Despite an ongoing pandemic, St. Andrew’s Community Hospital’s successful initiative saw the extension of Advance Care Planning beyond the Palliative Care ward to the Rehabilitation ward.
Save for a rainy day, prepare for our future, what would you like to do when you grow up, what are your retirement plans. These are some commonly heard sayings as we go through life in Singapore. We make many of such preparations but what about our health?
We can also make plans for our future health.
Due to restrictions as a result of the COVID-19 pandemic, I found myself serving in St. Andrew’s Community Hospital (SACH) for six months longer than I had anticipated. Harbouring a passion for Advance Care Planning (ACP), my initial efforts to learn more about this work blossomed into a full-fledged effort to introduce ACP into the Rehabilitation ward of SACH. A Quality Improvement Initiative was started in July after discussions with team members during the Circuit Breaker. Patients admitted into the ward are usually elderly and have suffered a health-related setback such as a stroke, a serious infection or surgery, and require some time to regain or improve their functional state. They prove to be a captive audience between therapy sessions!
ACP influencers, who are staff such as nurses, pastors and therapists, were trained to reach out to patients and their families to raise awareness of ACP. Using materials such as videos, brochures and workbooks from the Agency of Integrated Care, the team found that there was interest among patients in attending ACP awareness sessions.
During one such session, a patient raised his hand to show interest in having the discussion in the hospital. Another heard how we engaged another patient on ACP and said he too wanted to do it all along but did not have the time, and “this is the best time for me to do so while being an inpatient”. Some patients who live alone felt assured that they have been given the opportunity to think and discuss their end-of-life care plans. This only goes to show that many do wish to talk about how they wish to be cared for when they reach the end of their lives and to share what is important to them.
Our multidisciplinary team was really thrilled that this little project yielded very encouraging results. Over 30 patients in just one ward managed to complete an ACP discussion with a facilitator over a span of six months. Families have expressed gratitude towards the ACP team, as now they know more about what their loved ones would like for their future and will not feel guilty at making a wrong decision. They are thankful that these discussions bring the family closer together. Our staff awareness has also increased through this initiative and they are now more capable of carrying out an ACP discussion.
We aim to eventually roll out this initiative to the rest of the wards in SACH.
This year may have bought great disruption to the world. Amidst this, I was glad for the opportunity to carry out this life-affirming initiative and leave a legacy for others to build on.