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Rosemary Sims & Meagan Adams delivered the presentation at 2014 Transition Care Conference: Improving Outcomes for Older People. The 2014 Transition Care Conference: Improving Outcomes for Older People formed a National account of the consumers' transition care journey within the current aged care environment, highlighted new initiatives to improve TCP access and quality of care, and showcased innovative service delivery models across jurisdictions. For more information about the event, please visit: http://www.informa.com.au/transitioncareconference14
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IMPLEMENTATION OF ADVANCE CARE PLANNING INTO BENDIGO HEALTH’S TRANSITION CARE PROGRAM By Rosemary Sims and Meagan Adams
Advance Care Planning • DefiniDon • Why do we need it? • What do we want ACP to
achieve?
• Bendigo Health ACP Program
• Facilitators and Challenges • Where to from here? • Resources • QuesDons
What is Advance Care Planning?
“Advance Care Planning is the process of planning for future health and personal care whereby the person’s values, beliefs and preferences are made known so they can guide decision making at a future Dme when that person cannot make or communicate his or her decisions.”
(Advance Care Planning: have the conversaDon A strategy for Victorian health services 2014-‐2018)
Why is advance care planning important?
• Most people (~ 85%) will die a`er chronic illness, not a sudden event
• 80% of deaths occur under the care of healthcare professionals
• A doctor who is uncertain about what to do, and who has to make a decision, will o`en treat aggressively
• Up to half of us are not in a posiDon to make our own decisions when we are near death
• Our family have a significant chance of not knowing our views without discussion
• Many of us will be kept alive under circumstances that are not dignified, frequently suffering and in a way that we would not have wanted
What do we want ACP to achieve?
• Know who the person wants us to speak to if they are unable to speak for themselves
• Know what their beliefs, values and goals are in life
• Know want they want for their future medical treatment and end-‐of-‐life care
• Record this informaDon in a form that healthcare professionals are able to idenDfy and act upon when required
Bendigo Health’s ACP Program Key Components (based on the RespecDng PaDent Choices Model) • Requires ExecuDve support and governance • PaDent educaDon materials • ACP documentaDon and medical record process
• ‘Greensleeve’ • Internal documents MR • External documents • Electronic alerts
• PaDent journey process and handover
Bendigo Health’s ACP Program Key Components
EducaDon
• Unit in-‐services • On-‐line training via ACP Australia website • One-‐day workshop
Pilot sites – TCP, HARP, GEM/hospice, ICU, medical units
Results:
Pa+ents who par+cipated in Advance Care Planning Were more likely to have expressed future medical care wishes and appointed a subsDtute decision maker
Were more likely to have had their end of life wishes respected if they died
Families of pa+ents who par+cipated in Advance Care Planning and the pa+ent died during the trial:
Experienced less stress, anxiety and depression
Reported higher saDsfacDon with end of life care
Family members’ responses on quality of end of life care ques+onnaire
Interven+on group His death was really peaceful, and everyone knew
what to do
Control group He knew he was dying, and it was very hard for him.
We should have talked with him about it
Pa+ents’ responses on discharge ques+onnaire Interven+on group Very caring staff, no-‐one has asked me before what I
would want when I get really sick. It was really great. It made me feel relieved
Control group It was very hard to get informaDon on what was
happening
The doctors didn’t really listen
The impact of advance care planning on end of life care in elderly paDents: randomised controlled trial Karen M Detering, respiratory physician and clinical leader,1 Andrew D Hancock, project officer,1 Michael C Reade, physician,2 William Silvester, intensive care physician and director1
Documented ACP ac+vity from October 1st 2013 – April 30th 2014
Results -‐ acute
Results -‐ Community
Bendigo Health’s TCP ACP Program
• Bendigo Health TCP model • 16 staff trained • Central database established to record where the paDent is up to in the ACP process
Facilitators to ACP in TCP
• Training and mentoring to build confidence in the staff to have ACP discussions
• Long-‐term relaDonship with clients • Able to do ACP in small segments over a number of visits
• PaDent informaDon materials • Management support • High priority given to this aspect of care by the whole team
Challenges to ACP in TCP
• Lack of medical staff availability • GP lack of knowledge about ACP and their role in the
process • TCP does not have access to the acute or subacute
medical files unless they specifically call for it • Lack of Dme • Level of ACP Facilitator confidence
• having the 1st conversaDon • Discipline – working within your own role
• Access to paDent informaDon materials and paperwork • Not all staff have had training
PaDent feedback
Daughter… “having something in wri0ng that would give me guidance if I ever need to make a decision would be really beneficial”
ACP Facilitator “He and his family felt the process
was good and that the whole concept of ACP just makes sense.”
Resources
• Advance care planning: have the conversaDon A strategy for Victorian health services 2014-‐2018 “Advance care planning… Everyone’s business, Part of usual care, People having a say…while the sDll can” hmp://docs.health.vic.gov.au/docs/doc/Advance-‐care-‐planning;-‐have-‐the-‐
conversaDon:-‐A-‐strategy-‐for-‐Victorian-‐health-‐services-‐2014-‐2018
• A NaDonal Framework for Advance Care DirecDves
www.ahmac.gov.au/cms_documents/AdvanceCareDirecDves2011.pdf
• Advance Care Planning Australia website hmp://advancecareplanning.org.au/
• RPC Training hmp://advancecareplanning.org.au/training/
