6End Of Life Care supportive and palliative care deterioration death/bereavementACP / PPCLCPOne yearLast daysACP Advanced care PlanPPC Preferred priorities of carePPD Preferred place of deathGSF Gold standards FrameworkLCP Liverpool Care PathwayEoLC End of Life Care
11Assess Symptom assessment Personal needs Preferred priorities of care Place of carePlace of deathAdvanced Care planningStatement of wishes and preferencesAdvance decisionsPower of attorneyPatient focussedNeeds basedVoluntary
14Plan Communication Out of hours handover Drugs in home What drugsDN prescribingPharmacySyringes, diluentsOOH bypass numberCrisis prevention
155 Goals Patients are enabled to have a ‘good death’ 1) Symptoms controlled2) Preferred place of care3) Safe + secure with fewer crises4) Carers feel supported, involved, empowered, and satisfied.5) Staff confidence, teamwork,satisfaction, co-workingwith specialists and communication better.
167 C C4 Continuity Out of Hours C1 Communication C2 Co-ordination Register, PHCT Meetings, care planAdvanced care planning (ACP) eg PPCC2 Co-ordinationIdentified co-ordinator for GSF, keyworker for patientC3 Control of SymptomsAssessment tools,C4 Continuity Out of HoursHandover form + OOH protocolC5 Continued LearningLearning about conditions on patients seen, SEA / reflective practiceC6 Carer SupportPractical, emotional, bereavement, National Carer’s StrategyC7 Care in dying phase- Protocol LCP / ICP
17What should we do ?Level 1 – register, PHCT meeting, co-ordinator C1,2 Level 2 – Assessment tools, OOHs handover, education, audit and reflective practice C3,4,5 Level 3 – Carer/family support, bereavement plan and protocol for final days C6,7 Level 4 – Sustain and build on developments, practice protocol, extend
18Cancer (Cancer 1) Cancer (Cancer 3) Palliative Care (PC1) IndicatorPointsPayment stagesPalliative Care (PC1)The practice has a complete register available of all patients in need of palliative care/support.3—Palliative Care (PC2)The practice has regular (at least 3 monthly) multidisciplinary case review meetings where all patients on the palliative care register are discussed.Cancer (Cancer 1)The practice can produce a register of all cancer patients defined as a 'register of patients with a diagnosis of cancer excluding non-melanotic skin cancers from 1 April 2003'.5Cancer (Cancer 3)The percentage of patients with cancer, diagnosed within the last 18 months, who have a patient review recorded as occurring within 6 months of the practice receiving confirmation of the diagnosis.640–90%
19Deaths where terminal care has taken place at home Records and information (Records 13)There is a system to alert the out-of hours service or duty doctor to patients dying at home.2—Practice management (Management 9)The practice has a protocol for the identification of carers and a mechanism for the referral of carers for social services assessment.3Education and training (Education 7)The practice has undertaken a minimum of 12 significant event reviews in the past 3 years which could include:New cancer diagnosesDeaths where terminal care has taken place at home4Education and training (Education 10)The practice has undertaken a minimum of 3 significant event reviews within the last year.6
20Mr W deathGP and DN ad hoc arrangements - no PPoD discussed or anticipatedProblems with symptom control - high anxietyCrisis call OOHs - no plan or drugs available in the homeAdmitted to hospitalDies in hospitalCarer given minimal support in griefNo reflection by PHCT team on care given? Inappropriate use of hospital bed?
21Mr W with GSF On GSF Register - discussed at PHCT meeting (C1) DS1500 and info given to pt + carer (home pack) (C1, C6)Regular support, visits phone calls - proactive (C1, C2)Assessment of symptoms, partnership with SPC - customised care to pt and carer needs (C3)Carer assessed incl psychosocial needs (C3, C6)Preferred place of care noted and organised (C1, C2)Handover form issued – care plan and drugs issued for home (C4)End of Life pathway/LCP/minimum protocol used (C7)Pt dies in preferred place - bereavement support Staff reflect-SEA, audit gaps improve care, learn (C5, C6)
22Take Home message Identify patients in last year of life Assess needs Prognostic indicatorsAssess needsGSF toolsPlan for deterioration and death