Abstract
Background: This project is based in the geriatric department of Wye Valley NHS trust which serves Herefordshire and mid-Powys.
Introduction : In frail, older patients, cardiopulmonary(CPR) resuscitation has low rates of success. Lack of appropriately completed ReSPECT forms leads to futile attempts of CPR, repeated readmissions and patient harm. This project aims to improve patient centred advance care planning (ACP), and the quality of their documentation in the ‘clinician recommendations’ section in ReSPECT forms through development of new educational tools.
Methods: The Supportive and Palliative Care Indicator Tool (SPICT) was used to identify patients benefitting from ACP in the department. Data was collected on how many patients had ReSPECT forms and how well they were completed against standards adapted from the Resuscitation Council guidelines. Plan-Do-Study-Act(PDSA) cycle 1 was completed developing an aide-memoire (ReSPECT tool), and an interactive workshop. PDSA cycle 2 lead to design of the project poster titled ‘Revamp your ReSPECT discussions’ which was displayed on the wards, and shared on social media. PDSA cycle 3 was conducted to measure response and aid direction. Results: PDSA 1 showed 71% patients meeting SPICT criteria had ReSPECT forms. This improved to 82% by PDSA 3. PDSA cycle 1 revealed that only 32% of ReSPECT forms were completed to audit standards, by PDSA 3 this improved to 43%. The project received engagement from the wider healthcare community on Twitter/X where the project poster garnered over 36,600 views and has been shared in the trusts latest issue of safety bites.
Conclusions: Our work led to an improvement in the quality of documentation and illustrated a novel approach to communicating the standards expected when delivering patient-centred ACP. The interest received via social media highlighted the importance of sharing this experience. We plan on building on this success through wider communication of the standards.
Comments
Interesting work, have you thought about a follow on project looking at respect forms on discharge and if they are suitable for community settings or focused on hospital criteria.
That would be useful and would better reflect their final ReSPECT form prior to discharge. But the project does not focus entirely on the community setting.
The aim of the project is to make ReSPECT forms more useful in and out of hospital. The information in the ReSPECT form is also used as an inpatient by resident doctors who will provide care out of hours and should contain a clear ceiling of escalation of treatment, in terms of specific interventions. i.e. if patient has COPD if a limited trial of NIV is recommended/ not.
Therefore, we try to encourage reviewing ReSPECT status when patient is admitted to the geriatric department and updating the form on admission and on discharge.
Hope this answers your question.