Preventable harm may include avoiding unwanted medical treatment, which is an issue particularly for patients near the end of life, according to a blog post from a Beth Israel Deaconess Medical Center Physician on boston.com.
Beth Israel is one of the Institute for Healthcare Improvement's pioneer institutions for the program "Conversation Ready," which is designed to help hospitals deal with conversations surrounding end-of-life care.
The institution has adopted the 4-R's framework for preventing unwanted medical treatment and suggests the framework can be useful for improving communication for and quality of end-of-life care. The four R's are:
1. Reach out: Ask patients about their care preferences and about who will speak for them if they can't speak for themselves. Anticipate the types of conversations that must be had with various patients.
2. Record: Document patients' preferences in their medical records. Ensure all documents have the proper signatures and approval, whether from patients, physicians or family members.
3. Retrieve: Make patient preferences easily available in health records at any point in care. Determine which instructions belong in an electronic health record system and which belong only on paper.
4. Respect: Follow patient preferences as closely as possible, barring unforeseen circumstances. For unforeseen circumstances, spend some time thinking about how patient preferences might apply.
How exactly the 4-R framework applies to end-of-life care depends on the institution, documentation framework and other circumstances, according to the post.
For more information on the Conversation Ready Initiative, visit IHI's website.
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