New tools to promote Advanced Care Planning

For health-care workers, it can be one of the toughest conversations to start. But more and more, Advanced Care Planning (ACP) is being recognized across the country as having immense value, for both patients and caregivers alike.

ACP is all about talking to patients and their families about their values and wishes for end-of-life care. Here at Kingston General Hospital, we are now unveiling some new tools to help bring these discussions to the forefront.

"Our big goal with ACP is to be proactive, so we are discussing it early and often with our patients," says Kathy Kittner, Elder Life Nurse Specialist. "What we want to avoid at all costs is having these conservations with patients and their loved ones when they are in crisis, as no one reacts well in those sorts of situations."

To get things going, our Medicine program has unveiled some new tools for its staff and physicians to use, including 'Quick Tips' and 'Check List' sheets.

The 'Quick Tips' page gives caregivers some suggested questions they can discuss with their patients, such as, "What do you understand about your illness or what is happening to you?" and "Do you have the information that you need to make decisions about the kinds of treatment you want or do not want if you become very sick with a life-threatening illness?"

As for the new "Check List,' it then helps caregivers ensure they are covering all the bases during these talks and reminds them to create a record of it.

"It's important for us to always know what our patients want, and have their families know about it as well," says Kittner. "We don't want to be carrying out inadvertent and invasive procedures on patients if this is not what they requested from us."

The 'Quick Tips' and 'Check List' have now been hung on the back of every charting box on our Medicine inpatient units. To help reinforce them, ACP is also now being mentioned during the daily board rounds that happen on these units.

"During these rounds, the health-care team gathers to discuss each patient and Advanced Care Planning will now be brought up regularly as a gentle reminder to everyone to have these talks with every patient if it hasnít happened yet," she says.

Another important piece of the puzzle is to ensure all these conversations are then documented properly by staff and physicians and that they are easy to find in the patientís chart, along with other related documentation. To help with this, work is now underway to create a special ACP tab in each chart.

"All of our research shows that patients really appreciate Advanced Care Planning. They feel respected and heard and that they are part of the team with a real choice in their care," says Kittner, "It's all about engaging our patients and listening closely to what they are saying, which is what KGH is striving to achieve on many fronts."