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34 Advanced Care Planning documentation in a busy London Acute Medical Unit: Comparison of 2 retrospective audits
  1. Rochelle Findley and
  2. Lee Lingwood
  1. University College London Hospital NHS Foundation Trust


Background/Introduction An annual audit occurs at University College London Hospital (UCLH) revolving around the documentation of DNACPR, Treatment Escalation Plans (TEP) and mental capacity throughout the trust by the Transforming End of Life Care team. A deep dive into the potential barriers to improved documentation of these topics was carried out in the Acute medical unit (AMU) as this ward has a high turnover of patients and encounters patients early in their hospital journey.

Methods An audit of AMU was carried out assessing the rationale behind CPR status not being signed.

22 patients were sampled from AMU on 28/04/2021. Following data collection, three lectures were presented to AMU staff covering:

• Advanced Care planning

• Mental Capacity Assessment

• Recognising Dying and Last days of Life

A questionnaire was circulated to AMU doctors to assess ideas and confidence regarding CPR/DNAR and TEP. A post intervention reaudit was carried out on data from 50 patients sampled from AMU on 23/11/2021. P-values and 95% confidence intervals (CI) were calculated for observed differences pre and post intervention.

Results Pre intervention, 59.1% did not have a signed CPR decision at that point of admission. Post intervention 64% did not have a signed CPR decision. P-value of the observed difference was >0.05 and the CI covered the null hypothesis of 0. This suggests the change was due to chance.

Pre intervention 53.8% of the unsigned patients warranted further discussion. Post intervention 9% of the unsigned patients warranted further discussion. P-value of the observed difference was <0.001 and the CI did not cover the null hypothesis. This suggests the change is not due to chance.

Conclusions Education around the importance of advanced care planning and recognition of the dying patient may improve documentation of CPR decisions and TEP. Targeting ‘front door’ teams may improve patients’ long term desired outcomes.

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