Transcript PREFERRED PRIORITIES OF CARE

PREFERRED
PRIORITIES FOR CARE
An end of life care tool
CATHRYN GREAVES
June 2010
Haemodialysis in Kendal
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Nurse led unit
Recently extended and refurbished
Will have 17 HD stations
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HD Facilities for 68 patients (59 at present)
Patients range in age from 33 to 89 years
Median age 68 years (UK median 64.5)
Multiple co-morbidities in our patients
Dying on Dialysis
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About 30% of our Kendal HD patients die each
year
Most die in hospital often a long way from home
Commonest cause of death is cardiovascular
We are rarely surprised when one of our patients
dies
Often the surprise is that the patient has
survived so long!
Most of the time we can predict who is likely to
die
End of Life Care
I identified a need for better care for our
patients at the end of their lives
 In the words of John Reid, Secretary of State
for Health in 2005 in the NSF
‘we aim to support people with established
renal failure live life as fully as possible and
enable them to die with dignity in a setting of
their own choice’
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How did it all start?
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Nothing formal in place at Kendal or
anywhere for dialysis patients that I knew of
in 2007
I identified a need to discuss end of life
issues with our patients
Started better discussions on a need to basis
with patients
Heard about the PPC and decided to adopt
the tool for dialysis patients
Obstacles
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Discussions with staff highlighted a great
resistance……. Fear!
“You can’t tell a patient they are dying!”
With the support of the Manager, I enlisted
the help of a Dr and a CSW. Our End - ofLife team was formed
Now to set to and devise a plan to implement
the PPC
The plan:
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Felt that it was important to introduce it to
every patient
Personal approach
Spend time with each patient
Forms given out with a supporting letter to
take home
What is a PPC ?
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A care plan
Not a legal document
Patient held
An introduction to the CONVERSATION!
Communication document
What does it consist of ?
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Three questions
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1st and 3rd easy….ISH
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2nd can be massive!
Who is it aimed at ?
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You could say anyone
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But someone who has an E-O-L illness
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Definition:- any organ failure
Dementia - early stages
Cancer
MND and Parkinsons to name a few.
Who can implement it?
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Anyone who feels confident and comfortable
discussing end of life issues.
BUT
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Must have some communication skills
training
Leads should have Advance communications
skills training
Sage and Thyme or equivalent for others
Completing the PPC
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Best option is for the patient to complete it
with their relatives etc.
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You can complete it BUT in their words.
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Give the Lions Message in a bottle out also
What then ?
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The more people who know what the
patients wishes are - the more chance they
have of having them fulfilled.
GP, DN’s, Macmillan, Carers, Consultants,
Specialist nurses, Social Workers and family
members.
Emphasis on no guarantees.
Keep it in a safe place and take into hospital.
Update, review as needed.
Does it work ?
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Yes
We have to work on a culture change of our
perceptions around death and dying and that
of today's society.
We plan so much for life's beginning why not
for life’s end?
The more we do this…the more it will
become the norm.
Death Data:
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28 deaths from Jan 2007 – Jan 2010
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10 had a PPC in place
6 achieved their 1st choice of preferred place
2 achieved their 2nd choice of preferred place
2 did not achieve their preferred place due to
acute episodes in hospital i.e. cardiac arrest
4 were in the process of completing PPC
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2 of these patients died at home
Death Data:
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4 were unable due to mental capacity issues
10 had refused the PPC
Looking at roughly 50 – 50 refusal and
uptake
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80% of people who had a PPC in place died in a
place of their choice and were involved in all the
decisions made around their end of life.
Current Data:
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59 dialysis patients
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17 have PPC in place
14 are in the process of completing a PPC
4 have refused
6 ? around their capacity (looking into Best
interest)
18 to be offered the PPC
Continue to evolve and improve end of life
care offered to patients
Case Study
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Patient A
Transferred Renal failure due to Myeloma
Palliative team already involved
PPC introduced
Subdued at first
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Outcome…
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Case Study
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Patient B
Over 20yrs on dialysis
Very open from introduction
Family support
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Outcome…
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Case Study
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Patient C
? Capacity initially
Bad news re sister
Offered PPC
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Outcome…
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AND FINALLY……
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Thank you for listening
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Cathryn Greaves
PPC Coordinator
UHMBT
Cathryn.A.Greaves@m
bht.nhs.uk