A206: Widening the Treatment Escalation Plan beyond do not attempt cardiopulmonary resuscitation decisions within the Edinburgh Cancer Centre: is this happening enough?

Amy Armstrong1,Jenny Smith1,Jenna Schafers1,Louise Ratcliffe1,Moray Kyle1

1NHS Lothian, Edinburgh, UK

Presenting date: Monday 2 November
Presenting time: 13.10-14.00

Background

Explicit and specific anticipatory decisions about Cardiopulmonary Resuscitation (CPR) status and treatment escalation for any person who is approaching the end of life and or who are at risk of deterioration is important part of good-quality care. Acute oncology admissions warrant these decisions. Treatment escalation plans (TEP) are a means to facilitate an appropriate conversation and record clinical guidance to enhance patient care, and stop inappropriate treatments. They have been introduced into other trusts in a bid to improve patient involvement and experience of their treatment.

Method

Prospective ‘snap shot’ study to assess DNA CPR status discussion and documentation, escalation documentation, diagnosis and extent of cancer, co-morbidities and who performance status.

Following this, introduced a treatment escalation plan (TEP) document to cover and clarify a wider range of treatment options than DNACPR forms. Then further evaluation of patient notes.

Results

Only 8.7% of patients had any documentation within notes about escalation status.

50% of the patients had a performance status of 4, totally confined to bed or chair, cannot carry out any self-care. 61% of patients had metastatic disease and 36% with 1 or more major co-morbidities. Overall, 67% of inpatients were emergency admissions due to being acutely unwell.

Results 2 awaited – data currently being collected.

Conclusion

Edinburgh Cancer centre not good at recognising the impact of other medical comorbidities on likelihood of successful resuscitation attempt. Documentation was poor regarding DNACPR and advance escalation planning. Oncology patients can often be complicated, but even more reason to have plans in place to ensure provision of patient centered care in and out of hours. Do TEPs work well for oncology patients? Should they be standardised for all oncology departments?