1. Induction : 2012 End of Life Care

2. Introduction Discussion of EOLC may stir up unresolved bereavement issues – personal or professional. Discussion of EOLC may stir up unresolved bereavement issues – personal or professional. Varying levels of expertise/experience Varying levels of expertise/experience Palliative Care Link Nurses/LCP Champions Palliative Care Link Nurses/LCP Champions E-ELCA. End of Life Learning for all. E-ELCA. End of Life Learning for all.

3. Transforming End of Life Care in Acute Hospitals – The Route to Success – ‘how to’ Advance Care Planning (ACP) Advance Care Planning (ACP) Electronic Palliative Care Co-Ordination Systems (EPaCCS) Electronic Palliative Care Co-Ordination Systems (EPaCCS) Rapid Discharge Home to Die Pathway Rapid Discharge Home to Die Pathway AMBER Care Bundle AMBER Care Bundle The Liverpool Care Pathway for the Dying Patient (LCP) The Liverpool Care Pathway for the Dying Patient (LCP)

4. There are approx 2000 deaths per year in Ports Hospital – approx 6 deaths per day. There are approx 2000 deaths per year in Ports Hospital – approx 6 deaths per day. Many receive good care. Unfortunately a minority receive less than optimal care. Many receive good care. Unfortunately a minority receive less than optimal care. We must strive to give the end of life care that we would want for our loved ones & ourselves. We must strive to give the end of life care that we would want for our loved ones & ourselves. ‘Good death?’ ‘Good death?’

5. ‘How people die remains in the memory of those who live on’ Cicely Saunders Cicely Saunders

6. “ How we care for the dying must surely be an indicator of how we care for all our sick and vulnerable patients. Care of the dying is urgent care; with only one opportunity to get it right to create a potential lasting memory for relatives and carers.” Prof Mike Richards

7. What is Palliative Care? Active total care of patients & families – when disease is non curative Active total care of patients & families – when disease is non curative Provides relief from pain & other symptoms Provides relief from pain & other symptoms Aim is to achieve best quality of life Aim is to achieve best quality of life Responds to physical, psychological, social & spiritual needs Responds to physical, psychological, social & spiritual needs Extends to support in bereavement Extends to support in bereavement

8. Barriers to Diagnosing Dying? Groups & feedback Groups & feedback

9. Barriers to Diagnosing Dying Hope that patient may get better Hope that patient may get better No definitive diagnosis No definitive diagnosis Pursuance of unrealistic or futile interventions Pursuance of unrealistic or futile interventions Disagreement about patients condition Disagreement about patients condition Failure to recognise key symptoms & signs Failure to recognise key symptoms & signs Lack of knowledge on how to prescribe Lack of knowledge on how to prescribe

10. Barriers (cont) Poor ability to communicate with family & patient Poor ability to communicate with family & patient Concerns about withdrawing/with- Sholding treatment/resuscitation status Concerns about withdrawing/with- Sholding treatment/resuscitation status Fear of foreshortening life Fear of foreshortening life Cultural & spiritual barriers Cultural & spiritual barriers Medico legal issues Medico legal issues Lack of time/business of the ward Lack of time/business of the ward

11. Overcoming Barriers to Diagnosing Dying Sensitive communication around death & dying Sensitive communication around death & dying Team working Team working Appropriate prescribing & rationale Appropriate prescribing & rationale Recognising key signs & symptoms Recognising key signs & symptoms Appreciate cultural & religious traditions Appreciate cultural & religious traditions Be aware of medical/legal issues Be aware of medical/legal issues Refer to specialist palliative care – when necessary Refer to specialist palliative care – when necessary

12. The Liverpool Care Pathway is: An evidence based framework which provides guidelines for care in the last days of life & empowers doctors & nurses to deliver optimum care to dying patients & their families – wherever they are being cared for. An evidence based framework which provides guidelines for care in the last days of life & empowers doctors & nurses to deliver optimum care to dying patients & their families – wherever they are being cared for. It is underpinned by the principles of palliative care It is underpinned by the principles of palliative care

13. The Research Evidence To date there is evidence that the LCP: Improves confidence for nurses who are using the LCP Improves confidence for nurses who are using the LCP Demonstrates reduced symptom burden Demonstrates reduced symptom burden Improves anticipatory prescribing of meds for the 5 key symptoms that may develop in last days/hours of life Improves anticipatory prescribing of meds for the 5 key symptoms that may develop in last days/hours of life Improves MDT working Improves MDT working Improves documentation of care delivery. Improves documentation of care delivery.www.mcpcil.org.uk

14. Version 12 LCP Was launched end January 2012 Was launched end January 2012 Used in every setting Used in every setting Significant differences from version 11 Significant differences from version 11 LCP facilitator appointed & has now started work. LCP facilitator appointed & has now started work. Find out who your Palliative Care Link nurse is. Find out who your Palliative Care Link nurse is.

15. Specialist/General Palliative Care A significant proportion of people with advanced disease experience range of complex problems: A significant proportion of people with advanced disease experience range of complex problems: Unresolved symptoms – pain; nausea Unresolved symptoms – pain; nausea Complex psychosocial issues Complex psychosocial issues Complex end of life issues – hospice admit Complex end of life issues – hospice admit Complex bereavement issues Complex bereavement issues

16. Palliative Care End of Life Team – bleep 1384 – hands on nursing care; patient & family support. For patients 65 yrs & over. Based in Elderly Medicine. End of Life Team – bleep 1384 – hands on nursing care; patient & family support. For patients 65 yrs & over. Based in Elderly Medicine. Specialist Palliative Care Team: Room 11 Quad centre - Ext 6132. Referrals on intranet – under cancer service centre. Fax to 3332. Specialist Palliative Care Team: Room 11 Quad centre - Ext 6132. Referrals on intranet – under cancer service centre. Fax to 3332.

17. Case example

18. Factors influencing pain thresholds PHYSICAL Other symptoms Adverse effects of treatment Insomnia PSYCHOLOGICAL Anger Disfigurement Fear Helplessness SOCIAL Worry about family & finance Loss of-income -social position -role in family TOTAL PAIN (clinical pain) SPIRITUAL Why me? How can God allow me to suffer like this? What’s the point?