Background For the vast majority of persons entering residential aged care (RAC), ultimately, death is the discharge plan. Yet, at this pre-terminal stage of life, advance care planning (ACP) is frequently completed poorly or not at all. RAC staff frequently lack the skills and access to appropriate processes to support these complex discussions. In delivering rapid response outreach support to RAC’s the St Vincent’s Hospital Melbourne Residential In Reach service (RIR) recognised a pattern of poor end of life care due to a lack of prior ACP communication and decision making having occurred.

Aim To present a case study of an audit based approach utilised to support better ACP in RAC.

Methods Identification of RACs with frequent emergency department (ED) presentations agreeable to RIR Clinical nurse consultant detailed review of all RAC patient records to identify presence, quality and validity of ACP, supporting processes and barriers, and provision of recommendations.

Results The process demonstrates a significant gap in the current standard of ACP undertaken by RAC, describing a process which identifies specific issues and barriers within each RAC to support tailored recommendations being provided which will improve the quality of ACP, lead to better resident care and reduce unnecessary transfers to ED.

Discussion/conclusion The process developed has potential to be utilised to improve practice, by enhancing relationships between health services and the RAC sector to support skill sharing and development at the interface of health services ACP programs, such as between St Vincent’s bestCARE and the RAC sector’s ACP programs.