Rosemary Sims & Meagan Adams - Bendigo Health - Implementation of Advance Care Planning into Bendigo Health's Transition Care Program

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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

Published in: Health & Medicine, Business
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Rosemary Sims & Meagan Adams - Bendigo Health - Implementation of Advance Care Planning into Bendigo Health's Transition Care Program

  1. 1. IMPLEMENTATION  OF  ADVANCE  CARE   PLANNING  INTO  BENDIGO  HEALTH’S    TRANSITION  CARE  PROGRAM   By  Rosemary  Sims  and              Meagan  Adams  
  2. 2. 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  
  3. 3. 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)  
  4. 4. 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  
  5. 5. 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  
  6. 6. 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  
  7. 7. 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  
  8. 8. 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  
  9. 9. Documented  ACP  ac+vity  from  October  1st   2013  –  April  30th  2014  
  10. 10. Results  -­‐  acute  
  11. 11. Results  -­‐  Community  
  12. 12. 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  
  13. 13. 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  
  14. 14. 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  
  15. 15. 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.”  
  16. 16. 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/  

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