Page 214 - Hospital Authority Convention 2018

Service Enhancement Presentations
HOSPITAL AUTHORITY CONVENTION 2018

F6.7 Enhancing Partnership with Patients and Community 10:45 Room 421

Enhancement of End-of-life Care @Residential Care Home for the Elderly in Kwai Tsing
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Yip TH , Law CB , Tong BC , Yeung KM , Tang WH , Chan WM , Wong YF , Heung LW , Lee WY , Tsing WL , Lit CH , Sham
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SF , Leung CS , Leung SY , Leung PS , Sit HS , Kwok OL , Leung CS , Lam CY , Tam KY , Seto YO 4
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Department of Medicine and Geriatrics, Community Nursing Service, Department of Accident and Emergency, Princess
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Margaret Hospital, Department of Medicine and Geriatrics, Caritas Medical Centre, Hong Kong
Introduction
In Hong Kong, there is about 8.5% of elderly living in Residential Care Home for the Elderly (RCHE). Frail residents with
terminal illness suffered from multiple co-morbidities and repeated hospital admissions received prolonged life treatment.
There are many barriers to deliver quality of dying for frail elders such as lack of end-of-life (EOL) care knowledge and skills
either in hospital or RCHE; time constraint for healthcare professionals to discuss elders’ advance care planning (ACP) during
consultation; feeling anxious and stress for coroner procedure from RCHE carer and families if frail elders passed away in
RCHE. In 2012, Princess Margaret Hospital piloted an “Elderly PEACE Programme” at two subvented RCHEs. With high
commendations from patients, family and stakeholders in hospital and community, an enhancement of EOL care programme
was supported by the corporate rolling out to other RCHEs in Kwai Tsing (KT) District in October 2017.
Objectives
(1) To enhance quality of EOL care and practice in RCHE; (2) to support frail elders/family developing ACP in RCHE; and (3) to
empower RCHE staff/family on EOL care.
Methodology
PMH developed an infrastructure of EOL care model at KT in 2012 and its enhancement phase was commenced in October
2017. The Programme was a five-year service plan to be implemented in 41 elderly homes, and beneficiaries would be about
6,000 elders. Key strategies were: (1) a series of tailored EOL education and skills training to equip hospital and RCHE staff; (2)
sharing forums to engage cross-sectoral stakeholders including public and private organisations obtaining their continuous
support towards the Project; (3) medico-social shared care to identify frail elders who suffered advance chronic irreversible
medical illness and families with will of comfort care at the RCHEs; (4) family conference(s) to discuss and confirm ACP
and Do-Not-Attempt Cardiopulmonary Resuscitation (DNACPR) decisions; (5) tele-medico-consultation to support prompt
symptom control and disease management as appropriate; (6) palliative care team supports complex case management
and skill transfer on EOL care; (7) agreeable care protocols and structural administrative workflow to guide operations and
practice across specialties and settings (12) regular meeting and feedback collection for performance review and quality
improvement.
Results
Up till February 2018, 309 staff in hospital and RCHE and families received EOL training. 66 frail elders and families joined
the Programme and confirmed their ACP at the RCHEs. The mean age was 89 (range from 61-108). 56% of them suffered
from advanced dementia while 12%-18% were stroke, end stage organ failure and malignancy. They had 33% risk of hospital
readmission according to Hospital Admission Risk Reduction Programme for the Elderly (HARRPE). 30% of them died
Tuesday, 8 May 2018 the death episode) was 1.05 and their medical bed days were 2.72 days. Families and RCHEs’ carers commented that the
within five months after recruitment. All of them had not received cardiopulmonary resuscitation or traumatic procedures
as planned. On evaluation of the deceased patients, after joining the programme, the average A&E attendance (including
elders stayed more time in their familiar environment with their loved ones during the last life journey. Hospital staff also
commended that the programme not only enhanced their EOL knowledge but also improved quality of dying experience for
institutionalised frail elders in Hong Kong.

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