Thinking about the future: a QI project to educate and improve the understanding of advance care planning in the AMU.

Thinking about the future: a QI project to educate and improve the understanding of advance care planning in the AMU.

A Fisher; C Bruce; M Leyton; M Rainbow; J Evans

Acute Medical Unit; Torbay Hospital; Torbay and South Devon NHS Foundation Trust

Introduction:

Advance care planning (ACP) allows patients with serious illness or deteriorating health to discuss future care preferences, supporting a more holistic, patient-centred approach. However, public awareness of ACP remains low and is cited as a key barrier to its uptake in clinical practice.

A 2014 audit by the Royal College of Physicians revealed only 4% of 9000 hospital inpatients had any ACP documentation prior to admission. Lack of accessible information and insufficient training for health care professionals contributes to this gap, forming the focus of this quality improvement project (QIP).

Methods:

Using the Supportive and Palliative Care Indicators tool (SPICT), we identified 10-25 patients per cycle who were suitable for ACP conversations. Reviewing clinical notes, we assessed whether ACP conversations occurred and whether patients were given any signposting information. All data was recorded in Excel to track progress across cycles.

Interventions:

Our planned interventions included highlighting the project at daily AMU handover meetings, disseminating a high-quality leaflet with ACP information and signposting to locally and nationally endorsed resources, and use of ward posters to raise awareness of the project.

Results:

From this review, we were able to evidence that of 10 patients initially audited, 0% had any ACP conversations during their AMU admission, 0% were given any information on ACP, and 0% had any form of ACP subsequently completed during their AMU stay.

Following the planned interventions, 44% of 18 patients audited had ACP conversations during their AMU admission, 0% were given any information on ACP, and 39% had any form of ACP subsequently completed during their AMU stay.

Conclusions:

Our interventions improved rates of ACP conversations and documentation but highlighted the continued lack of information provision. For the next QIP cycle, we plan to provide targeted teaching sessions for AMU resident doctors with the aim of improving ACP engagement. Our hope is that this QIP sets the precedent for and is the catalyst of change.