Background The PEACE (Proactive Elderly Advance Care) plan supports proactive planning of community care escalation through documenting patient wishes and communicating these with care stakeholders in primary and secondary care. It has been shown to reduce inappropriate re-admissions to hospitals at the end of life. Since September 2018, Broomfield Hospital has been promoting the use of the PEACE plan for elderly patients at the end of life being transferred to care homes. During rollout, it became apparent that there was a need to improve understanding amongst doctors about the indications for the document and their competence in its completion as well as related communication with patients and carers.
Aims To assess local impact of using the PEACE plan and competency in completion, derive relevant training needs, and coordinate the provision of multimodal education interventions.
Method A 1-year pilot study of PEACE plan completion and patient outcomes was implemented across two elderly care wards with Gold Standards Framework accreditation. An online confidence and knowledge questionnaire was completed by junior medical doctors and the results were used to model a training programme.
Results The majority of patients died within the year. Only 8% were readmitted, most were turned around within hours. The questionnaire indicates that, although most junior doctors were aware of the plan, only half had completed the form at the trust. Overall confidence in completing the plan was below expected and discussing artificial nutrition and hydration was a particular area of concern.
Conclusions The PEACE plan reduced inappropriate re-admissions to Broomfield hospital at the end of life. Specific training is required to improve knowledge and confidence of junior doctors before its introduction to all medical wards. This will be delivered as presentations, simulation workshops with a focus on communication skills, and multimedia instructional aids.
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