Background This work was spurred following a presentation from a paramedic at the All Wales Palliative Care Conference in Gregynog in 2018, which highlighted the challenges for paramedics’ making clinical decisions for nursing home residents. For a patient nearing the end of their life, transfer from a nursing home to the emergency department can be inappropriate and have undesirable consequences.

Aims

• To ensure smooth transition of care from hospice patient to nursing home resident.

• To ensure patients‘ wishes nursing home residents are clearly communicated.

• To reduce unnecessary medical interventions and hospital admissions.

Method Based on feedback from paramedics, a patient-specific information document titled ‘Priorities for future care: Nursing Home Residents’ has been implemented at the hospice. This two-page document has been completed upon discharge over a six-month period.

Results From February to July 2019 we have successfully completed the care priorities document in 92% of our discharges (n=11). Of the 11 discharges, 2 patients were re-admitted acutely and died as an inpatient. Patient feedback has been universally positive whilst for Health Care Professionals, it has been used an opportunity to re-visit and review patient wishes prior to discharge. Quantitative data and feedback from the Welsh Ambulance Service is ongoing.

Conclusion The care priorities document aims to improve confidence and communication in future decision-making for patients entering nursing home residential care. It is hoped that the results from piloting this initiative will aid in the refinement of a single, standardised form for use across Wales.