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2 Rekindling primary carers’ relationship with advance care planning: a quality improvement project
  1. James Naughton,
  2. Huw Williams and
  3. Aoife Gleeson
  1. Aneurin Bevin University Healthboard, Cardiff University

Abstract

Background In 2017, a local priority setting exercise amongst stakeholders in palliative care identified gaps in the documentation and communication of Advance Care Planning (ACP) as barriers to high quality palliative care. We designed and evaluated an electronic template-based intervention to empower primary care teams to overcome these challenges.

Aims We aimed to increase recording and communication of ACP discussions. This was via (1) the development of an electronic palliative care recording and reporting toolkit and (2) evaluation using Quality Improvement (QI) methods.

Methods Six primary care practices were recruited for a 6 month QI project. Practices were supported through educational sessions and facilitation from the study team. Utilising regular feedback and repeated PDSA cycles, the template was adjusted to maximise usability and impact. Monthly reports with comparative statistics were shared with practices.

We collected continuous data over a 12 month period (6 months baseline data and 6 months intervention data). Data was collected via the template’s inbuilt reporting module, participant interviews, the research team’s observations and practices’ after death reviews. Run charts were utilised to correlate data trends with the timing of interventions such as monthly feedback reports and education sessions. Thematic analysis was applied to interviews and feedback from project participants.

Results/conclusion A tenfold increase in documentation of preferred place of death was demonstrated during the study period. Documentation of resuscitation wishes increased by 42% and documented anticipatory prescribing increased 9-fold.

Further work will establish the impact on patient outcomes and apply lessons learned to scale-up efforts. Challenges to overcome include: engaging primary care teams in ACP; the design and scalability of local e-solutions for managing palliative patients; and adequately resourcing this work to ensure sustainability.

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