Authors: (including presenting author): :
Wong YM (1), Chan B (1), Tin WWY (1), Cheng HY (1), Au Yeung PY (1) , Chu CC (1) , Chan CY (1) , Wong MC (1)
Affiliation: :
1. Department of Clinical Oncology, Tuen Mun Hospital
Introduction: :
The Advance Decision on Life-Sustaining Treatment Ordinance (2024) makes precise documentation of Advance Medical Directives (AMD) and DNACPR orders legally critical. To ensure validity within oncology environments, a Practical Handbook and transition workflow were developed to safeguard documentation accuracy and respect patients' legal rights.
Objectives: :
The project aimed to: (1) enhance staff competency in the new legal framework; (2) standardise transition and documentation workflows; (3) facilitate ordinance compliance; (4) establish an algorithm-based referral pathway for dedicated ACP discussion; and (5) implement robust compliance monitoring.
Methodology: :
Step 1: Tool Development — The clinical pool was reviewed to identify legacy DNACPR orders requiring transition, followed by multidisciplinary discussions. Two nurses at each palliative ward acted as advisors, and one nurse in charge oversaw all settings. They collaborated with an Associate Consultant responsible for document setting and a supervising Consultant to refine the handbook content and workflows through iterative meetings. Step 2: Handbook and CMS Integration — A handbook was developed featuring four flowcharts (AMD decision algorithm, AMD decision flowchart & validity checking), samples of seven signing forms, and appendices for responsible persons, revocation tables, and Life-Sustaining Treatment examples. Nine resident templates for specific scenarios (i.e., admission validation, revocation) and one nursing template specific for ACP were embedded in the CMS. A booking system enabled oncology clinic referrals to palliative clinics. Step 3: Staff Education — Training included a face-to-face talk for 35 oncology doctors. A Zoom lesson for all oncology nurses had 23 live participants, with the recording compulsory for all 58 nurses in the H1 and TSWH 5A palliative wards. Education focused on practical steps for applying the algorithm and completing the required documents. Step 4: Monitoring and Transition — An Excel register enabled monthly audits, and a standardised workflow ensured transition to the new legal DNACPR order with continuing effect.
Result & Outcome: :
From 15 December 2025 to 2 January 2026, five complex cases successfully transitioned to new DNACPR orders with continuing effect, validating the workflow’s feasibility. A post-implementation satisfaction survey (n = 28) showed 100% agreement that the handbook content was "clear and easy to understand," 100% reported the materials were "useful for clinical practice," and 100% confirmed significantly enhanced competency in document signing. Monthly audits demonstrated 100% compliance with electronic documentation standards and mandatory template usage. This integrated quality improvement initiative effectively prepared for the Ordinance and strengthened the delivery of legally robust end-of-life care.
