Thank you to Sue Oakes, from the Liverpool Heart and Chest Hospital for sharing this great piece of work which supports clinicians to consider advance care planning at different times in a patients illness/treatment.
Advance care planning is more frequently used with patients who have cancer or other life-limiting illnesses. However, the COVID 19 pandemic has highlighted the relevance for other patient cohorts.
In 2021 the Care Quality Commission looked at how DNACPR decisions were made in the context of advance care planning across health and care sectors including hospitals.They identified three key areas for Trusts to consiuder;
1. Information, training, and support
2. A consistent national approach to advance care planning
3. Improved oversight and assurance
At the Liverpool Heart and Chest Hospital, patients often have emergency interventions and complex surgery. Deaths are mainly in the critical care setting where the focus pre-procedure usually relates to the positive outcome and life-prolonging nature of surgery rather than exploring advance care planning.
Following the CQC report the specialist palliative care team at Liverpool Heart and Chest Hospital were asked by the Director of Nursing to identify opportunities to develop advance care planning across the Trust.
They focused on the informed consent process before surgery which already involves talking about the potential for life-changing complications or death. This makes it potentially an appropriate time to include discussions about advance care planning, patient preferences, and wishes. Athough not relevant to all acute admissions it is an innovative approach that can be used by clincians in the hospital.
The team have designed a visual aide called TREATMENT. This prompts clincians to have discussions about future care during the informed consent process. Click here to see an example of the TREATMENT tool
Congratulations to everyone in the Specialist Palliative Care Team at Liverpool Heart and Chest Hospital for developing this tool and using it to improve an existing process. We really look forward to hearing how this is embedded into clinical practice over the next few months and the difference it makes to patient care. We hope that the team will present their work at one of our Pallaborative North West meetings in 2023.