Transcript C7 - Care of the Dying (Terminal Phase)

Kirklees and Calderdale
Primary Care Trusts
Integrated Care Pathway
for the dying patient
Barbara Burke
End of Life Pathway Facilitator
C7 – Care of the Dying
(Terminal Phase)
Patients in last few days of life
need to be cared for appropriately.
WHY?
To enable patients to die well and
peacefully.
To enable relatives and carers to provide
care, be kept informed, and have
positive lasting memories if possible.
Staff involved have sense of satisfaction
that a ‘good death’ has been achieved.
OTHERWISE?
If Terminal Phase not
well addressed, there
is dissatisfaction with
care from both carers
and staff involved.
‘What might have
been’
HOW?
Using Integrated Care Pathway (based
on the Liverpool Integrated Care
Pathway)
(Devised by Dr John Ellershaw &
Team)
What is an
Integrated Care Pathway?
A map/tool of a patient’s planned care
for a specific clinical problem
Used by the multidisciplinary team
Provides a method of coordinating and
standardising care – reducing practice
variations
What is an
Integrated Care Pathway?
A Legal document, incorporating guidelines
for symptom control which reflect current
best practice
Provides a mechanism for continually
monitoring and evaluating processes,
practices and outcomes of care
Advantages of an
Integrated Care Pathway
Facilitates Clinical Governance
Clinical guidelines/protocols
Auditable data/demonstrable outcomes
Changes practice
Enhances communication
Reduces paperwork/time writing care plans
Effective learning tool
Pathways are NOT:
A criticism of current practice
Totally prescriptive
JUST a nursing document
Undermining of professional knowledge,
skill or competency
Complicated
Written in stone!
Why implement ICP
in care homes
Promotes high- quality, efficient,
effective, and equitable care
Patient and carer focused/definite plan of
action
Reduces crisis admissions to hospital in
the dying phase
Increases % of deaths occurring within
the care home
Why implement ICP
in care homes
Proactive
Enhances communication
Gives permission to discontinue regimes
Informs on symptom control
Empowers staff
Sensitive – one record – up to date/
demonstrates care given
Criteria for ICP
(Signs of Terminal Phase)
Multi-professional team agree patient is
dying and two of the following apply:
Patient bed bound
Only able to take sips of fluid
No longer able to take tablets
Semi-comatose
STOP CURRENT DOCUMENTATION
USE ICP INSTEAD
Structure of the
Integrated Care Pathway
Three Sections:
Incorporate physical,
social, psychological,
spiritual/religious
aspects
1. Initial Assessment
2. On Going Care
and Assessment
3. Care After Death
Outcome measures
(Goals) for each
section
Goal Achieved
Goal Not Achieved
= ‘V’ (Variation)
Integrated Care Pathway
VARIATION
Is deviation in patient’s plan of care
It does not necessarily denote failure in
care
VARIATIONS enable individualised care to be
given to the dying patient, whilst maintaining
continuity of care
Variations recorded separately (what, why,
action taken)
Variables as an Audit Tool
TREATMENT IS AUDITED BY MEANS
OF A VARIATION ANALYSIS
A variation is NOT a failure, but a
deviation from the expected path
Variations can provide auditable data
Lead to modifications in treatment
Improve practice
Kirklees and Calderdale
Integrated Care Pathway
SYMPTOM CONTROL
GUIDELINES ATTACHED TO
EVERY PATHWAY
Calderdale:
Palliative Care Team - 01422 222710
Overgate Hospice - 01422 379151
Huddersfield:
Palliative Care Team - 01484 342965
Kirkwood Hospice - 01484 557900