Goals of Patient Care Summary
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- Jeffrey Wilkerson
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1 Poster Session HRT11420 Innovation Awards November 2014 Melbourne Goals of Patient Care Summary Presenter: Dr Barbara Hayes Hospital Code Name:
2 SIGNIFICANCE The Goals of Patient Care (GOPC) Summary: facilitates proactive shared decision-making to establish medical treatment goals & treatment limitations Person Centred Care Advance Care Planning Raising awareness It brings together Capturing & implementing prior planning Shared decision-making for potential deterioration Medical Treatment Goals Emergency treatment escalation and limits (CPR/MET) CPR/NFR decision-making
3 Key problem Summary Need for greater pro-active decisions for deteriorating patients regarding treatment escalation and limits Aim of Innovation Increased pro-active discussions / documentation re medical treatment goals + appropriate limits to treatment escalation What we did Introduced Goals of Patient Care Summary (based on Southern Tasmania Goals of Care) Outcomes Increased documentation of medical treatment goals / limits
4 KEY PROBLEM Medical Emergency Team must often make decisions about end-of-life care: For a patient they do not know In a crisis At a time when it is more difficult to have a detailed discussion with the patient / medical substitute decisionmaker / family / other clinicians who know the patient Could we do this better?
5 AIM OF THIS INNOVATION Goal of Patient Care (GOPC) to be completed for: All medical admissions Surgical admissions 65yrs+ Other patients as indicated To collect accurate patient information regarding Prior Advance Care Planning Medical substitute decision-maker To identify overall goals for medical treatment To identify appropriate treatment escalation and limits Aim for 80% of GOPC to be completed <48hrs
6 BASELINE DATA Multi-centre study of MET Calls at seven sites in Australia, Canada and Sweden (including Northern Health) Prospective one month study of MET Calls for 518 patients Results: One third of Medical Emergency Calls involve initiating medical treatment limitations or initiating end-of-life care Jones D et al. Crit Care Med 2012
7 KEY CHANGES IMPLEMENTED Goals of Patient Care (GOPC) was developed and implemented as part of Accreditation Standard 9 Pilot of GOPC on one ward GOPC amended and education updated Extensive health service-wide education; GOPC + Advance Care Planning + CPR decision-making Implementation of GOPC on all wards / withdrawal of previous Limitation of Medical Treatment forms Continuous feedback from ICU liaison / Admitting Unit Physicians feedback to wards and refined education
8 OUTCOMES SO FAR Treatment Goal Category A. Curative/Restorative no limitations B. Curative/Restorative with limitations C. Non burdensome treatment & symptom management D. Terminal care for dying patient % completed < 48hrs 81% 60% of 168 files of 169 files
9 LESSONS LEARNT Prepare well before implementing Consult widely with Senior Medical Staff, Nursing Staff to develop support and ownership and to get feedback Put in place education for all medical / nursing staff and advice about how to obtain further information Support from Senior Medical Staff is essential ICU and ICU liaison provide real-time feedback to treating team if called to Medical Emergency Call when appropriate treatment limitations have not been considered It takes time to bring about culture change
10 Further information Dr Barbara Hayes Palliative Care Physician & Clinical Leader- Advance Care Planning, Northern Health phone: Dr David Crosbie Intensive Care Physician, Northern Health phone; (03)
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