Around 50 per cent of deaths in Scotland occur in an acute hospital.
So, during this national Dying Matters week, two NHS Lanarkshire hospital consultants are raising awareness of the NHS Lanarkshire Hospital Anticipatory Care Plan (HACP) and the benefits it can have for patients, families and clinical staff.
The plan has been developed and implemented over the last two years.
Professor D. Robin Taylor, Respiratory Consultant at University Hospital Wishaw, said: “Better patient care starts with being honest about a patient’s situation and effective planning. The HACP summarises decisions about the need for treatment escalation or limitation if a patient’s condition deteriorates.
“The HACP prompts discussion about the likely benefits, or not, of major medical interventions. This is often an important question for patients. They do not want treatment that may be burdensome if it is not going to achieve any meaningful benefit. It is vital to good quality care that this should be openly discussed especially at the end of life.
“The HACP is designed to ensure good communication about what treatments are likely to be beneficial and to distinguish them from ones that are going to have no benefit or are contrary to the patient’s wishes. One size fits all is no longer acceptable.
“Another major aim of the HACP is to reduce the risk of medical harms in a crisis situation. This is especially important at nights or weekends.”
In a major study of 300 patients, Taylor and Lightbody have shown that the HACP reduces medical harms by nearly two thirds. Often this is due to overtreatment.
The theme of Dying Matters national awareness week this year is ‘What can you do?’.
Talking about death makes it more likely that a person will die as they might have wished and helps those left behind know they had a ‘good death’.
The HACP can help move this conversation into action. It is designed to encourage shared
decision-making so that medical interventions are realistic especially if the prognosis is changing.
Dr Calvin Lightbody, Consultant in Emergency Medicine at University Hospital Hairmyres, said: “Around 30 per cent of patients admitted to hospital are in the last year of life. Understanding a patient’s illness trajectory and considering their wishes about treatment are key elements underpinning the HACP.
“Although it may be possible to turn things around and stabilise things, for many the chances are that success will only be temporary. Another crisis is not just possible but probable and, when it happens, the challenge is to manage it well.
“The HACP has been welcomed by ward staff across NHS Lanarkshire as a means of recognising and communicating the goals of treatment consistently. It provides easily accessible information especially out-of-hours and at weekends.”
Photo: Professor D. Robin Taylor, Respiratory Consultant at University Hospital Wishaw.