An Audit Into Advanced Care Planning for End of Life Care Patients at Kingston Hospital

Abstract

Background The End-of-Life Care (EoLC) Strategy 2008 highlighted the importance of early identification of potential for dying and Advanced Care Planning (ACP).1 2 3 Early awareness of poor prognosis helps patients and their relatives to understand their illness and make informed choices about their care; for instance whether to decline aggressive intervention and hospitalisation if it is unlikely to improve their quality of life. Aims and Objectives To prompt early communication within the MDT and with patients and their relatives about ACP for those deemed to be in their last year of life. Method Data from 40 discharged patients, who had been identified as likely being in their last year of life, was collected in each audit cycle.Cycle 1 was a retrospective case notes analysis from one Care-of-the-Eldery (CoE) ward. Five key areas of ACP were reviewed: resuscitation status, prognosis, ceiling of care, readmission plans, patient/family awareness of condition and prognosis.Prior to cycle 2, an ACP Summary proforma was implemented where discussions around the five key areas could be summarised. It was introduced at a CoE department meeting and teaching sessions were held for junior doctors.Results Tables 1 and 2 illustrate our findings.

Development of an audit tool for advance care planning documentation between the hospital and residential aged care facility interface

“…Similar ACP audits have been used at Kingston Hospital, UK, which found that implementation of an ACP summary and JMO teaching sessions improved resuscitation status, prognosis, ceilings-of-care and readmission status documentation in medical notes and at discharge. 5 The documentation of advance care planning preferences of RACF patients in our hospitals was suboptimal. Our audit tool can be used to improve advance care planning between RACF and hospital setting.…”