Background/Introduction:
Three decades old Advance Care Planning (ACP) documentations which include Advance Care Directive (ACD), Goals of Care (GOC) and surrogate or Medical Treatment Decision Maker’s (MTDM) records are essential for elderly patient care in maintaining concordance with their wishes as patients visiting the emergency department (ED) may sometimes present with cognitive impairment either because of an acute medical episode or chronic condition affecting their decision-making capacity. The no visitor policy implemented by clinical facilities during Covid peak cycles magnified the necessity of this records.

Aim/Purpose:
Our studies aim was to review the prevalence of ACD documents and validity of MTDM contacts in patients records at clinical facilities and cross reference with Victoria states data as maintained in the Victorian Emergency Minimum Dataset (VEMD).

Methods/Intervention/Activity:
Mixed methods were used in our studies which included an observational and cross-sectional designs in a before and after study. Interventions included undertaking further studies such as validation study on MTDM records, reporting on VEMD, Health Information System upgrade, staff education and hospital wide integration.

Results/Outcome:
Many eligible patients’ files lacked ACD records, performance at 8%, GOC (37%). Twenty percent (p=0.046) of staff were found to be aware of ACD records existence, location and its legal requirements while 49.3% (P<0.001) were found to have similar awareness about GOC. Valid MTDM record at 76% with 59% (p=0.023) of this being accessible.

Conclusion/Recommendations:
Given the consistently poor performance of ACP documentation over its lifetime for the most eligible patients, it is time to critically review its prominence.

AObjective: Advance Care Planning (ACP) is a legal document outlining the wishes made by a patient that relate to treatment options that are in their best interest. However, there is increasing evidence that an ACP that has previously been documented does not always benefit the current prognosis of the patient. Therefore, the aim of this study was to explore the experiences of Australian emergency doctors and nurses concerning the use of the of previously documented ACP at the point of care for patients and their families.
Methods: A qualitative study guided by an interpretative approach was employed. Semi-structured interviews were conducted with (n= 16) emergency department doctors and nurses across Australia. Data were thematically analysed using Dieklemann’s seven-stage data analysis.
Results: An analysis of the 16 interviews resulted in 4 major themes: (1) Benefits of Advance Care Planning; (2) Lack of ACP knowledge; (3) Communication; and (4) Availability of ACP information.
Conclusions: From the findings, ACP decisions were believed to be beneficial in decision making when patients, families, and ED staff, agree with the decision made. ACP decisions were often made a long time ago but were still used to open and start conversations around goals of care that were relevant to the patient’s current situation. Findings in this study further reinforced that the previously documented ACP was beneficial when used alongside goals of care at the point of care. Communication around advance care planning were suggested by some participants to be changed to goals of patient care.
Keywords: Advance Care Planning, Emergency Medical Services, Nurses, Patient Care Planning, Physician.

Background: Emergency nurses have long provided end of life care to dying patients in the emergency department. The challenges of the emergency department environment as a place to provide end of life care, including availability of resources, the emotional impact of caring for patients at the end of their life, and the communication barriers experienced by emergency nurses have been reported in the literature. Anecdotally, the COVID-19 pandemic resulted in changes to end of life care delivery, yet these were not reported in the published literature.

Aim: This study aimed to explore the experiences of emergency nurses who provided end of life care during the COVID-19 pandemic

Methods: A qualitative descriptive methodology was used for this study, with semi structured individual interviews conducted. Victorian emergency nurses, who worked during the pandemic were included as participants. Thematic analysis was used to analyse the data collected.

Results: Participants discussed and highlighted the following changes to end of life care provision specific to the COVID-19 pandemic; the strength of the emergency nursing team, the detriment of staff shortages due to COVID-19, communication barriers, confusion of visitor restrictions and family time envy.

Conclusion: This research examined how emergency nurses’ experiences changed when providing end of life care during the COVID-19 pandemic. The changes outlined prior to COVID-19 were consistent with the findings during COVID-19, albeit with added barriers, such as visitor restrictions, communication difficulties and empowerment from the nursing team as a whole.

Background/Introduction:
At Campbelltown we have recognised the need to help create a culture of collaborative communication and shared decision making with patients particularly at the End of life. We also understand the need for this vulnerable patient group to receive individualised care in a way that is consistent with their wishes in a private and comfortable space. Furthermore, we acknowledge the ED is not traditionally set up to provide this. So during the redevelopment of Campbelltown ED we applied for a Health Facility Guideline Variation to have a purpose built EOLC room. This was successful and we now have a dedicated EOLC Room, Named ‘Nanga Mai’ which our local Dharawal Elders translate ‘to dream’
Having Nanga Mai enables us to provide patients and loved ones with the individualised and holistic care they deserve without being subject to the chaotic surroundings of the greater ED.

Aim/Purpose:
To investigate staff views of caring for patients in a dedicated EOLC Room - Nanga Mai.

Methods/Intervention/Activity:
Approximately 100 staff have been surveyed so far regarding their experiences when providing care for patients in Nanga Mai.
We have asked about:
- The best aspects of the room
- Individual experiences
- Layout and design
- Co-located facilities
- Challenges
- Suggestions for improvement

Results/Outcome:
Preliminary data has been overwhelmingly positive across the responses.
Particularly around having a space big enough that allows families and patients to spend extended time together and also involved in the care of their loved one which is important for their grief.
The surrounding facilities to the room include a Toilet, Kitchenette and separate breakout space which have all be reported to be the best aspects of the room.

Conclusion/Recommendations:
We would like to share this resource with our ED colleagues across the country and use this work towards improving the care provided to patients and their loved ones across all ED’s.