Enduring Power of Attorney (EPA) - implementing and sustaining discussions

This change project focused on increasing the awareness and understanding of the Enduring Power of Attorney among members of a regional Mental Health Team, patients and carers. In 2011, 1405 Wardship orders, a provision under the outdated Lunacy Regulations Ireland Act, 1871, were signed in Ireland as opposed to 440 appointed Enduring Powers of Attorney, under Irish Power of Attorney Act 1996. This suggests a probable lack of awareness or understanding and uptake of the provisions for advance care instructions. A pre-audit revealed less than half of a selected population of the Psychiatry of Old Age patients were aware of the Enduring Power of Attorney. The project entailed developing guidelines for implementing discussions on the Enduring Power of Attorney, developing an information booklet on the Enduring Power of Attorney, facilitating training and information sessions and incorporating measures for regular reviews of the implementation into existent organisational structures. Kotter’s eight step change model was utilised to guide the change process implementation. Also, SWOT analysis was integrated prior to, during and after the implementation of the change process. The change objectives were attained, as evidenced by the development of information booklet, and approval of standard guidelines for Enduring power of attorney discussions with inclusion and exclusion criteria. Increased EPA awareness was demonstrated by staff, and patients and carers feedbacks. Also, most staff felt confident or supported after change was implemented. Post Audit of practice after implementation of the change showed 100% compliance by the second contact with the patient.