Anticipatory Care Planning Janette Barrie, Nurse Consultant Sheila Steel, Project Manager
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
History Lesson
Lanarkshire Death Rates and Place of Death 3500 Number of deaths by location 3000 2500 2000 1500 1000 500 0 Acute hospital NHS Continuing care Community hospital Care home Domicillary St Andrew's Hospice Other 2008 2009 2010 2011 2012 2013
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
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
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
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
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
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
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
ACPs Number What we found... Total number of ACPs in Care Homes 1600 1400 1200 Number of ACPs signed off and reviewed by GPs 1000 900 800 1000 800 600 400 200 700 600 500 400 300 200 0 Baseli ne Oct '12 Nov '12 Dec '12 Jan Feb Mar Apr North-East 0 7 22 103 108 141 171 199 227 245 234 236 322 312 324 328 338 North-West 2 12 24 73 155 254 265 273 342 372 372 329 360 369 389 334 365 South-East 56 73 108 319 382 445 442 508 519 436 462 468 426 465 475 436 442 South-West 2 36 77 118 192 227 227 232 241 255 258 261 272 281 290 289 298 Total 60 128 231 613 837 1067 1105 1212 1329 1308 1326 1294 1380 1427 1478 1387 1443 May Jun Jul Aug Sept ' 13 Oct Nov Dec Jan'1 4 100 0 Aug Sept Oct Nov Dec Jan'14 Month
Number ACPs in the Community... 6000 GP ACPs on ekis 5000 4000 3000 2000 1000 0 Sept Oct Nov Dec Jan '14
So what?? In one month 38 care home residents avoided hospital admission and remained in their preferred place of care:
Cost benefit... Average length of stay ~ 5 days at 350 per day. (http://www.isdscotland.org/health-topics/finance/costs/) 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...
The biggest impact Capturing Jean s wishes... Thanks to Jean and to Marc from Equals Advocacy Partnership
Thank you Janette.barrie@lanarkshire.scot.nhs.uk Sheila.steel@lanarkshire.scot.nhs.uk References: Baker et al (2012) British Journal General Practice;DOI: 10.3399/bjgp12X625175 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.