Transcript Slide 1

End of Life Care
Raising an awareness….
‘an introductory workshop for people who
work in settings where EoLC is provided’
Introduction
&
Housekeeping
Programme
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Welcome
Learning objectives & ground rules
Individual Introductions
Introduction to End of Life and Palliative Care
Thinking about who we support and staff involved
Your role in end of life care
Coffee
Case Study ‘Joyce's story’
Questions and evaluation
Lunch at 12.30 – 30 mins
Learning Objectives
By end of this morning, you will be able to:
• Explain what Palliative Care & End of Life Care
means and the key principles of these
approaches.
• Understand who is involved in EoLC.
• Understand & discuss how EoLC links to your
role.
• Apply an End of Life Care approach to a patient’s
story.
• Reflect on your learning and identify further
training needs
Ground Rules
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Confidentiality
Shared learning
One at a time
Respect one another’s opinions
Positive critique
Sensitivity
Time-out
Mobile phones/pagers off please
Any more?........
Getting to know you….
• Introduce yourself, your role & where
you work.
• What you hope to get out of the session
• Work in pairs
‘End of Life Care’
What does this mean to you?
There are no wrong answers!
• What sort of illness & conditions
might EoLC cover?
• Where might you find
people needing EoLC?
Think outside the
box!
End of Life Care
Key tools & documentation
What are you aware of?
End of Life Care Strategy
(DoH 2008)
• Promotes high quality care across the
country for all adults approaching the end
of life.
• Each year around 500,000 people die in
England.
• Some people receive excellent care at
the end of life, many do not.
• Most people would prefer to die at home.
In practice, only a minority manage to do
so.
• Services are not always joined up and as
a result communication between staff and
agencies can break down.
End of Life Care
• Care that helps all those with advanced, progressive,
incurable illness to live as well as possible until they
die.
• Draws attention to the needs of patients and their
families, in the last 6 months to year or so of life.
• It enables the supportive and palliative care needs of
both patient and family to be identified and met through
out the last phase of life and into bereavement.
• Includes the management of pain and other
symptoms and provision of psychological, social,
spiritual and practical support’.
Gold Standards Framework –
Prognostic Indicators
Provides guidance to enable better identification
patients who may need supportive/ palliative care
Highlights triggers for supportive/palliative care including:
The ‘Surprise’ Question
‘Would you be surprised if this patient were
to die in the next 6-12 months?’
So is End Of Life Care
different to
Palliative Care?
Palliative Care
• ‘An approach that improves quality of life of
patients and their families facing the
problems associated with life-threatening
illness, through prevention and relief of
suffering by means of early identification and
impeccable assessment of pain and other
problems, physical, psychological and
spiritual’
WHO-2008
The End of Life Care Pathway
The End of Life Care Pathway
Step 1
Discussions as
end of life
approaches
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Open, honest
communication
Identifying triggers
for discussion
Step 2
Assessment, care
planning and
review
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Agreed care plan
and regular review
of needs and
preferences
Assessing needs of
carers
Step 3
Step 4
Step 5
Coordination of
care
Delivery of high
quality services
Care in the last
days of life
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Strategic
coordination
Coordination of
individual patient
care
Rapid response
services
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High quality care
provision in all
settings
Hospitals,
community, care
homes, hospices,
community
hospitals, prisons,
secure hospitals
and hostels
Ambulance
services
Support for carers and families
Information for patients and carers
Spiritual care services
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Identification of the •
dying phase
Review of needs
and preferences
for place of death •
Support for both
patient and carer
Recognition of
wishes regarding •
resuscitation and
organ donation
Step 6
Care after death
Recognition that
end of life care
does not stop at
the point of death.
Timely verification
and certification of
death or referral to
coroner
Care and support
of carer and
family, including
emotional and
practical
bereavement
support
Coffee Break
We all have a role to play!
YOU!
The client
and family
What concerns do you have
in the part you play in
providing End of Life Care?
Remember…
• It’s OK to have concerns, most people
do
• It’s OK not to know the answer but
remember the question and pass it on!
• It’s not OK to ignore the concern either
yours or client/family
Introducing Joyce….
• Joyce, age 81, is a widow who lives
alone in a 2nd floor flat.
• Has Advanced Lung Disease
• In the past 3 years she has only left
her flat to go into hospital (4 times)
• Only family is a grandson & his family
who live close by
• Has told her grandson that she knows
that the doctors are unable to do any
more to help her.
• ‘Wants it all over now’
• Now stays in bed most of the time, has
no appetite and finds difficulty in taking
all her tablets.
• Has made it clear that she would like
to die at home in her own bed.
If You were in this position, what
would you expect from staff
looking after you ?
(helpful to think about Knowledge,
Skills and attitudes)
Holistic approach to care
Physical Care
Psychological
Care
Spiritual Care
Social Care
Supporting Joyce…
• Small group work
What do you think may help
Joyce remain at home?
What might help Joyce remain at
home …
• Making her wishes known to her family and professionals –
Advanced Care Plan
• Discussion of preferred place of death with healthcare
professionals.
• Ensure that Joyce is included on the Gold Standards Framework
(GSF) register at her GP practice (Thomas,2005).
• Healthcare professionals have an agreed plan of how to manage her
worsening breathlessness
• Increased care package including Carers Allowance & Continuing
Health Care funding
• Involvement of specialist palliative care nurses
• Hospice at Home
• Having a written statement of her wishes such as an ‘Advanced
Decision to Refuse Treatment’
Bereavement Care
Joyce dies peacefully with her family
near a few days later.
What may help the family at this time?
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Acknowledgement of what’s happened
Empathy & honest communication
Written & practical information
Contact details of who can help now
and later
Reflective Learning
One thing that you will take away
from this morning that may
change your practice
Where next?
• Further training within the county
http://www.gloucestershireccg.nhs.uk/?page_id=176
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Calendar of events (via website above)
E learning www.e-elca
Shadowing other staff
Personal reflection
Summary & Evaluation
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Final Questions?
Revisit objectives and hopes
Evaluation
Handouts
Certificate of attendance
References
Department of Health 2008. Advanced Decisions to
Refuse Treatment The National Council for Palliative Care
Department of Health 2008. End Of Life Care Strategy.
London: Crown Publications
NHS 2008 National End of Life Care Programme.
Advanced Care Planning. University of Nottingham
The Gold Standards Framework; the Liverpool Care Pathway;
the Preferred Priorities for Care tool: see
www.endoflifecareforadults.nhs.uk
WHO 2008. WHO Definition of Palliative Care Available at:
www.who.int/cancer/palliative/definition/en
Lunchtime- please be
back for 1pm