Background With advances in medical therapies, and increasing use of long-term ventilation, the number of children living in the UK with life-limiting conditions is increasing. Advance Care Plans (ACPs) allow families and, if appropriate the child themselves, to make important decisions about their care in an unpressurised environment. ACPs are essential to providing quality care for children with life-limiting conditions1 but are often initiated later than considered optimal. Objectives I aimed to investigate how many children admitted to Paediatric Critical Care (PCC) with a life-limiting condition already had an ACP in place and for those children without an ACP, if their deterioration could have been pre-empted and ACP discussions started earlier in a more appropriate setting. In addition, I looked into the accessibility of ACPs on Electronic Patient Records (EPR) to assess the sharing of information between the teams involved in the child’s care. Methods Over a 6 month period, the records of children admitted to PCC with a pre-existing life-limiting condition were reviewed to determine the following: Evidence of an existing ACP Documentation of ACP and resuscitation status on EPR Any ACPs completed during PCC admission Discussions regarding ACP during PCC admission Previous number of PCC admissions Results 32 patients with a life-limiting condition were admitted to PCC over the 6 month period. Their diagnoses included Rett syndrome, hypoxic-ischaemic encephalopathy and neurodegenerative disorders. 10 out of 32 children had an ACP in place prior to admission. Three children had ACPs completed during admission, following which one child died after withdrawal of care, and discussions about initiating ACPs occurred in three further patients. Of the patients with ACPs, 70% were for full resuscitation. The number of previous admissions to PCC ranged from zero to ten. Two-thirds of children without an ACP had at least one previous admission to PCC. The ACPs were often difficult to locate within our digital patient records and only two ACPs were recorded on the electronic Carevue system specific to PCC and four on hospital-wide EPR. Conclusions The majority of children with ACPs were for full resuscitation, and all were admitted to PCC, highlighting that not all ACPs equate to ceilings of care or ‘do not resuscitate’ decisions, but can instead be used to express the family’s wishes for their child’s care. Overall 20% of families were involved in ACP discussions during their child’s admission to PCC. This is a stressful and time-pressured environment in which to expect families to make such important decisions. We need to empower general and community paediatricians to start ACP discussions with families earlier, which would allow families the time and space to make these decisions. In addition, earlier implementation of ACPs can serve as a platform for further discussions in the event of the child being admitted to PCC acutely unwell. However, for ACPs to be fully effective we need a facility to allow ACPs to be easily located on EPR in order to facilitate sharing of information between teams involved in the child’s care. Reference The End-of-Life Care Strategy, Department of Health, 2008.