European Geriatric Medicine - Supplement 1 - Volume 7 - October 2016

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are associated with poor prognoses. In such situations, physicians
tend to find themselves helpless, being able to offer very few if any
treatment options and instead finding themselves settling and offering
information and support to the patients and their family, symptom
and pain management, emotional and spiritual support, all in an effort
to make the patient as comfortable as possible. Most such cases with
poor outcome are treated actually according to the principles of
end-of-life care. These decisions are part of the day-to-day fabric of
treatment in the Geriatric department and fall under the principles of
palliative care. The Geriatrics department at the Western Galilee
Hospital in Naharia has become the flagship department for providing
palliative care to elderly patients in non-oncological settings. As a
result, patients in need of such care have been transferred to our ward
from internal medicine and other wards Our presentation will include
a detailed description of the principles of palliative care that we
implement in non-oncological settings in the Geriatrics ward, the
significance of such a treatment model, and howwe can transform the
Geriatrics wards in every general hospital into departments capable of
providing this kind care.
P-298
Considerations on the feasibility and acceptability of an advance
care planning intervention for dementia residents in UK care
homes
K. Brazil1, G. Carter1, D. McLaughlin1, G. Kernohan2, P. Hudson1,
M. Clarke1, P. Passmore1, K. Froggatt3. 1Queen’s University Belfast,
2University of Ulster, Newtownabbey, 3Lancaster University, Lancaster, UK
Objective: The purpose of this study was to articulate a family focused
Advance Care Planning (ACP) intervention and evaluate its impact in
dementia care nursing homes.
Method: As part of a cluster randomised controlled trial including 25
care homes, carers of residents living with dementia in 13 of these
homes were exposed to an ACP intervention comprising: an ACP
facilitator; family education; a family meeting; documentation of ACP
decisions; and, orientation for GPs and care home staff about the
intervention.
A feature of the evaluation included documentation on the inter-
vention delivery and stakeholder interviews to assess the feasibility
and acceptability of the intervention. The ACP Facilitator maintained a
narrative journal and activity log associated with tasks during the
intervention delivery. They also completed an interview to discuss
their perceptions of the implementation, challenges and benefits of
the ACP model. Participating care home managers (n = 10) and family
carers (n = 20) also completed an interview to determine their
perceptions of such a model.
Results: On average, administration of each ACP intervention took
two hours. Findings from the interviews highlighted the accept-
ability of the intervention, also the importance of such a role to be
fulfilled within the care home environment was stressed, however
time and staff restraints were noted as key barriers. Nonetheless,
the interest and motivation of staff to make such a role possible
was clear.
Conclusions: This presentation identifies the feasibility and perceived
acceptability of an ACP intervention suitable for dementia residents in
UK care homes.
P-299
Antibiotics at end-of-life
D. Cardoso, L. Fernandes, R. Morais, M. Malheiro, C. Rodrigues,
J. Dantas, J. Rodrigues, J. Pereira, E. Cacheira, I. Verdasca, A. Botella,
A. Leitão, C. Fonseca, L. Campos. CHLO-HSFX
Introduction: Literature suggests that antibiotics are commonly
prescribed at the end-of-life, despite lack of evidence of its benefit,
in the absence of clinical symptoms of a bacterial infection. Apart of
this, there are also public health issues regarding antibiotic resistance.
Objective: Characterize and quantify the use of antibiotics at the end-
of-life.
Methods: Retrospective, observational study evaluating the last 5 days
of life of all patients who died in an internal medicine service, in a
period of 13 months. Characterize the use of antibiotics prescription
regarding microbacterial isolation and the functional status of patients
(ECOG-PS). Data was collected after consultation of clinical charts.
Results: Were included 70 patients, in 46% the etiology of death was
infectious. 86% of were under antibiotics within the last 5 days of
life. In 72% there were no microbacterial isolation, and only in23%
the antibiotic was prescribed according to antibiotic sensivity test.
Reserve antibiotic were used in 92% of patients. In the study
population 48,6% had an ECOG-PS score ≥3.
Conclusion: Despite the absence of microbacterial isolation or even
clinical benefit, 86% of patients were under antibiotic in the last 5 days
of life. The indiscriminate use of antibiotics and its clinical benefit
at the end-of-life are questionable, unless the utilization aiming
symptom control. We should rethink the indiscriminate prescription
of large-spectrum antibiotics and the consequences for public health.
P-300
The introduction of advance care plans into care home settings
L. Cottrell. East Lancashire Hospital Trust, Ribble Valley, United Kingdom
Objective: the aimof this Quality Improvement Project was to improve
palliative and end of life care for patients within care home settings
through the introduction of advance care planning (ACP) through an
initial pilot.
Setting: 34 bed care home and a 47 bed nursing home. These catered
for patients with physical disabilities, general frailty and varying
degrees of cognitive impairment.
Methods: Quality Improvement Methodology was used for this pilot.
A review of the literature was undertaken alongside stakeholder
interviews and process mapping in order to gather opinion. A pre
hospital admission audit was undertaken to provide a baseline for
comparison in 12 months time. Plan Do Study Act cycles enabled
theories to be tested and adapted.
Results: 76 out of 79 patients and their families engaged with the
process of ACP. 52 Do Not Attempt Resuscitation forms were completed
in line with patient wishes. All patients had a frailty score documented
on their medical record to aid risk stratification and end of life care
planning.
Conclusion: care home staff and the majority of patients and their
relatives welcomed the introduction of ACP. This enabled patient
wishes to be documented, improved multi-disciplinary communi-
cation and end of life care planning through the use of frailty scores.
It is too early to say whether the project has reduced avoidable hospital
admissions. The project will now be rolled out across the remaining
seven care homes and the data analysed in full at the end of the project
in 12 months time.
P-301
Can the Charlson co-morbidity index guide inpatient resuscitation
and escalation discussions?
O. David1, B. Patel1, C. Baulch 1, K. Broomfield1. 1RBCH, England NHS, UK
Introduction: The Charlson comorbidity index (1) is a prospectively
applicable weighted estimate of future mortality that takes account
of the number and seriousness of comorbid disease. It is not used
routinely in NHS (UK) geriatrics to help facilitate end of life planning
or discussion.
Methods: We conducted a scoping audit of co-morbidities, resusci-
tation and escalation documentation on several of our geriatrics
wards to see if gathering additional data on co-morbidity might be a
practical aid to guide patient, family and clinician discussion.
Results: Sixty nine (n = 69) patient escalation and resuscitation forms
were reviewed, with ages ranging from 73 to 102. Resuscitation
wishes were either “unknown ” or “for ” in 42% (29/69). Those opting
“not for resuscitation” had clear documentation in only 21% (14/69).
Ward escalation decisions to deteriorating health were not clear in 55%
(37/69), and often not discussed with patient or relatives. 73% (50/69)
Poster presentations / European Geriatric Medicine 7S1 (2016) S29–S259 S108