Advanced care planning (ACP) is a means of conveying one's wishes regarding medical treatment while still having the cognitive capacity to ensure one's preferences are known in the event that the ability to make decisions and/or convey them is later lost. As such, ACP can maintain an individual's autonomy. In the Residential Aged Care Facility (RACF) the use of ACP has become part of standard admission documentation, allowing residents and families to discuss and plan for possible future care needs.
An audit of ACP highlighted that although every resident had an ACP, they were not always completed correctly, had conflicting information, or were incomplete. In addition, some nurses reported anxiety or discomfort when approaching residents and relatives to discuss end-of-life care issues.
The project was conducted to determine what was considered to be best practice, and whether the RACF met best practice criteria. This would determine what changes would need to be made to improve completion of ACP, to provide residents and relatives opportunities to discuss ACP, and to increase nurses' confidence and skills in the area of ACP. Addressing these areas would thereby improve outcomes for residents, relatives, and staff.
The project was undertaken using JBI Practical Application of Clinical Evidence System (PACES) and Getting Research Into Practice (GRIP) online software. Using PACES, current best practice criteria were identified, and an initial audit was conducted to determine the RACF's performance, relative to best practice. GRIP was then used to develop strategies to change and improve current practice. Strategies were implemented, which included revision of documentation, education for residents and relatives, and also education for nurses.
Following the GRIP phase of the project, a post-implementation audit was conducted. Although the project was conducted over a relatively short time frame, results of this audit indicated that practice around ACP had improved.
See how an aged care facility turned their current practice regarding advanced care planning into best practice.
An audit of 71 resident notes in a 73-bed residential aged care facility
Acknowledgements Australian Government Department of Health and Ageing for financial support
Corumbene Nursing Home: Board of Management and Mr. Andrew Power (CEO) for their financial support, Residents and Relatives for their assistance in the project, the project team (Cecily Verrier DOC, and Heather Mc Ewing QPN), and also the nurses for their interest, support, and encouragement.
Joanna Briggs Institute (JBI), Adelaide JBI Jan 2008 cohort of Clinical Fellows, Craig Lockwood, Amanda O'Connell, and Zuben Florence.
Ruth Haynes, Residential Aged Care Liaison Team, Royal Hobart Hospital and Julie Dunbabbin GP South Tasmanian Division of General Practice for providing information, pamphlets, and education sessions.