Transcript Palliative Care- Hospital/ Community

Palliative Care- Hospital/
Community
End of Life care Initiatives
Right Care
Dr R Gaekwad
End of life care initiatives-overview
 July 2008, the Department of Health published
“The End of Life Care Strategy”, the first such
strategy in the UK.
 The aim of the strategy is to improve the
provision of care for all adults approaching the
end of their life, including support for their
families and carers.
 the implementation of this strategy would reduce
inappropriate admissions to hospital, and enable
more people approaching the end of their life to
have access to high quality specialist palliative
care, be able to live, be cared for and die in the
place of their choice.
Gold Standards Framework,
Liverpool Care Pathway for the Dying, and
Preferred Place of Care tools.
 commitment to raising the standards of care for this
special group of patients. It recognises that many
patients wish to be cared for in their preferred place of
choice, which may be their own home. It also pays
particular attention to the support for informal carers, and
to the provision of education and support for
professionals to deliver a consistent and high standard of
care.
Preferred Priorities for Care
 Preferred Priorities for Care (PPC; formerly known as
Preferred Place of Care) is an Advance Care Plan
(ACP), in which individuals can write down their
preferences and priorities for care at the end of life in
order to help prepare for the future.
 It is never too early to start a PPC plan particularly for
residents in care homes, which for many is their
permanent and final place of residence. The PPC
provides an opportunity for care home residents and
staff to work together to develop Advance Care Plans in
accordance with the new Mental Capacity Act.
 Residents can initiate the PPC at any time and this will
help staff follow their wishes and act as an advocate if
the resident loses capacity towards the end of their life.
Principles of GSF- 3 steps
1.Identify
Patients who may be in the last year of life & identify their stage
Use of the ‘surprise’ question, use of Prognostic Indicator Guidance,
Needs Based Coding
2.Assess
Current & future clinical needs & personal needs
Use of assessment tools, Advance Care Planning etc
3.Plan
Develop an action plan of care
Use 7 Cs key tasks, Needs Support Matrix, passport information etc
End of Life Care in Numbers
 1% of the population dies each year
 17% increase in deaths from 2012
 40% of deaths in hospital could have occurred
elsewhere
 60% people do not die where they choose
 75% deaths are from non-cancer conditions
 85% of deaths occur in people over 65
 £19,000 non cancer, £14,000 cancer average
cost/patient in final year of life
 2.5 million generalist workforce 5,500 palliative care
specialists
GSF works- improving end of life care
 Attitude, Approach and Awareness
Increasing confidence of staff about discussing end of
life care
Increasing openness and confidence of staff
 Patterns and Processes
Improved coordination and team working
Improving practical systems of care
 Outcomes for Patients and Carers
Fewer hospital admissions and deaths, more dying
where theychoose with considerable cost savings to
NHS
More advance care planning discussions
Liverpool Care Pathway
 The Liverpool Care Pathway (LCP) was developed
between the Royal Liverpool hospital and the city's Marie
Curie hospice in the late 1990s. The pathway was
developed to try to provide the same level of nursing
expertise at the end of life as during other treatments,
regardless of the patients' chosen environment.
 The pathway aims to guide members of the
multidisciplinary team in matters relating to continuing
medical treatment, discontinuation of treatment and
comfort measures during the last days.
LCP
 RECOGNISE THAT DEATH IS APPROACHING
Studies have found that dying patients will
manifest some or all of the following:
• Profound weakness - usually bedbound
• Drowsy or reduced cognition - semi-comatose
• Diminished intake of food and fluids - only able
to take sips of fluid
• Difficulty in swallowing medication - no longer
able to take tablets
LCP-Treatment of symptoms
.
 Discontinue any medication which is not
essential
 Prescribe medication necessary to control
current distressing symptoms
 All patients who are dying would benefit from
having subcutaneous medication prescribed
in case distressing symptoms develop
 All medication needs should be reviewed
every 24hrs
 If two or more doses of prn medication have
been required, then consider the use of a
syringe driver for continuous subcutaneous
infusion (CSI)
LCP
The most frequently reported symptoms are: • Pain (Morphine, Diamorphine, MST, Fentanyl)
 • Nausea / Vomiting (cyclizine, haloperidol,
metoclopramide, levomepromazine)
 • Agitation / Restlessness(Midazolam)
 • Excessive secretions / Noisy breathing
(Hyoscine butylbromide)
RightCare
 RightCare is a scheme which was designed by
Derbyshire Health United (DHU) clinicians to ensure that
seamless patient care takes place out of hours, when
General Practitioner (GP) practices are closed.
 RightCare is designed for patients with long term
conditions and complex healthcare needs, including end
of life patients.
 The scheme helps to prevent unnecessary admissions to
hospital and attendance at Accident and Emergency
(A&E), lower patient anxiety, provides reassurance and
allows patients to access the most appropriate heal
RightCare-suitability
 The service is suitable for people with complex
health problems and long term conditions Chronic Obstructive Pulmonary Disease
(COPD),
 those requiring palliative care,
 frequent users of Accident and Emergency
(A&E) and 999,
 some people with Mental Health Conditions and
Learning Difficulties
Right Care
 devised with the patient by their own GP or other
health care professional e.g. District Nurse,
Community Matron, etc. and then shared with
DHU, by secure e-mail
 valid for up to 6 months
 DHU currently share the information with NHS
Direct, East Midlands Ambulance Service, Royal
Derby Hospitals and Chesterfield Royal Hospital
 Patients will have the dedicated RightCare
Number which is shown on the RightCare Plan
which will put them in contact with DHU directly.