Future Care Plans in Older Adults

Introduction:
Future Care Plans (FCP) enable individuals to express their preferences for future healthcare, promoting person-centred, proactive care and shared decision-making. NHS Greater Glasgow & Clyde recommends that healthcare professionals consider FCP discussions for older people living with one or more long-term conditions who are at increased risk of hospital admission. This quality improvement project aimed to increase FCP completion on Ward 4 and improve documentation of FCPs, Treatment Escalation Plans (TEPs), and Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions within inpatient discharge letters.

Methods:
A two-cycle quality improvement project using a Plan-Do-Study-Act methodology was undertaken. Cycle 1 reviewed discharge documentation for 15 randomly selected older people (five per month) discharged from Ward 4 between November 2025 and January 2026. Following baseline data collection, an educational session on FCP principles, documentation and communication was delivered to doctors within the Department of Medicine for the Elderly. Cycle 2 repeated data collection using the same methodology for 15 people discharged between March and May 2026.

Results:
Across both cycles, fewer than 25% of people had a documented FCP. Following the educational intervention, FCP completion increased from 17% to 20%. However, only one FCP was completed by the Ward 4 team across both cycles, as some were completed pre-admission. Documentation of DNACPR and TEP decisions within immediate discharge letters was lower in Cycle 2 than in Cycle 1. 

Conclusion:
FCP documentation remained low despite local guidance recommending consideration of these discussions. A single educational intervention was associated with only a modest increase in FCP completion, suggesting that education alone may be insufficient to achieve sustained improvement. Future work should include repeated education, documentation prompts and integration of FCP discussions into routine discharge processes. Interpretation is limited by the small sample size and resident doctor rotation during Cycle 2, which reduced exposure to the intervention.