Transcript INTEGRATED CARE PATHWAY FOR THE ADULT DYING PATIENT …

Dignity in Care
INTEGRATED CARE PATHWAY FOR
THE ADULT DYING PATIENT
IN CARE HOMES
Julie Williams
Macmillan Nurse Specialist
for Palliative Care Education in Nursing Homes
10th July 2009
Dignity in Care
AIMS OF THIS PRESENTATION
• To introduce the Integrated Care Pathway (ICP) for the
adult dying patient
• Describe and outline how the pathway fits with the wider
national agenda
• To discuss the results of the ICP Pilot Baseline Audit
• To inform about the Implementation of ICP locally
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INTEGRATED CARE PATHWAY (ICP)
A DEFINITION
An integrated care pathway determines locally agreed
multidisciplinary practice, based on guidelines and
evidence where available, for a specific patient/client
group. It forms all or part of a clinical record, documents
the care given and facilitates the evaluation of outcomes
for continuing quality improvement”.
(National Pathways Association 1998)
Dignity in Care
What is the ICP?
• It was developed and initiated by the palliative care team in
Liverpool. Liverpool Care Pathway (LCP)
• It has been adapted for local use (ICP)
• A map/tool/framework for the delivery of planned care to the resident
during the dying phase
• It is a multi-professional document
• Provides a method of coordinating and standardising care –
reducing practice variations
Dignity in Care
What is the ICP?
• An evidence-based legal document, incorporating
guidelines which reflect current good practice
• Provides a mechanism for continually monitoring and
evaluating processes, practices and outcomes of care
delivered
• It details tasks, sequences and timescales.
• It has been developed to transfer to all care settings.
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The ICP is NOT
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A criticism of current practice
Totally prescriptive
Just a nursing document
Undermining of professional knowledge, skill and
competence
• Complicated
• WRITTEN IN STONE
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How the ICP Relates To
The National Agenda For End Of Life Care
The End of Life Care Strategy (2008) States
“ Good Primary Care Trusts will want to ensure that the particular
needs and wishes of all people who are dying should be identified
and addressed.
The Liverpool Care Pathway provides a well established mechanism
for achieving this.
Primary Care Trusts are therefore strongly recommended to ensure
that the Liverpool Care Pathway is adopted and its use audited in all
locations where people are likely to die.”
All national recommendations have highlighted
the importance of choice and an integrated health
and social care approach to end of life care
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How the ICP Relates To
The National Agenda For End Of Life
Care
•
The Cancer Plan (2000)
•
National Service Framework for
Renal Services (2004)
•
National Service Framework for
Coronary Heart Disease (2000)
•
National Service Framework for
Long Term Conditions (2005)
National Service Framework for
Older People (2001)
•
Our Health, Our Say (2006)
•
Building on Firm FoundationsImproving end of life care in care
homes (2007)
•
End of Life Care Strategy (2008)
•
•
The Gold Standards Framework
(2003)
•
Cancer Services Collaborative
Improvement Partnership (2003)
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Why implement the ICP in Care
Homes?
• People are living longer, with the percentage of deaths amongst
those aged 85 and over rising
• 58% of deaths occur in hospitals (2008)
• 64% of patients would prefer to die in their own homes
(2004)
• 17% deaths occur in care homes collectively accounting for around
35% of all deaths (based on ONS figures for 2004)
Dignity in Care
Why Implement the ICP in Care Homes?
• To enable residents to die peacefully in their home
• Reduce crisis admissions to hospital in the dying phase
• To enable relatives and carers to provide care, be kept
informed and have positive lasting memories if possible
• Staff involved have a sense of satisfaction that a “good
death” has been achieved
Dignity in Care
Benefits of using the ICP in Care Homes
• Promotes proactive high
quality, efficient, effective
and equitable care
• Informs on symptom
control
• Enhances good
communication and
teamwork
• It can save time and
reduce documentation.
• Gives permission to
discontinue regimes
• It helps prevent crisis
intervention
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Benefits of using the ICP in Care Homes
• Empowers and increases
staff competence and
confidence in caring for
dying residents and their
families
• It can highlight and
identify education,
training and resource
needs.
• Sensitive, One record
Up to date - provides
evidence of quality care
given to residents and
families
• It promotes the effective
use of resources
• It can prevent repetition
• It provides data for audit
and reflective practice
Dignity in Care
Considerations For Inclusion On The On
The ICP
• The resident has a known irreversible life threatening
illness of any aetiology.
• Reversible causes for the resident’s current deterioration
have been considered and appropriately managed.
• Intensive care and resuscitation have been discussed by
the team and have been deemed inappropriate.
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Criteria For Inclusion On The ICP
The Multidisciplinary Team has agreed that the resident is
dying and 2 of the following apply
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The resident is bed bound
The resident is semi-comatose
The resident is only able to take sips of fluid
The resident is no longer able to take tablets
Dignity in Care
Components Of The ICP
• Initial assessment
• Ongoing assessment and documentation of care on a 4
and 12 hourly basis
• Outcome Measures (Goals) for each section
• Variance recording
Goal Achieved (A)
Goal not achieved (“V” for Variance)
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Components Of The ICP
• Multidisciplinary communication/progress record sheets
• Information for family and carers
• Care after death
• Guidelines for staff
• Symptom control Guidelines
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How is the ICP being implemented in
Local Care Homes?
• ICP document and accompanying information leaflets
ratified by PCT
• Piloting in 4 GSF accredited Nursing Homes in Kirklees
• Education delivered to ALL care home staff prior to ICP
implementation
• Liverpool Care Pathway National team involved in
support with data analysis
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Key Findings from Baseline ICP Audit
Documentation from 4 Nursing Homes audited
• 20 Deaths in each home (Total 80 )
• Deaths that occurred :
Men -20%
Women -80%
• Age range of residents that died : 65years to 103years
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Key Findings from Baseline ICP Audit
Diagnosis of Residents that died:
- Dementia including Alzheimer’s disease - 43.75%
- Cancer
- 11.25%
- Long Term Conditions - 45%
(Including Stroke, COPD, Heart Failure & Circulatory problems
Renal failure, Neurological conditions & old age )
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Key Findings from Baseline ICP Audit
• Not for CPR documented 70 - 85%
• Family/Other aware of diagnosis documented - 80 - 95%
• Family/Other aware patient dying documented - 55 - 80 %
• GP aware of Patient’s condition documented– 55 – 85 %
• Plan of Care explained to Family documented– 55- 75%
• GP practice aware of death documented– 80 -100%
Dignity in Care
Key Findings from Baseline ICP Audit
• Anticipatory drugs were prescribed when residents
referred to Specialist Palliative Care team
• Residents with cancer had anticipatory drugs prescribed
• Majority of residents with dementia and long term
conditions did not have anticipatory drugs prescribed.
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Where next with the ICP
Implementation?
• Completed pathway data from the pilot areas will be
analysed at Liverpool
• Participating Care Homes will be asked to give formal
feedback to facilitators via questionnaire
• Feedback will be delivered to participating pilot areas
following data analysis
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Where next with the ICP
Implementation?
• Pilot documentation will be reviewed and amended if
appropriate
• Train the trainer ICP
( Nominated ICP Lead in each Care Home)
•
Pathways will then be audited annually
• Roll out ICP to further GSF accredited homes in Kirklees
and Calderdale
Dignity in Care
“You Matter Because you are you
And you matter to the end of life
We will do all we can not only to help you die
peacefully but also to live until you die”
Dame Cecily Saunders ( Founder of the Modern Hospice Movement)
YOU WILL NEVER BE FORGIVEN YOU IF YOU
GET IT WRONG
YOU WILL NEVER BE FORGOTTEN YOU IF
YOU GET IT RIGHT
For further information
[email protected]
[email protected]
www.lcp-mariecurie.org.uk
www.endoflifecare.nhs.uk
Dignity in Care
Thank You
Any Questions?