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February 28-March 01, 2019 | Paris, France
Palliative Care, Obstetrics and Gynecology
Stroke and Clinical Trials
International Conference on
Joint Event on
International Conference on
&
Journal of Research and Reports in Gynecology and Obstetrics | Volume: 3
Advanced care planning in elderly patients admitted with neck of femur fractures - are standards
being met?
Jenna Bhimani
and
Georgia Lamb
St Mary’s Hospital, UK
Background:
A fractured neck of femur is the leading cause
of injury-related mortality in elderly patients, with around
one third of patients dying within 1 year. The Gold Standards
Framework recommend that advance care planning (ACP)
should be carried out for patients with general frailty and co-
existing conditions that mean they are expected to die within
12 months.
Methodology:
We assessed the standards of ACP in
patients over 65 admitted to a surgical rehabilitation ward
with neck of femur fractures over a 3-month period. 57
patients were included in this study. Patient notes were
analyzed for documentation of a discussion regarding patient
wishes, resuscitation status including ceilings of care and
communication of advanced care plans in discharge summaries.
In order to identify those patients most in need of ACP, frailty
scores were calculated using the Rockwood frailty score.
Results:
Out of 57 patients, 30 were classified as frail and 9
as severely frail. 33 patients had a documented resuscitation
status, of who three were for full escalation. 77% of patients
with DNAR decisions had further ceilings of care documented
and 30% had ACP discussions. Of those without recorded
resuscitation statuses, 40% were classified as frail and 78% had
more than 3 comorbidities. Only 2 patients in this cohort had
ACP. of those patients that did have ACP, 63% received inpatient
palliative. 81% of the patients who had ACP subsequently had
this documented on their discharge summary.
Conclusions:
Complete ACP is only being undertaken in 11%
of patients in a cohort with an expected 1-year mortality of
30%. Frail patients at increased risk of mortality did not have
resuscitation decisions documented. On admission with a
neck of femur fracture, frail multimorbid patients should be
recognized and this injury act as a prompt for ACP in the elderly.
Speaker Biography
Jenna Bhimani is a junior doctor working in Care of the Elderly Medicine at St Mary’s
Hospital, London, UK.
e:
j.bhimani@nhs.netJenna Bhimani et al.
, Res Rep Gynaecol Obstet, Volume 3
DOI: 10.4066/2591-7366-C1-002