Introduction to ACP


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Overview of the recommendations of the ACP short life working group

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Introduction to ACP

  1. 1. Advance /Anticipatory Care Planning (ACP) OCTOBER 2010 Sandra Campbell Consultant Nurse - Cancer and Palliative Care Chair Sub group of SLWG3 on Advance Care Planning
  2. 2. Advance Care Planning  Department of Health (2006) ‘a process of discussion between an individual and their care providers irrespective of discipline’.  Working group definition (2010) Advance care planning as a philosophy, promotes discussion in which individuals, their care providers and often those close to them, make decisions with respect to their future health or personal and practical aspects of care. These discussions should result in a documented record of what the individual does/does not wish to happen.
  3. 3. Advance care planning Planning for end of life care can be done at any stage of life from well to dying but usually through facilitated conversations that will incorporate patient and carer choices. Anticipatory care planning Planning for situations including a change in health status we expect or anticipate may happen to patients with chronic conditions throughout the illness trajectory. The outcome of both may be documented in an Anticipatory Care Plan
  4. 4. Why the need for two terms?  Along life’s journey, we do not just develop a chronic condition, become unwell and then die, we will often have to face a very winding road with death perhaps expected on more than one occasion with difficult conversations and decisions required.
  5. 5. ABCD of Dignity Conserving careABCD of Dignity Conserving care (Chochinov, 2007)(Chochinov, 2007)  AA -- AttitudeAttitude  BB -- BehaviourBehaviour  CC -- CompassionCompassion  DD -- DialogueDialogue
  6. 6. ACP Toolkit (examples follow)  Umbrella for ACP  Conceptual Framework  ABCD practical guidance for Thinking Ahead  Definitions  Sample ACP plans and documents  Core components  Triggers for ACP  SBAR and a range of other supporting documents  FAQ’s  Reference List
  7. 7. LLLeeegggaaalll PPPeeerrrsssooonnnaaalll CCCllliiinnniiicccaaalll Advance Statement Self Management Plan (with professional) )professional) Thinking Ahead/ Statement of Wishes Anticipatory Care Plan (ACP) Advance Decision Liverpool Care Pathway AAnn AAnnttiicciippaattoorryy CCaarree PPllaann mmaayy ccoommpprriissee aannyy oorr aallll ooff tthheessee.. Their completion will inform the Electronic Palliative Care Summary Welfare Guardian Welfare Power of Attorney Electronic Palliative Care Summary/ OOH Handover form
  8. 8. A Conceptual Framework of Advance Care Planning – A Continuum of Opportunities Well person Culture of open discussion about death, dying and spiritual needs. Dying person Possible health/social triggers /Consider GSF / Prognostic Indicators eg PPSv2/ Assessment tools Health and social care professionals, Primary care team, Acute care team Working Reduction in risk of complicated grief Change in health status Chronic condition Sudden illness Life-limiting diagnosis Terminal diagnosis Last few days Making a will Getting financial advice Power of attorney Social work involvement Bereavement Solicitors, Social Workers , Voluntary agencies Marriage or civil partnership Buying a house Getting a mortgage Getting insurance Education, Faith groups Cultural groups Advance Directive or Advance Decision Statement of wishes Thinking Ahead Completion of Anticipatory care plan / Electronic palliative care summary / out of hours handover form/ LCP
  9. 9. ABCD of Thinking Ahead  A = ACP  B = Begin  C = Communicate and Co-ordinate  D = Delivery Advance and Anticipatory Care Planning, in practical terms are both about adopting a “thinking ahead” philosophy of care.
  10. 10. Change in health status Recognition of likely life-limiting change in condition and/or living alone Onset of a sudden illness Diagnosis of chronic progressive incurable condition Death expected in the next few days Liverpool care pathway (LCP) Anticipatory care plan Thinking ahead Statement of wishes Advance decision / Advance directive Electronic palliative care summary Out of hours handover Possible Outcomes of Anticipatory / Advance Care Planning Possible triggers Change in carer circumstances Changes in home circumstances The triggers and the outcomes are not necessarily sequential and the processes to be implemented should always be the result of considered clinical judgement and include discussion with the patient/carers By adopting an advance care planning philosophy, the right care will be given at the right time by the right person with the right outcome to the right quality standard. Possible triggers for implementing the philosophy of Advance Care Planning
  11. 11. SBAR communication tool  S: Situation  B: Background  A: Assessment  R: Recommendation Haig et al (2006)
  12. 12. Support for ACP  The development and implementation of ACP had been supported by a wide range of national and local policies and guidelines.  There is also a growing body of academic literature in support of ACP however this does need to be evidenced by robust research.
  13. 13. Potential benefits of ACP  Patients receive the care they desire  Appropriate management  Support for decision making  Reducing the risk of complicated grief
  14. 14. Summary of RecommendationsSummary of Recommendations 1.1. Advance care planning needs to be accepted as anAdvance care planning needs to be accepted as an overall concept covering an umbrella of terms andoverall concept covering an umbrella of terms and processes including anticipatory care planning forprocesses including anticipatory care planning for patients with Long Term Conditionspatients with Long Term Conditions 2.2. Agreed definitions essentialAgreed definitions essential 3.3. Engagement with whole population necessaryEngagement with whole population necessary 4.4. Core components need to be contained within anyCore components need to be contained within any documentdocument 5.5. Coordinated education critical to implementationCoordinated education critical to implementation 6.6. Suggested use of tools such as SBAR communicationSuggested use of tools such as SBAR communication tool and electronic palliative care summary to supporttool and electronic palliative care summary to support communication between teamscommunication between teams
  15. 15. Recommendations contd.Recommendations contd. 7.7. Formal audit and evaluation of any documentation,Formal audit and evaluation of any documentation, following death to assess outcome of ACPfollowing death to assess outcome of ACP 8.8. ACP discussions should contain components asACP discussions should contain components as recommended by DOH (2007) and DNACPR andrecommended by DOH (2007) and DNACPR and organ donation as appropriateorgan donation as appropriate 9.9. ACP should be considered on admission toACP should be considered on admission to Nursing/Care HomeNursing/Care Home 10.10. In applying ACP, there may be 3 types ofIn applying ACP, there may be 3 types of documentation, Legal, Personal and Clinicaldocumentation, Legal, Personal and Clinical 11.11. Local arrangements should be in place to ensure anLocal arrangements should be in place to ensure an updated copy of the anticipatory care plan is with theupdated copy of the anticipatory care plan is with the patient/carerpatient/carer
  16. 16.  An Advance/Anticipatory Care Planning philosophy isAn Advance/Anticipatory Care Planning philosophy is advocatedadvocated  A coordinated approach to education is requiredA coordinated approach to education is required  A collaborative approach with improved communicationA collaborative approach with improved communication with patients/carers and between teams is crucialwith patients/carers and between teams is crucial  The transition fromThe transition from livingliving with a chronic condition towith a chronic condition to dyingdying will be as seamless as possiblewill be as seamless as possible  The vision is for equitable care for patients with longThe vision is for equitable care for patients with long term conditions and those at the end of life to facilitateterm conditions and those at the end of life to facilitate the right thing being done at the right time by the rightthe right thing being done at the right time by the right person, to the right quality standard with the rightperson, to the right quality standard with the right outcome!outcome! In ConclusionIn Conclusion