Author Credentials

Sydney Shepherd, MD Katie Salyers, MD Carolyn Curtis, MD Adam Franks, MD Courtney Wellman, MD

Author ORCID Identifier

Courtney Wellman, MD ORCID#0000-0001-5425-3415

Adam Franks, MD ORCID# 0000-0002-3710-6138


advance care planning, advance directive, geriatrics, medical power of attorney, living will, quality improvement


Family Medicine | Geriatrics | Quality Improvement



Advance Directives (AD) allow patients to maintain autonomy during incapacitation. Patients and their caregivers benefit from these documents in times of crisis. Overcoming barriers to AD completion and documentation can improve patient care quality.


A retrospective chart review was performed initially, after consolidation of the electronic health record (EHR) and after alteration of the EHR, to evaluate the availability of a patient’s medical power of attorney (MPOA), living will (LW), and code status.


Baseline documentation of MPOA (7.33%), LW (6.00%), and code status (5.33%) within the outpatient EHR was low. After 2 cycles, this improved to 13.10%, 13.10%, and 36.55%, respectively. Improvement in code status documentation was statistically significant (p=<0.00001).


Altering the EHR can improve the rates of AD documentation. Further interventions in the EHR should include easily accessible documents and address other barriers, including educating both patients and providers.