Proposed Topic (Most preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Authors (including presenting author) :
Kwok ML (1), Wong CS (1), Wu YM (2), Woo LC (2),Chan YF (2), Ho YLE (2), Kwok LP (2)
Affiliation :
(1) CND, BBH/ SCH/ SH
(2) Infirmary Unit, Cheshire Home Shatin
Introduction :
At Cheshire Home Shatin (SCH), over 80% of patients are long-stay cases, spending their final moments of life here. Advance care planning (ACP) is a crucial process that allows individuals to express their preferences for medical and personal care at the end of life. By promoting ACP, our aim is to preserve patients' dignity and provide them with the most appropriate and respectful care. However, nurses have had limited involvement and initiative in ACP discussions. Therefore, there is a need to promote ACP among our patients, ensuring comfort, quality care, and equipping nurses with the necessary knowledge and skills to initiate ACP discussions with their family members.
Objectives :
1. Enhance nurses' competency in initiating ACP discussions with family members.
2. Increase the percentage of patients who have signed ACP to meet up to 90% in the coming year.
Methodology :
In the past, local staff training was conducted, and an ACP workgroup was established in 2017. However, nurses were not taking up the initiative role in ACP discussions. After the pandemic, ACP promotion was revisited through staff training and the ACP workgroup. Local staff training programs, such as the RAE program and the ACP in the End of Life (EoL) Program, were provided to enhance staff knowledge and skills and empower staff to participate in ACP discussions. Additionally, education sessions for relatives were conducted by the Health Resource Center (HRC) to help them understand ACP. ACP ward facilitators play a vital role in leading ACP promotion, proactively initiating discussions with family members, and guiding newcomers to start ACP discussions upon admission.
Result & Outcome :
The percentage of patients with signed ACP has gradually increased from 1.4% in 2017 to 86.2% in the infirmary unit and 53.6% in the disabled unit in 2023. Nurses who participated in the training sessions provided positive feedback, indicating increased familiarity with ACP content and improved confidence and competency in initiating ACP discussions with relatives. All newly admitted patients had ACP discussions initiated by ward nurses upon admission, and ward nurses timely review the ACP content with family members proactively.
Local staff training programs and the ACP workgroup have successfully enhanced nurses' confidence and competency in initiating ACP discussions with family members. The percentage of patients with signed ACP has shown a positive trend over the years. Moving forward, our goal is for over 90% of long-stay patients to have care in place, empowering choices for life's journey with ACP in SCH, and ensuring their last wishes and dignity are considered in their care.
