Proposed Topic (Most preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Authors (including presenting author) :
HO SKS, CHAN HL, CHAN TS, LEUNG WT, PANG HS, KNG PLC
Affiliation :
Department of Medicine and Geriatrics, RTSKH
Introduction :
Since 2016, the division of geriatrics RTSKH has implemented CHF program in end-of-life (EOL) care. By 2018, more than 4-fold increased (14.3% and 62.9% respectively) of clients opted for CHF, and nursing buy in participation increased from 33.3% to 59.6%. Eventually, feeding guidelines and protocol as a model of care was developed to guide the adoption of CHF overcoming practical or medico-legal concerns. In a survey for geriatric nursing (2019), 46(64.8%) respondents agreed that the guide could safeguard ward staff performing CHF, but responses also highlighted the needs for training, limited feeding time and family expectation. Up to 2023, the program has been implemented for 8 years. More staff training, public educations and community collaborative service has been in place. This study reviews 6-year clinical data of the program trend from 2018 to 2023, so as to explore further improvement of service in the future.
Objectives :
Review data of the CHF program in Geriatrics to identify the trend of practice in RTSKH from 2018 to 2023, and to explore potential service enhancement opportunity for future development.
Methodology :
More data on the implementation of CHF was collected for analysis from 2018 onward, including the demographic data of patients, the type of EOL program that patient joined, episodes of implementation of CHF were recorded, such as date of admission, date transfer from medical wards to geriatrics wards, date of starting CHF, date of discharge /dead; availability of documents including communication form (consent form) for CHF, Advance Directive, Advance Care Plan etc.; the main person perform feeding, time keeping patient “nil per oral” before CHF and so on. Data is summarized in the result.
Result & Outcome :
Results
A total of 396 patients (527 cases episodes) were recorded in the statistics. The number of cases received CHF in Geriatrics division each year was 57, 101, 71, 126, 95 from 2018 to 2022 respectively and 77 in 2023 till November. In comparison with 2018, increasing trend for acceptance of CHF was revealed. All patients opt for CHF when they join EOL program, and 100% nursing staff implemented CHF according to ACP. Before 2021, 15 cases had missing ACP for CHF, but no missing of any documentation after 2021. A trend that people were having better support in EOL care, as it was revealed that besides the RTSKH EOL program, more patients had joined other EOL program of other public hospitals and that of palliative care were recruited. The percentage of cases not supported by any EOL program in the community was getting less these years, 14(11.1%) in 2021, 7(7.4%) in 2022 and 4(5.2%) in 2023. Limited by the time access to EOL service and the practice of CHF in acute wards, there was time lagging in starting oral feeding for patients. The average time lag in non-geriatrics ward for implementation (no. of days/case) was 6.2 in 2018, 2.4 in 2019, 3.6 days in 2021, 6.8 days in 2022 and 3.8 in 2023. The overall time lag is 4.7 days in average (range 0-56), median 2 days.
Conclusion
CHF is a very meaningful intervention in EOL care. Riding on the increased awareness and acceptance of the general public and the health care professionals, more patients were benefit with the enjoyment of “Free feed”. However, despites the average time lag to initiate CHF is not prolonged, some patients still had to wait for 1-8 weeks before achieving their wish to eat orally. Individuals even suffer from “No oral food” till they passed away. Therefore, there is a necessity to extend the care to acute care setting for timely implementation of CHF. It is especially important in the aging Hong Kong population as been foreseen more and more elderly will be using the Acute Care service of the public sectors.
