30 Hospital avoidance – the role of advance care planning and IPOS in patients with heart failure

<h3>Introduction or background</h3> Heart failure follows a pattern of multiple hospital admissions in the final months of life; the final admission is thought to be avoidable in 29.5% of cases.¹ <h3>Aims and objectives</h3> Support Community heart failure specialist nurse reviews with Specialist Palliative care physician support and IPOS to : 1) explore advance care planning, 2) support symptom control via IPOS to avoid unnecessary hospital admission, 3) upskill Heart failure nurses in providing Palliative care <h3>Methods</h3> Patients thought to benefit from Palliative care input were identified through Heart Failure MDT or via the caseload of Community Heart Failure Specialist Nurses (HFSN) Patients were offered an IPOS and the HFSNs were trained in Advance Care Planning. Their confidence in this area was measured by a pre and post-intervention self-reported Thanatophobia and Palliative Care Self Efficacy Scale.^{2 3} Subsequent HFSN contacts were reviewed to monitor patient progress and admissions. <h3>Results</h3> 24 patients of a HFSN community caseload were offered an IPOS Serial IPOS scores for two patients demonstrate a reduction in burden of symptoms secondary to HFSN Palliative interventions Advance Care Planning: a review of caseload notes for the patients with IPOS suggests that 3 patients of a 24 patient cohort (12.5%) were able to avoid hospital admission in the final few months of life; secondary to ACP training and IPOS. Thanatophobia scales for the two HFSNs demonstrated a 32% and 43% reduction in distress in providing Palliative care and working with dying patients. <h3>Conclusions</h3> Upskilling HFSN to engage in Advance Care Planning and IPOS has supported Patients with symptom control and holistic support. IPOS was able to identify previously unaddressed symptoms of patients with Advanced Heart failure in the Community Hospital admission avoidance for End stage Heart failure patients is possible via Palliative care training for HFSN. <h3>References</h3> Failure to Function A review of the care received by patients who died in hospital following an admission with acute heart failure ncepod (2018) Mason S, Ellershaw J. Assessing undergraduate palliative care education: validity and reliability of two scales examining perceived efficacy and outcome expectancies in palliative care. <i>Med Educ</i> 2004 Oct;<b>38</b>(10):1103–10. doi: 10.1111/j.1365–2929.2004.01960.x. PMID: 15461656. Granat L, Andersson S, Hadziabdic E, <i>et al</i>. Translation, adaptation, and validation of the self-efficacy in palliative care scale (sepc) for use in swedish healthcare settings. <i>BMC Palliat Care</i> 2022;<b>21</b>:48.