PG65 Experiences of a pilot in-situ simulation course for advanced care practitioners in the emergency department to sign do not resuscitate forms for patients approaching the end of life

Abstract

Introduction Emergency Medicine is a unique speciality often meeting people at the worse moments of their life. Death is an everyday occurrence, and with that comes the skills needed to talk to patients and families about when their end of life may be nearing. The Royal College of Emergency Medicine‘s guidelines suggests health care practitioners need the skills to talk to these patients. Within our department, we have advanced care practitioners (ACP) working as independent practitioners. These ACPs come from a nursing, paramedic or physiotherapy background. They have had further masters level training to do this role. Our department advocates early conversations with patients who have a frailty score of 7, 8 or 9 as per the Rockwood frailty score. With our hospital supporting the signing of do not resuscitate forms by ACPs, provided they have had sufficient training. Methods We developed a full day course in October 2019 which incorporated some lecture-based teaching and then in-situ simulations within the emergency department. Teaching topics covered difficult conversations, do not attempt cardiopulmonary resuscitation and legal aspects. The four simulations were Scenario 1: An end Stage COPD patient who was on the maximum of medical intervention. Scenario 2: A very frail patient who had multiple comorbidities and presents with another pneumonia. Scenario 3: A patient with a GI malignancy who has a massive bleed. Scenario 4: A frail patient who has a head injury on warfarin. Our aim was to gather feedback to see what educational benefit this brought to our ACPs. Results 9 participants completed the pilot course, none of which had, had formal training to have this type of conversation. This is despite these ACPs all having a minimum of 5 years post qualification. All felt their confidence had increased from no confidence to neutral or fairly confident. They also felt this was useful for their training. Discussion and Conclusion This course has provided our ACPs the skills and confidence to have these difficult conversations with patients. Despite the small numbers involved it is positive first step. More work is needed in order to understand the clinical impact.