The implementation of "Goals of Patient Care" medical treatment orders in residential aged care facilities

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Residents in aged care facilities are often the frailest in our society. They regularly have issues with cognition which can hinder their decision making capacity and which deteriorates over time. Residents or substitute medical decision-makers (Persons Responsible) often complete advance care plans to help inform future medical decisions in case of clinical deterioration. The residential aged care facility “Goals of Patient Care” form is a medical treatment order based on the patients advance care plan or wishes. This serves as a communication tool for staff in the aged care facility, visiting doctors (regular or locum GPs), ambulance staff and emergency department staff. The form helps guide healthcare decisions made on behalf of the resident in both planned and emergency situations. The form is filled in with the resident, or substitute medical decision maker, if the patient is unable due to presence of dementia. Residents’ GPs will be invited to be involved in the process also. We intend to implement the form in 3-4 pairs of residential aged care facilities. In each pair will be one facility using the intervention and one not using it. We will compare outcomes in both the intervention facilities (using the medical treatment order) and the control facilities (not using the medical treatment order). This comparison will look at residents’ usage of hospital services, including emergency reviews, emergency admissions, length of stay and outpatient reviews, to see the effect “Goals of Patient Care” has on these. We will also gather baseline characteristics on all residents involved including their previous 12 month hospital usage. We will investigate the uptake of the “Goals of Patient Care” form, ability of the residents to make healthcare decisions, presence of dementia without diagnosis in the residents, and death and place of death of residents. Our qualitative outcomes will include improvements in communication, ease of medical decision making and effect on conflict. We will gather data up to 12 months after the implementation of the form. We will survey the healthcare workers prior to implementation, and organise focus groups and brief interviews to investigate our qualitative outcomes with the healthcare providers involved at 6 and 12 months.