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50 Discussions on advance care planning – as specialists, are we confident in tackling this subject?
  1. Dawn Matthews,
  2. Emer McKenna,
  3. Julie Gater and
  4. Melanie Sheard
  1. Douglas Macmillan Hospice, Stoke-on-Trent


Background The Advance Care Planning Procedure approved by the Clinical Governance Committee states ‘All patients will be given the opportunity to plan their future care.’ The aims of the procedure are to:

  • Provide a consistent approach to advance care planning across all service areas

  • Ensure that the Advance care plan (ACP) is considered when the patient moves between services

  • Ensure the ACP is reviewed as the patient‘s condition changes.

  • Ensure that staff understand what can and cannot be included in an ACP

In accordance with the requirements of the CQUIN, this audit aims to monitor the proportion of patients who were offered the opportunity to discuss advanced care planning.

Methods 30 community based patients, 5 patients from the day therapy unit and 10 patients from the inpatient unit were randomly selected by the administration team. Inclusion criteria were for patients to have been seen at least 3 times, and for the patient to have capacity.

A retrospective review of the medical notes was conducted and details of ACPs were recorded, using a pre-determined audit questionnaire.

Results Initial results have shown that 80% of ACP discussions were commenced by the first hospice service assessing the patient, and the remaining 20% had these discussions on contact with a second service. 46.7% were discussed during routine assessments. Discussions about preferred place of death (72%) and resuscitation (76%) occurred more frequently than those about Lasting Power of Attorney (33.3%). Of the patients who had died, 61.5% of ACPs were reviewed in the month before their death.

Conclusions This audit showed that Advance Care Planning is being discussed with patients and considered when moving between services. Further training is needed to ensure ACPs are reviewed as a patient‘s condition changes and that all aspects of the ACP are discussed and documented.

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