{"id":2052,"date":"2024-03-20T13:03:22","date_gmt":"2024-03-20T13:03:22","guid":{"rendered":"https:\/\/blogs.bmj.com\/spcare\/?p=2052"},"modified":"2024-03-14T11:18:08","modified_gmt":"2024-03-14T11:18:08","slug":"a-different-approach-to-advance-future-care-planning-dnacpr-conversations-for-older-people-living-with-frailty-a-quality-improvement-project-for-nhs-wales-advance-future-care-planning","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/spcare\/2024\/03\/20\/a-different-approach-to-advance-future-care-planning-dnacpr-conversations-for-older-people-living-with-frailty-a-quality-improvement-project-for-nhs-wales-advance-future-care-planning\/","title":{"rendered":"A Different Approach to Advance & Future Care Planning DNACPR Conversations for Older People Living with Frailty – A Quality Improvement Project for NHS Wales’ Advance & Future Care Planning Strategy Group"},"content":{"rendered":"

Author Details <\/em><\/h4>\n

Laura Ellis-Lane\u00a0 B.Sc. Physiotherapy; M.Sc. Advanced Clinical Practice; PGC Falls and Osteoporosis; Professional Doctorate Candidate. <\/em>Consultant Therapist – Frailty \/ Older Peoples\u2019 Rehabilitation , <\/em>Care of the Elderly \u2013 East Integrated Health Community \u2013 Betsi Cadwaladr University Health Board, Wales, United Kingdom<\/em><\/p>\n

\"\"<\/a><\/p>\n

Dr. Wendy Wilkinson\u00a0 B.H.Sc. Occupational Therapy; M.H.Sc Occupational Therapy; Professional Doctorate; NICE Scholar. <\/em>Consultant Therapist – Frailty \/ Older Peoples\u2019 Rehabilitation <\/em>Care of the Elderly \u2013 East Integrated Health Community \u2013 Betsi Cadwaladr University Health Board, Wales, United Kingdom<\/em><\/p>\n

\"\"<\/a><\/p>\n

 <\/p>\n

Introduction:<\/strong><\/h4>\n

Traditionally, conversations relating to advance and future care planning (AFCP) and do not attempt resuscitation (DNACPR) decisions have been considered the responsibility of medical doctors. Over the past 10 years, the profile of the NHS workforce has changed. Key changes have seen a greater diversity in allied health professionals (AHP) and nurses stepping into senior clinical \/ consultant roles, responsible for the care of older people. These professions are required to hold advanced clinical practice (ACP) qualifications, clinical competencies and experience, often equivalent to their medical consultant counterparts. They will nowadays often be asked to get involved in senior reviews such as mortality reviews and discussions with coroners.<\/p>\n

 <\/p>\n

Background:<\/strong><\/h4>\n

In 2022, two consultant therapists were recruited to Betsi Cadwalladr University Health Board in North Wales (UK). These roles were designed to provide a pragmatic approach to managing frailty and older peoples\u2019 rehabilitation, in line with Welsh Government\u2019s Prudent Healthcare Principles (2016)[1]<\/a>. The daily work of these consultant therapists reflects many of the roles, values and responsibilities to those of a consultant geriatrician on a rehabilitation ward in the community hospitals, including being named senior responsible clinician (SRC). One of the tasks of the clinical role in dealing with seriously unwell patients with palliative needs and frailty, is to lead on Advance & Future Care planning and DNACPR discussions, sensitively eliciting the views of patients and those close to them, and fulfilling the duty to consult.<\/p>\n

In the last review of the All Wales DNACPR Policy (2022)[2]<\/a>, medical and nursing consultants were both named as being eligible to sign section 6 of the All Wales DNACPR form if they fulfil the role of an SRC in their organisation, but the policy was less clear and specific about consultant AHPs. Of course, not all AHP and nursing consultants work in a role where they accept the level of responsibility expected of an SRC, and of course not all work with frailty and in settings with a lot of palliative and end of life care. But there are many very senior and experienced AHPs, working for instance as Occupational Therapists, Physiotherapists or Paramedics and with training in palliative and end of life care, for whom these sorts of conversations happen weekly, if not daily.<\/p>\n

In the national all Wales DNACPR policy review scheduled for 2024, AHP consultants (with equivalent clinical knowledge, skills and competencies), will become eligible to discuss and endorse DNACPR decisions alongside their medical and nursing consultant colleagues. This has been recommended following a series of stakeholder engagement and quality assurance activities to ensure that this amendment is underpinned as being of sound quality, safety and acceptability by older people and those with palliative care needs nearing the end of life. This change is also supported by the Older Peoples\u2019 Commissioner for Wales[3]<\/a> as well as the Ruth Crowder the Chief Allied Health Professions Adviser for Wales.<\/p>\n

 <\/p>\n

Methods and Results:<\/strong><\/h4>\n

In 2023\/24, the following activities were undertaken in partnership with the All Wales DNACPR group.<\/p>\n