THE STATE OF PLAY: CURRENT ADVANCE CARE PLANNING (ACP) PRACTICE IN RESIDENTIAL AGED CARE IN ONE REGULAR AUSTRALIAN AREA HEALTH SERVICE
Background Respecting Patient Choices (RPC) model of ACP has been established in Australia for 10 years. Peninsula Health has 35 residential aged care facilities (RACF) in its catchment area, yet few residents present to acute care with an ACP.
Aim To assess the current levels of ACP implementation including the degree of variation from the RPC model of evidence-based practice in the aged care sector.
Methods 30 participating RACFs underwent a comprehensive survey conducted via interview and a random 10% sample health record audit to collect data. Data was collated and graphed across 30 domains of enquiry into ACP practice.
Results The survey revealed a state of broad variance in how ACP is implemented and practiced. Only 21% indicated they routinely invite the resident to participate in ACP discussions. 20% of audited health records showed any evidence of the resident's involvement in ACP and only 41% had evidence of a substitute decision maker. Only 24% files evidenced recording of medical end of life care wishes (figure 1).
Discussion Significant gaps were identified in the nature and content of discussions undertaken and in the recorded level of involvement enabled from residents or their representatives.
Conclusion This study reveals that Aged Care Facilities need significant support to enable a transition to best practice in ACP.
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