How does the platform make advance directives available at the moment of decision?

The problem

When a resident is actively dying at 2 a.m., the nurse should not be searching a filing cabinet for the advance directive. And the family should not find out the next morning.

How the platform runs it

Every resident’s advance directive status is visible at a glance. At 2 a.m., the nurse opens one screen and sees exactly what the resident’s wishes are. When hospice is involved, the care plan is shared, visit schedules are visible, and communication between staff and hospice is logged. Significant condition changes notify the family immediately with clinical context.

On the shift

The admission process surfaces advance-directive status as a required field. Mrs. K.’s POLST scan is on the chart, her code status is in red on every screen the clinical team opens, and her healthcare proxy’s contact information is one tap from the resident header. When she enters comfort care, the system suppresses scheduled labs, adds the hospice nurse to the care team with appropriate access, and triggers the documentation set the surveyor will want.

What the outcome looks like

Evidence focus: advance-directive status, proxy contacts, hospice context, and decision lineage are available at the point of review. No satisfaction or hospitalization outcome is claimed here.

What goes wrong without it

Without explicit advance-directive workflow, code status lives on a sticker on the binder that may or may not match what the family said in the latest conversation. The 3 a.m. transfer that should not have happened — because the resident was DNR-DNI — happens, and the family discovers it the next morning. The hospice handoff is reconstructed from memory; the surveyor finds the gap during the next standard survey.