What tools can we use?
As health care professional we will find some planning tools more useful than other, however we should still encourage everyone to think about all the different tools.
- Anticipatory Care Plans
- Power of Attorney
- Emergency Care Plans
- Carer Support Plans
We need to use these records as a foundation for all clinical decisions that we make. We should always try and involve the person and those that matter to them as much as possible when making treatment plans.
Anticipatory Care Planning (ACP)
An ACP is one of the most important documents that we can help people with. It is a record of what matters to them and information that will be useful in making any decisions. If someone loses capacity, or we cannot discuss the situation with those that matter to them, we can use the record of discussion to help us make decisions.
Power of Attorney (POA)
If someone has a welfare Power of Attorney, and they have lost capacity, we must include the attorney in the discussions. Even if someone still has capacity it is a good idea to try and involve the attorney where possible.
If someone is admitted to hospital, or is likely to be admitted we should enquire about emergency care plans and where possible help to implement them. These emergency care plans will often identify things which people may be concerned or stressed about e.g. a family member or pet. By helping to quickly resolve issues we can make people feel less anxious.
Anticipatory Care Plans – Information for Professionals
What is an Anticipatory Care Plan?
Anticipatory Care Planning helps people to think ahead and understand their health. It helps people know how to use services better and it helps them make choices about their future care.
This is a process and should involve ongoing conversations between a person, the people that matter to them and the health care professionals involved in their care.
The decisions made during these conversations are recorded in an Anticipatory Care Plan.
The plan should include:
- a summary of discussions
- a record of the preferred actions, treatments and responses that care providers should make following a decline in health
ACPs will often include information about care at the end of life. This includes where people would prefer to be cared for and their wishes about different treatments, including resuscitation. All these discussions should be had sensitively and with consideration.
How do I use an ACP to inform Care?
People’s wishes and the wishes of those that matter to them, must always be taken into account when deciding on treatment plans. By doing this you will make a plan specific to this individual and based on what is important for them.
An ACP can help us plan for where treatment should be delivered and this in turn may lead to discussions about the level of treatment which can be provided in these locations. It is important that we come to an understanding with people regarding their health goals so that we can make realistic plans.
What is the difference between a Treatment Escalation Plan (TEP) and an Anticipatory Care Plan (ACP)?
What is a TEP?
A Treatment Escalation Plan (TEP) is a document which is completed during a hospital stay (usually on admission or following a change in circumstance). This document records decisions related to escalation of treatment, and the investigations and interventions that are deemed appropriate in the event of deterioration. The aim of this process is to give clear instruction so as to avoid any unnecessary or non-beneficial interventions at the end of life.
A TEP is only valid until a the person is discharged or has died. Upon each new admission a new TEP must be completed.
What is an ACP?
An Anticipatory care Plan (ACP) documents the goals and preferences of the person, which may include decisions about end of life care and treatment. This helps everyone make a unique treatment plan which reflects the person’s wishes and values. An ACP is a record of ongoing discussions which may evolve as circumstances change. An ACP may be used in acute or community settings. Anyone may have an ACP and the document is valid at all times.
An ACP may inform what information is recorded in a TEP (review the Portal ACP on admission). Similarly any new discussions or decisions that are made when making the TEP should be recorded on the Portal ACP so that colleagues out-with acute setting have all the relevant information they require.
More information on TEPs is available on the NHSGGC Realistic Medicine webpages.