Download the PARIS Documentation Template from the RPACE Website under "Resources for Download", or from your shared drive at your respective teams.

All RPACE documentation follows PARIS Guidelines. Please refer to PARIS User Help or your local Clinical Resource Nurse if you have any PARIS related questions

See documentation information in the section 2.6.

See documentation information in the section 2.6.

Where paper charting is utilized, all members of the interdisciplinary team are asked to document on the VCH form entitled the Advance Care Planning/Goals of Care Discussion Record (form VCH.0109)

What to document

The clinician should document how this patient was identified as being in need of a conversation (e.g. answer to the “Surprise Question”, Clinical Frailty Scale ranking, SPICT indicators, a request made by patient). Guidelines around documenting the goals of care discussion will be outlined in Module 2.6.

 

Access to the document

This form can be found on the intranet and can be ordered through Printing Services.

 

Location within the chart

The form is located in the paper chart just before the green sleeve that contains the Medical Orders for Scope of Treatment (MOST) form.

 

Rationale

The Advance Care Planning/ Goals of Care Discussion Record allows for centralized, multidisciplinary documentation of all information pertaining to a patient’s goals or wishes. The centralization of goals of care documentation allows for rapid access to this vital information, reduces the risk that goals of care charting will be missed within discipline-specific notes, ensures that all members of the team are on the same page, and ensures that the patient’s wishes are respected whenever possible.

 

In order to avoid double-charting, clinicians can document a brief note in their own discipline’s progress notes directing readers to the documentation: “Please see the ACP/GOC Discussion Record for identification of the need for a goals of care conversation.”