is always visible in the Banner Bar at the top of PowerChart. CareCompass is how new orders for eMOST are flagged to NUAs and Nursing. While CareCompass may not be the preferred view on your unit, we recommend that units check it on a daily basis, either designating this task to the NUA, or to the night shift nursing staff doing chart checks.
Q: I work outside of acute care and have been receiving your invites. I presume these sessions are for acute care or is this something for all programs?
A: The training Introduction to Advance Care Planning (Learning Hub Course 23660) is available and applicable to all medical and clinical staff (including all nursing and allied health staff) who have client/patient/resident interactions. The ACP PowerForm is available within the EHR and information entered there is viewable across encounters.
We are working to make ACP a team-based effort across the organization so the more people trained and documenting appropriately the better.