Background Advance Care Planning (ACP) is integral in facilitating end of life care (EOLC) preferences for patients. Evidence suggests that patients would prefer to die at home but recognise “the practical and emotional difficulties of exercising this choice”. Whatever the cause of death, patients may experience symptoms so drugs should be prescribed pre-emptively and available in the patient's home. Patient records need to have documentation supporting the preference(s) for death (PPOD), CPR status and available drugs for administration within the home but professionals need this information as suggested by having an electronic palliative care coordination system (EPaCCS).
Aim To standardise the components of ACPs within an electronic patient record to facilitate effective data transfer to an EPaCCS.
Method Baseline review of electronic patient records within a hospice setting, identifying components of ACPs and comparing what components are transferred to the EPaCCS.
Results 30 electronic patient records were randomly identified: the majority (73%) of patients had a cancer diagnosis (22/30), median age of 68 years. Interestingly 97% (29/30) of patients had reference to discussions about PPOD. 47% (14/30) had a documented preference for home, 23% (7/30) initially didn't want to discuss with only one (1/30) person on initial meeting having a preference for hospice. 13% (4/30) had documented changes in their PPOD. Within our local EPaCCS, only 37% (11/30) of patients were registered on this system; 55% (6/11) had their PPOD documented with the remainder (5/11) having had a recorded PPOD in their electronic patient record.
Conclusions Documentation supporting the components of ACPs: PPOD, CPR status, pre-emptive drugs, is fundamental in facilitating the majority of individuals to die in their PPOD of home. However if data systems don't cross talk to each other, in a ‘push/pull’ system of data transfer, the success of implementing a loco-regional EPaCCS is questionable.
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