Aims An audit of children and young person’s advanced care plans (ACPs) in two district general hospitals (centres A and B) against NICE guidance .
Methods Centre A: consultants were emailed to identify the population with ACPs.
Centre B: two consultants who write ACPs were approached for their patient lists, and the rest of the consultant body was emailed. Patient lists from both centres were cross-referenced with the community nursing teams and paediatric A and E.
Each ACP was reviewed to check validity, resuscitation plan, wishes during life and death, review date and distribution to members of the multidisciplinary team (MDT).
Results 12 children were identified in centre A, and 31 children in centre B. The majority of ACPs were for ACT category 4  (80% of ACPs in centre A, 69% in centre B). 80% of patients across both centres had demographic details and a resuscitation plan clearly documented. Wishes for life were documented in 50% of cases in centre A and 73% of cases in centre B. Distribution was variable and data was not available for some cases. Paediatric A and E was the most reliable place to find ACPs (80% in both centres) and GPs the least (only 50% of all patients where data was available).
Conclusions Centre B, where there are two dedicated palliative care doctors, had a higher number of ACPs. Centre B had improved documentation, including ‘flagging’ patients on the hospital IT system. Despite this, distribution of ACPs to members of the MDT was not improved. Both centres are developing ACP databases to contain a record of all patients with ACPs in one place, which will highlight review dates and distribution to the MDT. Resuscitation plans and demographics were clearly documented, and there is a move towards documenting ‘wishes for life’ at both centres. With greater awareness of paediatric palliative care needs and an increase in the paediatric population with life-limiting conditions, the importance of ACPs cannot be underestimated. With this, dedicated ACP co-ordinators may be required to improve distribution and review. Consideration of electronic formats held by parents may improve access to up-to-date copies of ACPs.
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