Introducing Anticipatory Care Planning to a Movement Disorder Clinic in a Day Hospital

What was the issue you were addressing or working on?

Formal Anticipatory Care Planning and recording were not carried out within the Day Hospital (Medicine for the Elderly). Ensuring that anticipatory care and forward planning are introduced at the most appropriate time in an older person’s life is crucial to planning future care. The team agreed that patients who attended the Movement Disorder Clinic would be most appropriate due to their diagnosis of a degenerative long term condition and in addition these patients are well known to the team and are reviewed regularly.


What you did?

The pilot provided dedicated staff time for the purpose of introducing Anticipatory Care Plans (ACP) for patients attending Day Hospital (Movement Disorder Clinic) Commencing in March 2013 the pilot will run for 12 months.  Discussions with patients are based on the context of an anticipated deterioration in the patient’s condition. Patients and carers are seen at the day hospital and the ACP is developed through a patient centred discussion. Data is being collated throughout the pilot.

An additional 11.5 hrs of staff time dedicated to the development of ACPs was established. Staff nurses attended training offered by Palliative Care Teams and arrange to see patients privately within the Department to complete the ACP. A Standard Operating Procedure was drawn up and agreed by the Multidisciplinary Team. The staff nurses contact the patient either at a routine appointment or by telephone. Nursing staff firstly liaise with the Patients GP and if ACP not in place, then information is given to the patient and their consent obtained to progress. The discussion with patients and carers is entirely voluntary and recorded on the agreed NHS Tayside ACP form. Following completion a copy is shared with the patient, GP and medical notes and a review date is set.


What were the outcomes - benefits or otherwise?

As at September 2013, 74 patients were offered ACP’s of which 38% have completed these, with 24% declining. Common reasons given by patients declining are that they felt it wasn’t the right time for them to consider their future or felt it was unnecessary. 26% of the patients have still to respond to the offer and follow up arrangements are in place. A common reason for the delay is that the patient has not yet spoken to the family/carer.

Patient/carer evaluation has commenced in the form of a patient questionnaire and we are awaiting responses. Benefits will be fully realised or otherwise following analysis of the patient evaluation. Until we have all this information it is difficult to say if we would do anything differently. Further evaluation planned is whether this process has helped to avoid unwanted or unnecessary admissions to hospital.

All staff agree that progress with making the ACP an electronic document which can be shared between primary and secondary care is key to having this document readily accessible in the event of deterioration in a patient’s condition. This is something NHS Tayside is currently progressing.

In completing the ACP have patients are provided with an opportunity to consider future health in a ‘thinking ahead’ discussion in the context of an anticipated deterioration in their condition, express their care  preference alongside a nurse with working knowledge of their condition and allow for this to be recorded and shared with the health care professionals involved in their care. Patients reported to the nurse that they found this to be a positive experience.


Contacts - to find out more

Gillian Phimister,  Gillian.phimister@nhs.net