Kathryn Cunning, Practice Nurse General Practice plays a key role in - PowerPoint PPT Presentation

Dr Helen Tom, General Practitioner & Kathryn Cunning, Practice Nurse

General Practice plays a key role in  Witnessing of Power of Attorney Forms  Encouraging discussion re: End of Life Wishes  Witnessing of Advanced Care Directives

Brought to our attention early 2009: 84yr old woman, living with her Son & DIL, in Bendigo  Multiple health issues including: ◦ Diabetes Mellitus Type 2 ◦ Vascular Dementia ◦ Chronic Renal Failure

 Developed Osteomyelitis with Rt 2 nd Toe amputation ◦ Prolonged hospital admission due to issues of guardianship ◦ Deemed not competent to make her own decisions ◦ VCAT hearing appointed her Grandson, who lived in Melbourne, her Guardian ◦ He transferred her to the Austin Hospital for more Acute Care ◦ Recognised the need for all patients to have Medical Power of Attorney & Advanced Care Planning.

 A Clinic decision was made to include the discussion of Medical Power of Attorney & Advanced Care Planning, at all Health Assessments & Care Plans where relevant.  Target Population : Over 75yr old patients in their Health Assessments MY ROLE:  Discussion with the patient  Witness of relevant documents  Provision of Advanced Care Document

 Medical Power of Attorney ◦ Less than10% of Over 75yr old patients had completed Medical Power of Attorney  Advanced Care Directive o Less than 5% of Over 75yr old patients had completed an Advanced Care Directive

 Seeking Legal Advice initially from OPA  Over 75 Year Health Assessment  Comprehensive Medical Assessments (CMA’s)  GP Management Plans (GPMP & TCA)  General Public  TEMPLATES DEVELOPED:  Over 75yr Health Assessment  Advanced Care Directive

 Medical Power of Attorney ◦ Over 95% of the Over 75yr old patients now have a completed Medical Power of Attorney  Advanced Care Directive ◦ Less than 50% of the Over 75yr old patients have completed an Advanced Care Directive.

 93 yo Woman ◦ Mild dementia ◦ Heart Failure ◦ Peripheral Neuropathy ◦ She is medically managed and has told her MPO that she does not want to be kept alive if fully demented. ◦ Can Medical POA ask her doctor to cease her heart medications when she can no longer make decisions for herself?

 78 yo woman life long intellectual disability living in an aged care facility ◦ Facility policy is that everyone must have an ACD. In absence, the staff are advised in medical emergency to fully resuscitate ◦ The staff and doctor felt that full resuscitation would be a burdensome intervention. ◦ Her brother in Maryborough, who never visits, asked for full resuscitation in a medical emergency . He does not have MPOA. ◦ Do we need to contact her guardian to override his wishes or can the doctor and nurses make a decision?