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Introduction Goals-of-care (GOC) discussions are often delayed or uninitiated for people with dementia, potentially contributing to inappropriate end-of-life treatment. The Serious Illness Conversation Guide (SICG) facilitates structured GOC discussions about patient values and care preferences, but a dementia-specific Guide adapted to the Asian cultural context has yet to be developed. This study aimed to adapt and iteratively revise the SICG-C, and assess its acceptability among caregivers of people with dementia. Methods We adapted the SICG for caregivers of people with dementia in Singapore using a three-phase, approach. Phase 1 involved adapting the patient-facing SICG to caregiver-facing language (version 1). In Phase 2, we iteratively tested the guide with 6 and 13 caregivers in 2 rounds of interviews to derive the final version of the Guide. In Phase 3, 50 caregivers rated each SICG-C item from Versions 1 and 3 using a structured questionnaire, with presentation order alternated to minimise order effects. Results Sixty-nine caregivers were recruited in this study. Qualitative interviews revealed that caregivers valued professionalism and reassurance from clinicians, while also emphasising their own experiential knowledge as distinct from clinical expertise. Many struggled to articulate their loved ones’ priorities due to cognitive decline and the absence of prior discussions, often expressing uncertainty about whether their assumptions reflected what their loved ones would have wanted. Caregivers were sensitive to language implying poor prognosis and preferred phrasing that conveyed continuity of care and partnership. None of the caregivers had been informed by their loved ones of their goals and priorities, reaffirming the value of the SICG-C. In the final survey (n = 50), caregivers showed a strong preference for Version 3 over Version 1, with 21 of 22 items rated significantly higher (all p<0.001). The final SICG-C was rated highly acceptable. Conclusion The SICG-C enables clinicians to initiate timely, values-based GOC discussions with caregivers of people with dementia. Its structured, sensitive language addresses caregiver concerns and may be used to support proactive care planning in dementia. Further research is needed to evaluate implementation in routine clinical practice.

Background Medication errors (MEs) can lead to adverse effects and mortality, especially in older adults, due to physiological changes and accumulated multi-morbidities associated with ageing. Hence, interventions to reduce MEs among older adults are important and examining their effects will provide us with the impetus to improve upon current local measures to further reduce MEs. Objectives To review the effectiveness of the interventions that have been implemented locally to reduce MEs. Methods Using chosen keywords, searches were conducted in Pubmed and Google scholar. Based on their abstract, relevant articles were chosen from all retrieved articles that were published in English. Relevant online resources and other journal articles referenced in the chosen articles were also referenced in writing this narrative review. Results and Conclusion Although MEs occur globally, studies examining the prevalence of MEs within Asia are lacking and the impact of various local interventions to reduce MEs is also poorly understood. Electronic prescribing, a national electronic health records repository, education in geriatric pharmacotherapy, a more centralised pharmacist’s role and the use of prescribing assessment tools are local interventions whose effectiveness in reducing MEs are supported, instead, by overseas studies examining such similar interventions. Locally, more studies are needed to examine the effectiveness of interventions in reducing MEs in various settings.

BackgroundThe national Advance Care Planning (ACP) programme was introduced in Singapore General Hospital (SGH) in 2013. While ACP referral rate within SGH increased, its completion rate remains low. Strategically, SGH ACP Workgroup was created in 2019 to strengthen ACP adoption and completion. This paper features two system enhancements; integration of ACP referral in Computerised Physician Order Entry (CPOE) system and adaptation of ACP documentation template in Sunrise Clinical Manager (SCM).MethodsSGH ACP workgroup consists of an interprofessional team of 17 doctors, one nurse and two allied health professionals, with secretariat support from Division of Medicine. Through ground engagement and review of work processes, the workgroup identified barriers contributing to inappropriate ACP referrals and low adoption by clinicians. With support from hospital leadership, the workgroup adapted CPOE from Seng Kang General Hospital, and mandated ACP advocacy by clinician prior to referral. Furthermore, to encourage bite-size ACP conversations and documentation by clinicians, the workgroup adapted ACP Clindoc template from Changi General Hospital.ResultsSince the implementation of ACP system enhancements in September 2021, there is 10% increase in advocated referrals. 29% of total referrals are made through CPOE, while remaining referrals are made via existing referral platform which is estimated to cease in 2023. Within 826 ACP documentations submitted in Clindoc, 122 documentations were for completed ACP. These documentations were submitted by the ACP team, six doctors, 15 nurses and three MSWs.ConclusionsPositive results from both system enhancements suggest reduction in inappropriate ACP referrals through advocacy and increased ACP conversations and documentations by clinicians. Nevertheless, more can be done to capitalise on these enhancements as only a handful of clinicians have started using the systems. ACP workgroup will continue to engage in targeted hospital-wide roadshows and webinars to engage clinicians on these enhancements and collect feedback for further improvement.