This report documents the advance care planning activity that is currently being undertaken or is planned within Betsi Cadwaladr UHB. This document provides information about various streams of work aiming to deliver individualised care to patients in North Wales.
BCUHB has developed a fully approved ACP document and are mid-way into a 3 year Macmillan funded initiative offering advance care planning (ACP) discussion opportunities in North Wales. The ACP is offered in Welsh or English on the trust intranet, internet and hard copy from hospital Macmillan information pods. Exploration of an ‘App’ for ACP completion on a patient’s phone is underway.
We have facilitated 24 highly successful ACP workshops training 390 healthcare professionals from primary, secondary and community care including voluntary and statutory sectors. Early signals from an electronic survey of staff attending the workshops indicates that learning acquired is being transferred with ACP discussions being held and ACP documents completed. Further workshops are scheduled to run in the autumn.
ACP activity in hospice day care is monitored and we are able to show outcomes for day care patients.1 An ACP education resource pack is nearing completion and consists of a video, completed ACP for the video ‘patient’, workshop workbook, ACP Bingo, information booklet for healthcare professionals and an ACP facilitator guide. ACP is included on the 6 steps training programme, and undergraduate nursing students. Abstracts have been accepted for national and international conferences in Paris, Rome and Manchester.
The BCUHB dementia strategy aims to assure the quality of care at end of life irrespective of the place of care. With this in mind we believe that advanced care planning at as early a stage as possible is fundamental for people affected by dementia to set out their end of life preferences. To facilitate this all nursing staff in Memory Services have been trained to offer a conversation about ACP’s to all people newly diagnosed with dementia. That training is available to other staff and, as the conversation will occur when the person feels that the time is right, Older Person’s Mental Health Services are now building a network of staff across all services to be able to respond to this.
Treatment Escalation Planning
The Health Board have just approved a Treatment Escalation Plan document and supporting information for healthcare professionals, patients, families and carers for use in primary, community and secondary care settings. All supporting information which includes an information leaflet and frequently asked questions (FAQs) will be available in English and Welsh. The formal roll out of the document will begin in September, 2018.
Awareness and training sessions have commenced across all healthcare settings focusing on the key areas such as Emergency Departments, GP Out of Hours, Welsh Ambulance Service and Acute Admission Units. Feedback from the sessions provided has been very positive and the tool will promote personalised patient clinical care.
All documents completed will be monitored for quality purposes and an audit programme following the patient journey in respect to the Treatment Escalation Plan will be carried out.
The work around Treatment Escalation Plans is being aligned to Critical Care Escalation work to ensure a consistent approach is used.
We have an annual memorial service held at St Asaph Cathedral in November where we celebrate our donors.
In May 2018, we did a promotion of Organ Donation at Wrexham Mosque, this was well received and we plan to present at Mosques in other areas during 2018-9.
We are exploring opportunities to promote organ donation in schools in 2018-9; however, this is dependent on schools agreeing to host sessions.
We have memorial art works in situ at Ysbyty Gwynedd and Wrexham Maelor Hospital; the Ysbyty Glan Clywd art work is under construction currently. All displays are in the public reception areas and support a positive image of organ donation and a talking point for patients and visitors.
Do Not Attempt Cardiopulmonary Resuscitation
The All Wales DNACPR policy is in operation across the Health Board with relevant training materials and an IMCA referral pathway available on the intranet. There is a rolling programme of end of life care (EOL) training in primary and secondary care with generic e-learning package on EOL care decision-making available via the EIDO platform. This will be promoted once linked to ESR. There continues to be targeted communication emphasising a duty to consult patients and/or their representatives where DNACPR or other treatment ceiling are being considered.
IMCA referral pathway have been refined following consultation with the IMCA service. These changes are incorporated in relevant EOL care training sessions.
Efforts being made to capture information relating to DNACPR policy compliance via stage 2 mortality reviews. Following incidents and concerns highlighting issues around consultation, accurate completion and ongoing communication; discussion is underway to consider the potential benefits of adopting a DNACPR check list to improve compliance with the DNACPR policy.
We are currently reviewing the mental capacity assessment forms/best interests decision making tools in use within the Health Board.
1. Johnstone RP, Poolman M, Ryan K, Schofield P, Watt B. Assessing advance care plan discussions in hospice day care. Palliat Med Hosp Care Open J. 2017; 3(2): 32-38. Doi: 10.17140/PMHCOJ-3-12