European Geriatric Medicine - Supplement 1 - Volume 6

S82

Poster presentations / European Geriatric Medicine 6S1 (2015) S32

–

S156

Methods:

A retrospective analysis of 350 consecutive patients

evaluated over a 18 month period in the geriatric clinic of the

University Hospital of Nancy.

At the beginning of the consultation, two questions were asked:

“Do you know why the oncologist sent you?” and “What is the

nature of your illness?”

Results:

60% of 350 patients did not know why they will be

evaluated by a geriatrician. This was due to the fact that the

oncologist had poorly explained the reasons and principles of

this consultation. 55% of patients did not know that the lesion

was cancer. The greater part of the time, they had forgotten the

diagnosis because of cognitive impairment. During the consultation,

the cancer diagnosis was announced, and patients were not

surprised.

Conclusion:

In France, the diagnosis of cancer is mandatory,

whatever the age. However, the great majority of the patients is

unaware of their disease, and the reason of their consultation.

Often families prefer not to inform their parents of the presence of

a serious illness.

P-190

Capacity assessments in DNAR orders

M. Rouhani

, A. Kawsar

, T. Dessain

, S. Nathwani

, J. Day

N. Dossetor

, B. Miller

NHS, London, United Kingdom

Objectives:

Clear documentation of capacity is essential in order

to maintain patient safety, autonomy and medico-legal clarity. The

aims of the study were to evaluate whether clinicians are formally

assessing capacity, using a recommended hospital proforma or

otherwise, when implementing a DNAR in patients deemed to lack

capacity.

Methods:

Data was collected in patients deemed to lack capacity

with DNAR orders, across geriatric and acute medical wards at a

large tertiary hospital, over April to May 2015.

Data collected included patient demographics, documentation

of capacity in the notes, documentation of a formal capacity

assessment and the use of the recommended hospital capacity

proforma.

Results:

Total sample size was 40 patients, with a mean age of

85 years. A ‘Lack of Capacity’ statement was documented in the

notes in 5% of cases (n = 2). None of the cases (0%) had either

documentation of a formal capacity assessment, or a completed

hospital capacity assessment proforma.

Conclusions:

The results of this study suggest there is very

poor formal documentation of a mental capacity assessment in

patients who are deemed to lack capacity on their DNAR form.

This could have profound implications in cases where capacity is

fluctuant or where a discussion could not be had with relatives.

A revised hospital capacity assessment proforma has therefore

been implemented and the relevant teams informed. This new,

revised form aims to aid decision making, which many clinicians

find particularly difficult in such patients, and provide clear

documentation for the patient records. Re-audit pending.

P-191

DNACPR and Mental Capacity Act documentation

–

prospective

study

S. Saber

, V. Melchionda

, A. Kayani

, C. Mohanan

, N. Veale

J. Crook

, A. Qureshi

, S. Jessani

Broomfield Hospital, Chelmsford, United Kingdom

Objectives:

This study aims to investigate the completion of

DNACPR forms, documentation of Mental Capacity Act 2 (MCA2)

forms where applicable and involvement of patients/families in

decision-making.

Methods:

This is a prospective, cross-sectional study. The seven

medical wards were examined for patients with DNACPR forms.

Each patient’s demographics, clinical information were retrieved

and DNACPR forms scrutinized.

Results:

77 patients with DNACPR forms were found on medical

wards at a single point inspection. The average age was 82

years and half were male. 39 (51%) patients had co-morbidities.

61 (79%) had life-limiting conditions. The commonest reason for

admission was fall or confusion (32%) followed by shortness

of breath/Pneumonia (29%). The most significant reasons for

completing a DNAR form were largely frailty, poor reserve and

multiple co-morbidities (45%), followed equally by cancer and

respiratory/cardiac diseases (13%). However, no reasons were

recorded in 11 (14%) cases. Only 30 (39%) patients and 47 (61%)

families were aware of the DNACPR decision made. Discussions

with patients or families were not always recorded, 10% and 6%

respectively. Where patients had no capacity to consent to DNACPR,

only 4 (10%) cases had MCA2 forms completed. The vast majority

of forms, 63 (82%), were signed or counter-signed by consultants,

while only 14 (18%) by Registrars.

Conclusions:

Greater care is needed to ensure indications for

DNACPR are clearly stated and MCA2 forms are prepared before

proclaiming DNACPR. Patients and families should be involved in

decision making where possible for more suitable patient care

delivery.

P-192

Mortality and morbidity in end of life care

–

in hospital

retrospective study

S. Saber

, V. Melchionda

, V. Niki

, J. Owusu Ajei

, B. Band

S. Agarwal

, A. Qureshi

Broomfield Hospital, Chelmsford, United Kingdom

Objectives:

This study aims to explore the demographics and risk

factors of inpatient deaths, as well as the availability of appropriate

documentation of DNAR decisions and advance care plans, the

reasons for the rates of in-hospital mortality and discharge delays

for end-of-life patients.

Methods:

This is a single-centre retrospective study. A list of

patients who passed away in hospital June-November 2014 was

compiled and their case notes examined for relevant data.

Results:

332 deaths were recorded June-November 2014, of which

55 files were irretrievable. Out of the 277 cases examined, 130

(47%) were males and the average age was 81

13 years. 159 (57%)

of patients had multiple (≥3) co-morbidities and 165 (60%) had

lifelimiting conditions. 125 (45%) had previous admissions in the

last 2 years. 260 (94%) had DNAR in place but only 16 (6%) were

previously discussed on the community. 32 (12%) had advanced

care planned. The average length of stay in hospital was 12 days

with an average of discharge delays by 5 days. 56 (20%) were on

“fast-track”(End of Life Care) discharge planning and reasons for

delays in this included family opposition to caring for patient at

home or discharge, delays in equipment arrival and unavailability

of funding or of bed in hospice/home.

Conclusions:

A greater effort is needed to promote DNAR and

advance planning discussion in the community, involving patients

and their families. This will help tailor individualized patient care,

avoid unnecessary readmissions and reduce long hospital stays,

delays/failures in fast-track discharges.

P-193

M-EndoL: Investigating the impact of MRSA infection and

colonization in end-of-life-care and geriatrics

A. Sturm

, C.C. Sieber

Institute for Biomedicine of Aging, N¨urnberg, Germany;

Friedrich-Alexander Universit¨at Erlangen-N¨urnberg, Nuremberg,

Germany

Objectives:

The impact of infection and colonization with MRSA

or other multi-resistant pathogens (MRE) on patients in end-of-