jill mann - barwon health - advance care planning – process & systems supporting acp at barwon...
DESCRIPTION
Jill Mann presented this at the 2014 Managing the Deteriorating Patient Conference. The conference discussed the latest strategies to recognise and respond to the acute patient in clinical deterioration. You can find out more about next year's conference at http://bit.ly/1sjQubiTRANSCRIPT
Advance Care Planning Managing the Deteriorating Patient Conference *
22-23 September 2014 * Novotel Melbourne on Collins
Jill Mann Program Coordinator
September 2014
Overview
A community program Policy & Procedure Patient Information Clinical Alerts Digital Medical Record Resuscitation & Management Goals Recent Case Study
Advance Care Planning – A community program
Barwon Health ACP program:
• Dedicated program to provide & implement ACP
o Total program staff = 3.9 FTE
o Train staff in key areas to implement ACP i.e. HARP, Pall Care, Renal, Aged Care
o Staff education
o Community Awareness
o Barwon Medicare Local
o GP engagement
o ACP for all health sectors and to wider community
o Referral process
ACP Referral
SELF
GP/ Specialists
Community Programs
SACS Acute
BH ACP Program ACP Facilitation
Repository for ACP Documents Audit
Activation of Alerts HIS scanning Distribution
Review Death Audit
Aged Care
Barwon Health DMR
GP/ Specialists
Other Hospitals
Pt/MEPOA Family
Lawyers
AV If No
CPR/LPT
Other Hospitals
Key Aligned Policies (examples)
Policy/Procedure Department
Alert Policy Clinical Practice
Not For Resuscitation – Acute & Sub-Acute Clinical Practice
Not For Medical Emergency Team calls and Changing Medical Emergency Team call criteria
Clinical Practice
Resuscitation Response for Community Health & Rehabilitation Community Health
Resuscitation Choices Residential Aged Care
Choice and Decision Making Residential Aged Care
Goals of Care (Resuscitation and Management Goals) Safety and Quality
Consent Policy for Investigations, Procedures and Treatment Risk Management
Advance Care Planning in Community Palliative Care Palliative Care
BOSSNET
DMR
ACP Activity
0
250
500
750
1000
1250
1500
1750
2000
2250
2500
2006-07 2008 2009 2010 2011 2012 2013 2014
Referrals
Completed ACP's
Declined
Reviews
Deaths with ACP2010
GP Pilot
Study
2012
GP Trial
2013 GP
Outreach
Service
2014
6 mths data
Recent Case Study
Summary of admission:
“patient admitted to ICU (HDU) with Type 1 respiratory failure & bilateral pulmonary infiltrates for NIV….diagnosis of a new haematological malignancy (likely ALL or high grade lymphoma).Pt received intermittent NIV …as tolerated. As per her previous advance care plan, treatment limitations were discussed and it was decided that … would be for NIV + blood products + antibiotics and not for ICU, CPR, defibrillation or intubation. …condition deteriorated throughout the course of the day and as per further discussions with family the decision was made for active palliation. Patient deceased peacefully at ..”
ACP & MEPOA completed via ACP Clinic at GP’s less than 3 weeks prior to admission.
Patient goals – maintain cognition, independence with ADL’s, ability to converse with family, stated she had a strong faith & did not fear death.
