Abstract

This poster aims to describe challenges and learning points in endeavours at starting systematic advance care planning (ACP) in Tan Tock Seng Hospital, a 1200-bed tertiary hospital in Singapore

Based on the model of ACP espoused by Respecting Choices of Wisconsin, USA, a disease-specific pilot project was initiated in the department of cardiology in 2010 and a POLST-like pilot project in the departments of respiratory medicine, neurology and neurosurgery.

28 staff comprising nurse clinicians, case managers and medical social workers were trained in the Respecting Choices model of ACP facilitation. Less experienced facilitators were mentored by senior staff with experience in ACP facilitation. The facilitators also met regularly to share experiences. 5 patients with advanced heart disease, 5 with advanced chronic obstructive pulmonary disease and 2 patients with advanced neurological diseases underwent facilitated ACP discussions by trained facilitators. Outcomes were documented and scanned into the hospital medical records system.

Significant challenges faced were relatively low awareness of ACP among the general public and healthcare professionals as well as the need for clear workflows and co-ordination across multiple disciplines. There are ongoing endeavours at continual quality improvement through forums aimed at engaging the staff and the public, workshops to enhance the skills of facilitators, audits and improvement in resource allocation.

A systematic approach to ACP faces significant challenges in the initial stages of the endeavour in a complex hospital environment. ACP is resource intensive and a clear vision, high level support as well as a multi-pronged approach are paramount for successful implementation.