P-18 Continuous quality improvement to increase ACP visibility in inpatient wards

Background Regular audit from 2012 to 2014 revealed six incidents of patient’s advance care plan (ACP) being missed by inpatient medical care, resulting in incongruence of medical treatment with patients’ ACP. Aim To enhance the visibility and awareness of completed ACP form in the general wards at a restructured hospital by piloting ‘EOC/ACP’ folder for EOC (Extent of Care or medical order) form and duplicate of ACP form. Methods The ‘EOC/ACP’ folder was piloted in a few inpatient wards to enhance visibility of EOC and ACP forms and to remind medical team of patient’s ACP. Roadshows were done to present new workflow to hospital clinical and nursing leadership. The emergency department staff was engaged as well to remind doctors to print copies of ACP forms from patients’ electronic medical records to be handed over to the admitting ward team, for filing into the ‘EOC/ACP’ folder. Continual education is planned for new staff such as doctors and nurses on new workflow. Results Feedback received from medical and nursing teams were encouraging and this ‘EOC/ACP’ folder will be rolled out to the general wards in phases. Discussion As the ACP team implements the ‘EOC/ACP’ folder in the wards, the team will conduct regular audit on congruence of care delivered with patient’s ACP preferences upon patient’s death. Further enhancements include having an ACP alert, and a link to the national ACP IT system in the electronic patient records. Conclusion The ‘EOC/ACP’ folder is a quality improvement tool that aims to eradicate incidence of patient’s ACP being missed in inpatient wards.