O-70 Incorporating advance care planning into the care of residents in a dementia unit

Abstract

<h3>Background</h3> ACP was introduced into our 40-bed dementia unit in 2011. As residents are typically unable to make choices regarding future care, we developed a specific process based on, and maintaining the essence of, the New Zealand ACP process for competent people. <h3>Aim</h3> To describe the process of incorporating ACP into the care of people with significant cognitive impairment, and to identify the challenges, risks and benefits. <h3>Methods</h3> The ACP process is described. Questionnaires provided to staff and families. Vignettes describe a variety of examples of the ACP process in practice. Retrospective and current file audits. <h3>Results</h3> <i>Challenges</i> include staff finding time, and lack of confidence and ability, for ACP conversations. <i>Risks </i>include inappropriately excluding the resident from the conversations. <i>Benefits </i>include improved end of life experience for residents and their families, and reduced requirement for crisis intervention. <h3>Discussion</h3> Concern has been expressed that ACP for people with significant cognitive impairment is not appropriate, or is risky. Our experience tells us that not only is a safe and effective process possible, it is essential if the preferences of people with significant cognitive impairment are to consistently be taken into account. Maybe the process needs to have a different title? <h3>Conclusion</h3> The process we use improves efficiency and effectiveness of the healthcare we provide, by promoting a proactive approach to the care of residents, positively impacting residents, staff, GPs and the wider healthcare team.