3458 Advanced care plans on older person medicine wards at Queen Alexandra Hospital, Portsmouth

Abstract Background Whilst working within the Older Person Medicine (OPM) department, we noted that there were many frail patients who were not having Advanced Care Plan (ACP) discussions. Our preliminary retrospective data collection showed that 39% of OPM inpatients died within a year of their admission. Patients with a Clinical Frailty Score (CFS) >7 or > 2 admissions in the last year were at highest risk of this 1-year mortality. Aim Our quality improvement project aimed to highlight patients in which an ACP discussion may be appropriate and therefore improve the frequency of ACP discussions and their documentation, especially on the discharge summary for their General Practitioner (GP) and other Allied Health Professionals to access. Methods We developed a sticker which was placed in the medical notes of patients who met our inclusion criteria (CFS ≥ 7 and > 2 admissions in last year) during a 2-week period in April/May 2024. This acted as a visual prompt to clinicians to consider ACPs and document if discussions had been initiated. It also prompted transcribing this information onto hospital discharge letters. Results Following our intervention, within 2 different clinical areas (OPM Same Day Emergency Care (SDEC) and an OPM inpatient ward), there was an 88% increase in the number of ACPs being completed for the appropriate patient cohort. Conclusions We expect that an increased number of appropriate ACPs being completed will result in reduced numbers of inappropriate hospital readmissions for patients who would be best managed in the community, including primary care. By more clinicians taking part in ACP discussions, we expect staff will feel more confident in having these conversations and subsequently ensure that the patient remains at the centre of all care, respecting their autonomy and involvement in shared decision making with regards to their health and advanced wishes.