Anticipatory Care Plans

What was the issue you were addressing or working on?

This project focused on the implementation of Anticipatory Care Planning within all care homes in Lanarkshire and with the Community Nursing Services. This involved updating the ACP documentation, identifying ACP champions within care homes and community nursing and an intensive programme of education to ensure sustainability of the approach and to ensure preferred wishes for care are met.

What you did?

ACP is a process which enables meaningful discussion and recording of future healthcare wishes and preferences in advance to a deterioration of health. This process helps to empower and enable individuals to make informed choices about their own health and wellbeing and discuss any concerns with those close to them or involved in their care. This includes respecting individual choice and embedding dignity and care in practice. Essentially this captures all the essential qualities and requirements for establishing a robust mechanism for person centred care, whilst including best practice to build upon and improve care in Lanarkshire.

The project ran from May 2012 to May 2013.  Organisations involved in the project included independent care homes, North Lanarkshire Council and South Lanarkshire Council, Carers organisations and other voluntary organisations.  All community Nursing teams were involved as well as condition specific Clinical Nurse Specialists and the palliative care MCN.


What were the outcomes – benefits or otherwise?

Use of ACPs within care homes has increased.  33% of care home residents in Lanarkshire now have an ACP.

Community nurses offer anticipatory care planning to patients with complex and palliative care needs.

“I’m pleased to know that my preferences will be considered in the event that I am unable to make decisions for myself. More importantly that my wife and family are aware of my choices for the future and an ACP is an excellent way of capturing these.”  Mr William Steel Age 75

“ACP is being cascaded in our home. Staff are being educated and ACP is discussed with all new admissions”. Feedback from ACP questionnaire. Care Home Manager South Lanarkshire.

“ACP is recognition of empowerment for all our residents. We need to ensure choices and preferences are recognised” May Robertson. Care Home Manager

Contacts – to find out more

Janette Barrie,  01698 858293

Sheila Steel, Anticipatory Care Planning (ACP) Project Manager/Nurse Tel 01698 377784

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