Anticipatory Care Planning. Janette Barrie, Nurse Consultant Sheila Steel, Project Manager

Transcription

1 Anticipatory Care Planning Janette Barrie, Nurse Consultant Sheila Steel, Project Manager

2 Geography Lesson Population 570,000 Ageing and slightly increasing population Deprivation 88% NHSL wards in the poorest 60% of Scottish wards Decline of heavy industry Fatalistic culture Resp Disease, CHD, Stroke & Cancer

3 History Lesson

4 Lanarkshire Death Rates and Place of Death 3500 Number of deaths by location Acute hospital NHS Continuing care Community hospital Care home Domicillary St Andrew's Hospice Other

5 Prompts... Person Centred Care Review of Palliative Care Patient Choice Dignity Respecting patients goals and wishes Preferred Place of Care Anecdotal reports of wishes being ignored Introduced Anticipatory Care Planning

6 What is Anticipatory Care Planning? Anticipatory Care Planning (ACP) can help patients plan for the future. Provides the opportunity to think about, talk about, write down and communicate patients preferences and priorities for care. Encourages a thinking ahead approach the what if s Have greater control and choice Communication biggest challenge

7 Anticipatory Care The process is voluntary and the discussion is entered into only if the patient wishes to do so. It is not legally binding Patient may wish to change their mind The anticipatory element addresses the clinical aspect an extension of self management

8 Why do we need them? An ACP can help patients and their families understand what is important to them when planning care, especially if it is their wish to be cared for at home and to stay at home, avoiding any unnecessary hospital journeys or admissions Improves communication Removes the burden from families Provides guidance for care home and health staff

9 Evidence National and international evidence Recognition of a deterioration in condition Patient s goals recognised Reduced hospital LOS Improved communication Education essential, communication skills required Public Awareness Further reading: Craig J (2013) York Health Economics Consortium

10 What we did... Tested the concept (2010) Targeted approach using cascade training within Care Homes, Community Nursing, Acute Hospitals Identification of ACP champions Education for Community Nursing Educations session within the Acute Hospital environment Data, Data, Data

11 How we did it? Care Home Staff Community Nurses Acute Hospital Staff Emergency Response Centre Social Workers General Practitioners Patient Advocacy Carer Groups General Public Specialist Nurses COPD Heart Failure Multiple Sclerosis Parkinson s Disease Renal Stroke

12 ACPs Number What we found... Total number of ACPs in Care Homes Number of ACPs signed off and reviewed by GPs Baseli ne Oct '12 Nov '12 Dec '12 Jan Feb Mar Apr North-East North-West South-East South-West Total May Jun Jul Aug Sept ' 13 Oct Nov Dec Jan' Aug Sept Oct Nov Dec Jan'14 Month

13 Number ACPs in the Community GP ACPs on ekis Sept Oct Nov Dec Jan '14

14 So what?? In one month 38 care home residents avoided hospital admission and remained in their preferred place of care:

15 Cost benefit... Average length of stay ~ 5 days at 350 per day. ( Average cost per day 350 1,750 per patient for 5 days Total 190 occupied bed days For 38 patients - 66,500 costs avoided in one month! However...

16 The biggest impact Capturing Jean s wishes... Thanks to Jean and to Marc from Equals Advocacy Partnership

17 Thank you References: Baker et al (2012) British Journal General Practice;DOI: /bjgp12X Barrie J, Campbell J, Ross C, (2010) Preferred Place of Care Audit, NHS Lanarkshire. Craig J (2013) York Health Economics Consortium. Introducing ACP in Lanarkshire, an evaluation (2010), NHS Lanarkshire Steel S, Campbell J, (2013) ACP in Lanarkshire, NHS Lanarkshire.