Authors (including presenting author) :
Seto YO(1)(3), Kwok OL(1)(3), Leung CS(1)(3), Lam CY(1)(3), Wong WY(1)(3), Hui SL(2)(3), Lam PL(1)(3), Tse LK(2)(3), Lee PL(2)(3), Chan YH(2)(3), Chan CT(2)(3), Tang YY(2)(3)
Affiliation :
(1) Department of Medicine & Geriatrics (M&G), (2) Community Nursing Service (CNS), (3) Caritas Medical Centre (CMC)
Introduction :
Around 40% of all deaths in Hospital Authority involved RCHE residents who have repeated hospitalizations in the last 12 months of life without Advance Care Planning (ACP) discussion. Over 4800 elderly living in 66 RCHEs were covered by Caritas Medical Centre. Community Geriatric Assessment Team (CGAT) in collaboration with Palliative Care (PC) specialists is committed to providing quality EOL care to target residents with life-limiting diseases & chronic illnesses through holistic care and early discussion of ACP.
Objectives :
To enhance quality EOL care through training and onsite support
To identify terminally ill residents to formulate ACP with tripartite engagement
To facilitate adherence of ACP in the last patient journey
Methodology :
Two designed CGAT nurses and a PC nurse worked with Geriatricians, CGAT nurses and RCHE staff to roll out the program to 56 private & 10 sub-vented RCHEs. This was a retrospective study of residents recruited from Oct 2016 to Sep 2019. Patient’s demographical data, diagnosis, admission episodes, Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) order & treatment options, feedbacks from families were reviewed with data analysis conducted.
Result & Outcome :
Up to Sep 2019, 89% (N=59) of RCHE had joined the program, over 700 RCHE staff had received training. From Oct 2016 to Sep 2019, 401 residents and families were served with ACP discussed and 100% non-hospitalized DNACPR signed. The mean age was 87 years old (range 61-108) and 70% was female. 95% patients were mentally incompetent and only family members were involved in discussion. The principle diagnosis was advanced dementia (50%), CVA (21%), End stage organ failure (14%) & Malignancy (11%). Among them, 51% (N=204) opted not for mechanical ventilation, 37% (N=149) not prefer Ryle’s tube feeding. Overall mortality was 63% (N=254) with mean survival after entry of the program was 162.9 days, 21% (N=54) died in A&E and 79% (N=200) died in ward. The mean number of A&E attendance was 2.2 and the mean acute bed day in medical ward was 13 (in the last 90 days patient journey) in compare with before program was 2.1 and 20.4 respectively. The adherence of DNACPR order was 99.6% as one patient with CPR done in A&E. Other life sustained treatment decisions were adhered before death. All bereaved families rated ‘Agree’ or ‘Very Agree’ on ACP “can help to relieve their decision burden of EOL care” and “understand the disease with acceptance”. Conclusion: The program enhanced the quality of EOL care in RCHE. Residents’/families’ value, wishes and preferences were identified and actualized. Training to RCHE, CGAT and hospital staff was crucial to facilitate adherence of ACP wishes.
