Recording and sharing Advance Care Plans during a COVID-19 outbreak
At the end of Unit 4, you will:
- understand how to record Advance Care Plans during a COVID-19 outbreak
- understand how to share Advance Care Plans during a COVID-19 outbreak
- understand how to update Advance Care Plans during a COVID-19 outbreak
Recording Advance Care Plans during a COVID-19 outbreak
- Reflective activity: if you see a pencil throughout this section, take a few minutes to think about each question and if helpful, write down your answers.
Take a few minutes to think about how, and where, Advance Care Plans are currently recorded in your care home.
- How easy is it to locate Advance Care Plans in your care home?
- If you are unsure, who could you ask?
- Have processes changed as a result of COVID-19?
Following a Family Care Conference or advance care planning conversation, you will need to record the decisions and plans that have been made for the resident’s care.
What to record?
It is important to record the nature of the discussion, who was involved and their relationship to the resident and any decisions, wishes or preferences that residents or family members have made regarding future care. This includes information about any of the items covered in Unit 2, for example Do Not Attempt Cardiopulmonary Resuscitation (DNACPR).
It may also be relevant to record any worries or concerns that residents or family members have, or any areas where there are disagreements and a final decision has not been made.
It may be appropriate to record where there have been conversations with the family about best interests care decisions.
How to record?
When recording the Advance Care Plan, give as much detail and information as possible. Some decisions may need documenting legally for example, Advance Decision to Refuse Treatment and power of attorney. Document the dates of conversations, who they were with and by what means, for example phone or email. There may be policies in place in your care home about how to record this information.
During COVID-19, there is likely to be less face-to-face contact with family members, and more contact over email, telephone or video call. Some contact may be by letter. Therefore, it is important that you record any wishes or preferences that might be expressed during these informal day-to-day conversations with family members, outside of a formally timetabled Family Care Conference or advance care planning meeting. The same is true for day-to-day conversations with residents. In this instance, you may need to discuss any wishes that are expressed with a senior member of staff at the care home, in case these need to be discussed further.
Where to record?
Advance Care Plans should be recorded on both paper and electronic systems. This is particularly important during COVID-19, to ensure Advance Care Plans are easily accessible to a range of multi-disciplinary health and care professionals. Ensure the Advance Care Plan is stored safely and securely. It is important that Advance Care Plans are visible at the front of a resident’s file or care notes, and a statement is included on their notes to say a care plan is in place. This will make it more accessible in case it is needed in an emergency, and make sure it is transportable, in case a resident needs to be moved to a different place of care suddenly. You may want to consider having several paper copies of the Advance Care Plan to hand in case multiple professionals need sudden access to it.
In Scotland and Northern Ireland, the Key Information Summary is the national electronic system where an Advance Care Plan should be recorded. In England the Summary Care Record is the national electronic system and in Wales this is the Individual Health Record.
- Takeaway activity
Discuss with a relevant member of staff where Advance Care Plans could be kept for residents in your care home during a COVID-19 outbreak. Which health and care professionals can access different electronic systems? How can you ensure paper and electronic Advance Care Plan records are maintained and updated?
Sharing Advance Care Plans during COVID-19
It is equally important to ensure that Advance Care Plans are shared with all of the necessary health and care professionals, so that the wishes and preferences about future care are always available. The Advance Care Plan should follow your resident throughout their care journey if they leave the care home.
It is best practice to obtain and record consent before sharing an Advance Care Plan. During COVID-19, it may be necessary to share Advance Care Plans without documented consent, if this is within the best interests of the resident. You can discuss the policy for this within your own care home.
Unit 2 outlined who should be involved in advance care planning. The Advance Care Plan should be shared with these same professionals:
Out of hours healthcare provider
Emergency care providers
- Which local services and organisations would you need to contact for each of these categories?
- Are there other partners you work with that should also be included?
Updating Advance Care Plans during COVID-19
- Can you think of circumstances, particularly during COVID-19, that would require a resident’s Advance Care Plan to be updated?
As you know, life during the pandemic is very unpredictable. As such, it might be necessary to refresh or update the Advance Care Plan if circumstances change. Here are some occasions when it may be necessary to consider amending the Advance Care Plan:
- if the wishes or preferences of the resident or family members change, for example what treatment they might like to receive
- if the circumstances in the family change, for example a different key contact becomes more appropriate
- if the health of the resident changes or deteriorates suddenly
- if the cognitive capacity of the resident changes or fluctuates
- if local policies, procedures or guidance relating to COVID-19 changes
- if a resident is clearly entering the end of life stage, it might be appropriate to review their Advance Care Plan with family members
- Key point
If changes are made to Advance Care Plans, it is important that they are updated across electronic care records and paper systems. This means the updated version should be shared with the health and care professionals outlined previously. Outdated copies of the Advance Care Plan should be destroyed and replaced with up-to-date versions which are clearly numbered and dated.