Background Advance care planning and intervention to improve quality of life must follow identification of patients within the last year of life. Highet et al. (2014) found only 24% of those patients identified within the last year of life had DNACPR forms completed.

Aims For community specialist nurses to be competent and confident in carrying out compassionate DNACPR discussions, decisions and documentation

Approach In July 2014, 8 senior community palliative care nurses successfully completed DNACPR competencies. The nurses were able to recognise when during a patient's journey there was a need or opportunity to discuss advance care planning. Gold Standards Framework meetings further informed the approach.

If patients lacked capacity a multi-professional approach in conjunction with previous wishes and preferences informed a Best Interest decision. DNACPR forms would be counter signed by consultant/GP involved in this patient’s care.

All DNACPR forms would be completed, accompanied with an advance care planning letter, advising of a crisis plan and preferred place of care and discussed with the team leader. The documents were communicated to all professionals involved in the patients care and the original DNACPR form and letter are placed in home in the community nursing notes.

Outcomes Over 10 months 49 DNACPR forms have been completed by community specialist nurses in the patients’ home promptly after the discussion and documented in the patient’s electronic records. (Of the 28 patients who died, 11 died at home, 11 in a hospice and 6 in hospital).

Conclusion Community specialist nurses are best placed to have sensitive end of life discussions with patients.