Standards › ASF Health Standards v10 › Standard 65: Advance Care Planning, Palliative Needs and Dignity

Standard 65: Advance Care Planning, Palliative Needs and Dignity

5 criteria · ASF Health Standards v10 · Draft for review

Each criterion below shows what the surveyor checks, the evidence to show, and what counts as met, partly met or not met.

Colour key: Red = Essential, required in every setting. Green = Recommended. Amber = Standard.

AD.1 Patients Are Asked About Their Wishes for Future Care

Standard

Patients with serious or progressive illness are offered a conversation about their future care, at a time and in a way that suits them. Their wishes are recorded where they choose to share them.

Questions the surveyor asks

1. Is every patient with a serious or progressive illness offered a conversation about future care at a defined point? A conversation that is never offered is never had.
2. Is the conversation held in a private setting, at a time chosen with the patient, with an interpreter where needed? A rushed or public conversation does not produce honest wishes.
3. Are the patient's wishes recorded in the notes, and is the patient told where the record is kept? Wishes that are not recorded are not followed.

Why it matters. A person living with serious illness may want to talk about what matters to them in future care. Being offered that conversation, at the right time, lets their wishes guide the care.

Evidence to show. Advance care planning conversation template and a sample of 5 records (anonymised).

Good

• each patient with serious or progressive illness offered a conversation about future care, and the outcome recorded.

Failure

• a patient with advanced cancer never asked about their wishes.

Partly met when

• Not offered: Conversation not offered to every eligible patient.
• Not recorded: Conversation held but not recorded.

How to implement

• Each eligible patient: Offer the conversation and record the outcome.
• Yearly: Re-check this criterion against its evidence (Advance care planning conversation template and a sample of 5 records (anonymised)). Record the date and who checked, and correct any gap found.

What the surveyor does

• What the surveyor sees: Watches the process at the point of care and reads a sample of the records for the last 3 months.
• What the surveyor asks: Ask the patient: has anyone talked with you about what matters most to you in your future care?
• What is uploaded: Advance care planning conversation template and a sample of 5 records (anonymised).

E-learning. Healthcare Ethics for ASF Accreditation

AD.2 Advance Directives Are Recognised and Followed Where Permitted

Standard

Where a patient has made an advance directive, it is found, recorded and followed. Where it cannot be followed, the reason is recorded and the patient or their representative is told.

Questions the surveyor asks

1. Is the presence or absence of an advance directive recorded on admission, or at the start of care? A directive that nobody looks for is not followed.
2. Is the directive followed, or is the reason for not following it recorded and explained to the patient or representative? An unexplained departure from a stated wish damages trust.
3. Is there a process for checking that the directive is still current with the patient? A directive made years earlier may no longer reflect the person's wishes.
4. Is there evidence that documented directives influence care decisions when relevant? A directive that exists but is never used is not followed.

Why it matters. An advance directive is a patient's written choice about future treatment. It must be found when it is needed and followed where the law allows.

Evidence to show. Advance directive recording procedure and a sample of 5 records (anonymised).

Good

• an advance directive found, recorded in the notes, and followed where permitted, with any limit explained.

Failure

• a directive in the file that was not read during an arrest.

Partly met when

• Not found: Directive exists but cannot be found.
• Not followed: Directive recorded but not followed where permitted.

How to implement

• On admission: Ask about and record any advance directive.
• Yearly: Re-check this criterion against its evidence (Advance directive recording procedure and a sample of 5 records (anonymised)). Record the date and who checked, and correct any gap found.

What the surveyor does

• What the surveyor sees: Watches the process at the point of care and reads a sample of the records for the last 3 months.
• What the surveyor asks: Ask the clinician: if this patient arrived in cardiac arrest, how would you know whether they have an advance directive?
• What is uploaded: Advance directive recording procedure and a sample of 5 records (anonymised).

E-learning. Healthcare Ethics for ASF Accreditation

AD.3 Palliative Needs Are Identified and Met

Standard

Palliative care needs are identified using a defined method. Symptoms are assessed and controlled, and the patient and family are offered support. The service does not wait for the end of life to offer palliative care.

Questions the surveyor asks

1. Is a palliative care need assessed using a defined method at a defined point in the pathway? Needs that are not assessed are not met.
2. Are symptoms such as pain, breathlessness and distress assessed and treated, with the response recorded? Untreated symptoms are the most common cause of avoidable suffering.
3. Is support offered to the patient and family, and is access to specialist palliative care arranged where needed? Palliative care is a service for the family as well as the patient.

Why it matters. Palliative care is needed for many patients long before the end of life. Identifying those needs with a defined method, and treating the symptoms, relieves suffering early.

Evidence to show. Palliative needs assessment tool and the symptom record for a sample of 5 patients (anonymised).

Good

• palliative needs identified with a defined method, and symptoms assessed and treated.

Failure

• a patient in severe pain for days with no assessment.

Partly met when

• No method: Needs identified without a defined method.
• Symptoms not treated: Symptoms assessed but not treated.

How to implement

• On admission and each review: Identify palliative needs and assess symptoms.
• Yearly: Re-check this criterion against its evidence (Palliative needs assessment tool and the symptom record for a sample of 5 patients (anonymised)). Record the date and who checked, and correct any gap found.

What the surveyor does

• What the surveyor sees: Watches the process at the point of care and reads a sample of the records for the last 3 months.
• What the surveyor asks: Ask the patient: how are your symptoms being managed, and has anyone asked how you feel?
• What is uploaded: Palliative needs assessment tool and the symptom record for a sample of 5 patients (anonymised).

E-learning. Accreditation Training for This Standard

AD.4 Dignity Is Protected in Every Interaction

Non-negotiable

Patients are treated with respect for privacy, dignity and cultural and religious needs. Care is not withheld or delayed because of a patient's identity, status or background. Complaints about dignity are recorded and acted on.

Questions the surveyor asks

1. Is privacy protected during examination, personal care and conversations about the patient's condition? Loss of privacy is a common and avoidable harm.
2. Are cultural, religious and personal needs for food, dress, gender of carer and prayer recorded and met where possible? A need that is not recorded is not met.
3. Are complaints about dignity or discrimination recorded, investigated and answered to the complainant? Complaints that are not answered teach patients not to complain.

Why it matters. Patients who are dying or seriously ill still have privacy, dignity and their own beliefs. Respecting them in every interaction is part of care, not an extra.

Evidence to show. Dignity and privacy standard and the patient feedback on respect (sample of 5).

Good

• each patient treated with respect for privacy, dignity and cultural and religious needs, in every interaction.

Failure

• a patient left exposed during a procedure in front of visitors.

Partly met when

• Privacy not respected: Patient exposed or overheard.
• Beliefs ignored: Cultural or religious needs not met.

How to implement

• Every interaction: Respect privacy, dignity and beliefs.
• Yearly: Re-check this criterion against its evidence (Dignity and privacy standard and the patient feedback on respect (sample of 5)). Record the date and who checked, and correct any gap found.

What the surveyor does

• What the surveyor sees: Watches the process at the point of care and reads a sample of the records for the last 3 months.
• What the surveyor asks: Ask the patient: did the staff respect your privacy and your beliefs during your care?
• What is uploaded: Dignity and privacy standard and the patient feedback on respect (sample of 5).

E-learning. Patient Identification, Informed Consent and Patient Rights

AD.5 Staff Are Trained in Dignity and Communication

Standard

Staff receive training in communication, dignity and care for people with serious illness, and training is recorded. Training is refreshed at a defined interval.

Questions the surveyor asks

1. Is training in communication and dignity given to all staff who have direct contact with patients, and is it recorded? Communication is a clinical skill that must be taught and kept up.
2. Is training in breaking bad news and in conversations about end of life included, with the attendance recorded? Staff who avoid these conversations leave patients without information.
3. Is the training refreshed at a defined interval? Skills that are not practised decline.

Why it matters. Caring for people who are seriously ill and their families is hard. Staff trained in communication and dignity handle those moments with more skill and less harm.

Evidence to show. Training record in communication and dignity for all clinical staff.

Good

• staff trained in communication, dignity and care for people with serious illness, with the training recorded.

Failure

• a staff member giving bad news in a corridor with no training.

Partly met when

• Doctors only: Training given to some staff only.
• Once only: Training not refreshed.

How to implement

• Each year: Train staff in communication and dignity and record it.
• Yearly: Re-check this criterion against its evidence (Training record in communication and dignity for all clinical staff). Record the date and who checked, and correct any gap found.

What the surveyor does

• What the surveyor sees: Watches the process at the point of care and reads a sample of the records for the last 3 months.
• What the surveyor asks: Ask a nurse: what training have you had in talking with a family about serious illness?
• What is uploaded: Training record in communication and dignity for all clinical staff.

E-learning. Patient Identification, Informed Consent and Patient Rights