040Advance Care Plans – A Missed Opportunity?

Abstract

Background: Nearly half of all deaths in Ireland occur in hospital [1]. We aimed to review the deaths under our service, and evaluate the use of Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) forms and the presence or absence of Advance Care Plans (ACP). Methods: This was a retrospective chart review of patients admitted on unselected take over a 12 month period. Results: Of 679 patients admitted, there were 73 deaths. Data were available on 71/73, median age 80yrs old. 83% (59/71) were admitted from home, and 15% (11/71) were admitted from nursing homes (NH). 62% of those who died (44/71) had a life-limiting illness, dementia being the most common (27/44). 3/71 patients had an ACP. 7/11 NH patients had no documentation of resuscitation status in their transfer letter. DNACPR decisions occurred in 68/71 prior to death. The median time from completion of the form until death was 7.5 days. The DNACPR decision was discussed with only 1/68 patients. The decision was discussed with family in 54/68, and there was no discussion with either the patient or family in 7/68. Conclusions: Death is common, with almost one in ten patients dying during their admission. There is also a high burden of multimorbidity, but despite this, uptake of ACPs was low, especially in the frail NH population. It is challenging to involve the patient themselves during the acute phase of their illness and indeed may add to their distress. Consideration should be given to the timing of these decisions and the expanding role of ACPs. A wider societal discussion and public education programme around DNACPRs and ACPs are essential components in improving these important and challenging discussions.