Advanced Care Planning Flashcards
Who might an advanced care plan be especially relevant for?
- People at risk of losing mental capacity e.g. through progressive illness
- People whose mental capacity varies at different times e.g. through mental illness
What is an Advance Decision?
This allows you to write down any treatments that you don’t want to have in the future, in case you later become unable to make or communicate decisions for yourself.
- Legally binding
- If a healthcare professional ignores this, they could be taken to court
- Also called a living will or an advance directive
What is an Advance Statement?
This allows you to record your wishes, feelings, beliefs and values in case you later become unwell and need care or medical treatment. It helps:
- Explain how you’d like to be cared for
- Detail any values or beliefs that inform the decisions
- Helps make sure that if you lose capacity, your wishes are known and can be followed.
What is a Lasting Power of Attorney?
Allows you to give someone you trust the legal power to make decisions on your behalf in case you later become unable to make these decisions.
What are the 2 types of LPA?
- LPA for Property and Financial Affairs: covers decisions about money and property
- LPA for Health and Welfare: covers decisions about health and personal welfare
Why is it good to have an Advance Care Plan?
- Reduce uncertainty
- Prevent unwanted treatment
- Prevent unwanted hospital admission
- Determine future goals for end of life
What is included in the GSF Thinking Ahead Statement?
- At this time in your life, what is important to you?
- What elements of care are important to you and what would you like to happen in future?
- What would you not want to happen? Is there anything you worry about or fear happening?
- Who would speak for you - your nominated proxy spokesperson or LPA?
What treatment questions are in the GSF Thinking Ahead Statement?
- Do you have a legal refusal of treatment or ADRT?
- If your condition deteriorates where would you like to be cared for (different options or choices)?
- Do you have any special requests, preferences or other comments?
- Are there any comments or additions from other people you are close to?
What are appropriate stages in patients lives we could introduce ACP discussions?
- During admission to hospital if their condition deteriorates
- During GP reviews
- When admitted to a care home
- When patient/carer discusses end of life related thoughts and concerns
What is a DNA-CPR?
In some circumstances CPR may be perceived as inappropriate, futile or unlawful. It may cause unnecessary trauma leading to an undignified death or the prolongation of pain and suffering. It is important to identify these patients where CPR would be inappropriate and would prolong the process of dying.
What is a ReSPECT form?
- Recommended Summary Plan for Emergency Care and Treatment
- Summary of personalised recommendations for one’s clinical care in a future emergency which they do not have the capacity to make or express choices.
- Such emergencies may include death or cardiac arrest but are not limited to those events
What are the agreed realistic clinical recommendations for a ReSPECT form?
- Level 1: ward level care
- Level 2: HDU care e.g. non-invasive ventilation
- Level 3: ICU care (full escalation)
What are the values of the ReSPECT form?
- Reach shared understanding of person’s current health and how it may change in near future
- Identifying preferences in an emergency
- Record an agreed focus of care either towards life sustaining treatments or prioritising comfort
- Shared decisions about specific types of care and realistic treatment
- Deciding whether CPR is recommended
What are the major points about a DNA-CPR?
- This is a decision made by healthcare professionals, the relatives and patients do not have a right to demand treatment that is clinically inappropriate
- Does not apply in a reversible cause of person’s respiratory/cardiac event that was not envisaged when the DNA-CPR was made
- Can be reviewed regularly so can be taken away
