Janette Barrie, from NHS Lanarkshire, discusses Anticipatory Care Planning.
In Lanarkshire, we started developing anticipatory care planning a few years ago. Our initial brief as part of the Scottish Government’s Long Term Conditions Collaborative programme, was to present an example of an anticipatory care plan (ACP) used within the care home environment. Although there was a plethora of different care plans, nothing fitted the Scottish government’s criteria of an ACP, so our journey began.
Our first steps involved searching the literature to clarify the concept, identify the ACP process and the core content of supporting documentation and resources. Unfortunately there was very little to be found in the available literature and the term ‘Anticipatory Care’ was also used in relation to a national Health Screening Programme which caused a degree of confusion.
We convened a stakeholder group to oversee the development of the ACP documentation and ACP processes ensuring that every possible group included. During the testing phase, it became clear that ACP could have a huge influence on person centred care, where and how a person could be cared for, and for ensuring patient’s wishes were met at every stage of their journey.
The essence of Anticipatory Care Planning is to help people with long term conditions to have the confidence, control and choice that comes with knowing what might happen, spotting small indications of change and being ready to do the right things with the right supports from the right people. It should be tailored to the stage of the patient’s condition and as such exemplify person centred and holistic care, and respect for the individual’s goals, wishes and choices (NHSScotland 2013). It’s also about collectively managing risk by working with individuals to help them adopt a “thinking ahead” approach to have greater control in the event of a flare up of their condition or what might be put in place should their carer become unwell.
Within the context of palliative care where the person’s condition is expected to deteriorate, the term anticipatory care fits under the umbrella of advance care planning. The aim of advance care planning is to develop better communication and recording of decisions ensuring patient’s wishes shared with those who need to know. The anticipatory element addresses the clinical aspect of the person’s care where the patient or carer are aware of any change in clinical symptoms and know what action to take should the person’s condition deteriorate. This includes recording the patient’s preferred place of care and their preferred wishes for end of life care. This aspect of anticipatory care planning is based on the discussion between an individual and their care provider, not necessarily a nurse. Indeed, some of our 3rd sector colleagues, Equals Advocacy and Carers groups, have been very active in supporting ACP. It is very important however, to remember patients wishes must be communicated to the GP to allow, with the patients permission, electronic sharing of this information. GPs are the gatekeepers of eKIS, so all information must be entered into the system by them.
The ACP discussion is completely voluntary and takes place in the context of an anticipated deterioration in the patient’s condition. ACP is not legally binding and the caveat exists that the patient has the right to change their mind at any time.
To raise awareness we have taken a proactive approach by implementing a programme of work to embed the use of ACP throughout Lanarkshire which included a very successful public awareness campaign. The intention is to get to a stage where it is common practice to offer every patient with a long- term condition an ACP which can range from a self-management plan through to end-of-life care plan (when appropriate). This will empower individuals and carers to identify early, any circumstances that may have a negative or detrimental impact on their health and wellbeing, and on their long-term condition. ACP’s provide individuals with an opportunity to make informed choices about their own health and wellbeing, and discuss any concerns with those close to them or involved in their care.
ACP is consistent with a number of strategies including A Healthier Future, 20:20 Vision and The NHS Scotland Quality Ambitions, all of which recognise the need for “working with people to ensure shared responsibility for prevention, anticipation and self management.
Janette Barrie, NHS Lanarkshire