993 IMPROVING ADVANCE CARE PLANNING ON A GERIATRICS WARD: A QUALITY IMPROVEMENT PROJECT

Abstract

Abstract Introduction Despite ongoing improvement work in our hospital regarding Advance Care Planning (ACP) in the community and specialist palliative care settings, our team was concerned that ACP was underutilized for inpatients. We aimed to increase the number of ACPs (specifically focusing on re-admission avoidance) made on our geriatrics ward, and to communicate these effectively with community colleagues. Method We retrospectively reviewed 26 deaths on our ward during a three-month period, and found significant missed opportunities to discuss ACP, e.g. 54% of patients had more than one admission in the six months prior to death. We developed a novel co-morbidity score to help support our decision-making, and used aspects of the Gold Standards Framework’s Proactive Identification Guidance. Our working group, led by a consultant geriatrician, focused on increasing the team’s engagement with ACP, including use of an ‘ACP Champion’, and we worked to align our documentation with that used elsewhere in the Trust. We used a paper form, resembling a DNACPR, to prompt community teams to re-consider whether admission was necessary. We made ACPs for six patients during this four-month pilot phase, and followed them up over the next five months. Results Following our interventions, follow-up of our patients showed 83% had ACP described in their discharge letter; 33% had ACP mentioned on their Summary Care Record (SCR); 0% of patients who had died re-presented to hospital prior to death. Conclusion Our project showed that diligent attention to making ACPs for suitable patients was successful in preventing re-admission. Despite this, communication about ACPs in the discharge letters and transfer of this information to the SCR was suboptimal. This demonstrates that even with a focused team, mistakes can happen. I’m now working on a subsequent project focusing on improving understanding of ACP amongst junior doctors.