PoET is an ethics-based quality improvement (QI) intervention designed to align long-term care (LTC) practices with Ontario’s Health Care Consent Act (HCCA). Building on prior success in reducing emergency department (ED) transfers and improving palliative care, the PoET-Linc study piloted documentation indicators to assess alignment within LTC medical records.
Over two years, LTC homes participated in a four-week Provincial PoET Program involving observation, mentorship, and workflow-integrated changes (e.g., policies, documentation, communication). Three months later, chart audits examined key indicators: treatment proposals, discussion of risks and benefits, capacity assessments, and documentation of consent.
Results showed major documentation gaps. While treatment proposals were usually recorded, risks and benefits appeared in only 25% of cases, and consent was missing in 21%. In 72% of cases, consent was obtained from substitute decision-makers without documented evidence of resident incapacity. Additionally, 40% of ED transfers lacked any documented consent.
The study found that while these indicators can partially reflect HCCA alignment, meaningful assessment requires context-sensitive measures, which are currently too time-intensive. Further work is needed to develop feasible and accurate indicators of informed consent practices.
Project Leads: Henry Siu, Jill Oliver, Paula Chidwick Contact: Henry Siu (siuh3@mcmaster.ca)
Research Project Update