Ms Maree White1
1Nepean Blue Mountains Local Health District, Penrith, Australia
Biography:
Maree is a Clinical Nurse Consultant, working for the Nepean Blue Mountains Local Health District as the Advance Care Planning Coordinator.
She has been a nurse for 26 years, specialising in Supportive and Palliative Care for 15 years before moving into the Advance Care Planning Coordinator role.
Maree is passionate about delivering true person-centered care, using a shared decision-making model and believes Advance Care Planning is key to supporting consumers and their loved ones, as well as the health professionals who look after them.
Abstract:
Background:
In August 2023, Nepean Blue Mountains Local Health District (NBMLHD) established an Advance Care Planning (ACP) Coordinator role. Resuscitation Plans (RPs) emerged as a familiar and accessible tool in initial ACP discussions with clinicians. RPs document treatment goals and a plan in the event of deterioration, ideally following a goals of care (GOC) conversation. Recognising this clinician-led access point to ACP, and the availability of RP quantitative data, RP data systems were developed to support ACP implementation and engagement.
Aim:
To use Resuscitation Plan (RP) data to engage clinicians with advance care planning.
Method:
Clinical Excellence Commission (CEC) Death Review data were obtained to monitor RP presence at end of life. RP data were extracted from the electronic medical record (eMR) and visualised via a Power BI dashboard. Inpatient data from Inpatient Patient Management System(iPM) was filtered to exclude day-only, maternity, paediatrics, mental health and drug and alcohol admissions. Analysis focused on adult medical and surgical inpatients, with demographic data including age, diagnosis and Residential Aged Care Home status. Data are shared with specialty teams and embedded into meeting agendas to support clinician engagement.
Results:
Clinician engagement is increasing as trigger points for identifying people for important conversations develop.
–A 74% increase in patients dying with a RP in place in NBMLHD hospitals.
–A targeted ward project identifying patients at risk of deterioration led to a 215% increase in RPs completion over 12 months.
–Review of a medical specialty revealed that fewer than 18% of inpatients aged over 80 had an RP in place.
Conclusion:
Embedding ACP through RP data fosters practice change and improves outcomes for patients, families and clinicians. Sharing accessible, meaningful data and enabling peer comparison supports practice change, leading to culture change and service improvement.