Background Since 2012, Tan Tock Seng, a tertiary hospital in Singapore has a dedicated advance care planning (ACP) team to initiate and coordinate ACP work. POLST type discussions (known as ‘preferred plan of care’ locally) were held with patients whom the hospital team would not be surprised would pass away within 12 months as well as with their loved ones.
Aim Post-ACP death audits were carried out by the ACP team to find out congruence of patients’ ACP preferences with delivery of medical care in hospital.
Methods Audits of electronic and hard copy case notes were done for patients with advance care plans once death was registered in the electronic patient records.
Results A total of 191 patients have had their ACP preferences audited upon their deaths from 2012 to June 2014. Majority of patients (99%) made decisions for no CPR (cardio pulmonary resuscitation), with 77% of them choosing limited additional interventions compared to 21% for comfort measures. 1% of patients opted for CPR and full treatment. DNR (do-not-resuscitate) order was honoured for 97% of patients. 30% of patients wanted to die at home, while 14% wished to pass away in hospital. 33% of patients have no preference on place of death.
Discussion There is a high rate of congruence between patients’ ACP and medical treatment rendered during hospital admission. There is ongoing work to audit outcomes of death outside of hospital.
Conclusion The POLST type of ACP is a useful and effective tool in starting ACP in acute hospitals.
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