Transcript Slide 1

electronic Palliative Care
Summary (ePCS)
SCIMP November 2009
Dr Peter Kiehlmann
GP, Aberdeen & National Clinical Lead
Palliative Care eHealth
[email protected]
http://www.scotland.gov.uk/Topics/Health/NHS-Scotland/LivingandDyingWell
http://www.ecs.scot.nhs.uk/epcs.html
Outline
Journeys
Context
What is ePCS?
Why is it needed?
Timescale
Benefits
The maze of trees
3 Steps in Gold Standards Framework
3. Plan
2. Assess
1. Identify
GSFS - Key Tasks - 7 Cs
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C1
Cancer Register & Team Meetings, Pt info, Treatment cards, PHR
 C2
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Co-ordinator
Key Person, Checklist
C3
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Communication
Control of Symptoms
Assessment, body chart, SPC etc
 C4
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Continuity Out of Hours
Faxed Form
C5
Learning about conditions on patients seen
C6
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Continued Learning
Carer Support
Practical, emotional, bereavement, National Carer’s Strategy
C7 Care in dying phase
Reactive patient journey:
in last months of life
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GP and DN ad hoc arrangements & no ACP in place
- was PPoC discussed or anticipated?
- what is pt/carer understanding of diagnosis /prognosis?
• Problems of anxiety & symptom control
• OOH Crisis call - no ACPor drugs available in the home
• Admitted to and dies in hospital
• Was Carer supported before/after loved one’s death?
• Did OOH, PHCT or Hospital reflect on care given?
• Was use of hospital bed appropriate?
GSFS Proactive pt journey:
in last months of life
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On Pall Care Register - reviewed at PHCT meeting (C1)
DS1500 and info given to pt + carer (home pack) (C1, C6)
Regular support, visits phone calls - proactive (C1, C2)
Assessment of symptoms, partnership with SPC customised care to pt and carer needs (C3)
Carer assessed incl psychosocial needs (C3, C6)
Preferred Place of Care (PPoC) noted & organised (C1, C2)
OOH form sent – care plan & drugs in home (C4)
End of Life pathway/LCP/minimum protocol used (C7)
Pt dies in their preferred place - bereavement support
Staff reflect-SEA, audit gaps improve care, learn (C5, C6)
Outline
Journeys
Context
What is ePCS?
Why is it needed?
Timescale
Benefits
Illness trajectories
High
Cancer
F u n c tio n
GP will have 20 pts die every year
A
Organ
Low
failure
death
Time
H igh
O rgan System Failure
F u n c tio n
B
Low
death
Tim e
High
Dementia/Frailty
C
Function
Sudden
death
death
Low
Time
Palliative Care
for whom?
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diagnosis of a progressive or
life-limiting illness
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critical events or significant
deterioration during the disease
trajectory indicating the need for
a change in care and
management
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significant changes in patient or
carer ability to ‘cope’ indicating
the need for additional support
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the ‘surprise question’
(clinicians would not be
surprised if the patient were to
die within the next 12 months)
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onset of the end of life phase –
‘diagnosing dying’
Place of death Scotland 1981-2006
Place of death. Scotland 1981 to 2006
Source GRO Scotland
100%
Home
90%
80%
70%
60%
Nursing
Homes
etc.
50%
40%
30%
Hospital
20%
10%
06
05
20
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20
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20
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20
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20
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81
0%
So by 2030…
if current trends continue
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home deaths will reduce by 42.3%
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Less than one in 10 (9.6%) will die at
home
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increase in institutional deaths of
20.3%.
Choice-preferred/actual place of death
Higginson I (2003) Priorities for End of Life Care in England Wales and Scotland National Council
Place:
Home Hospital Hospice Care Home
Preference 56%
11%
24%
4%
Cancer
25%
47%
17%
12%
All causes
20%
56%
4%
20%
What stops people dying at home?
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Symptoms
 Carer Breakdown
 They don’t know
they can
 They don’t know
they are dying
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Home situation
 Patient and family
wishes
 Lack of services
 Admitted by out of
hours doctor
Susan Munroe, Marie Curie Cancer Care and Scott Murray, University of Edinburgh,
& Scottish Partnership for Palliative Care 2005
Living and Dying Well
Living and Dying Well
•Assessment and Review of palliative and end of life
care needs
•Planning and delivery of care for patients with
palliative and end of life care needs
•Communication and Coordination
•Education, training and workforce development
•Implementation and future developments
Activities from
Living and Dying Well
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Board Delivery Plans
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Triggers and Assessment tools
Palliative Care Registers
Service Information Directories
Community Nursing
Care Homes
Education champions
Anticipatory Rx & Equipment
DNA CPR Policy
E-Health inc. ePCS
1st 6month review encouraging
Outline
Journeys
Context
What is ePCS?
Why is it needed?
Timescale
Benefits
ECS
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New GP Contract
 GP not responsible 24/7
 Risks to safe, effective care
 Patient info from GP computers
-> ECS store twice daily
 Medication & Allergies
 97% of GP Practices
 >5 million patients
Explicit Consent to view
 ‘Read only’ available to…
 NHS24, A&E, AMAU, SAS
ePCS - What is it?
An electronic Palliative Care Summary
 An extension to Emergency Care Summary (ECS) &
 Gold Standards Framework Scotland (GSFS)
 For use both In Hours & OOH
 ePCS replaces current faxed communications
 Allows GPs & Nurses to record in one place
Diagnosis, Rx, Pt Understanding & Wishes,
Anticipatory Care Plans, review dates, lists for
meetings
ePCS Overview
GP /DN
consultation ePCS
OOH
clinician
NHS
24
ePCS display
A&E
update
ECS
Store
Ambulance
1. During consultation
Practice Admin.
Staff
Audit
2. Due to prescription
trail 3. Team meeting or other
contact
TBD…
ePCS Dataset
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Consent - Palliative care data transfer
Carer details and key professionals
Diagnosis – as agreed by patient by pt & GP
Current Rx –Rpt, 30/7 Acute, Allergies;
Patient wishes
 Preferred Place of Care [PPoC]
)
 DNA CPR decision
) Anticipatory
Patient’s & Carer’s understanding of ) Care
diagnosis/prognosis
) Plan
Just in Case – Rx & equipment
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Advice for OOH care
)
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GP Mobile no., death expected? Cert. etc )
EMIS - Summary
ePCS no diagnosis added yet
Diagnosis agreed with pt & added
Patient/Carer Wishes
New ECS build screenshots
Access to PCS Information
Base ePCS –view in Adastra
Mobile ePCS - Adastra
Using ePCS in practice –
a continuing process
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Does this pt have Palliative Care Needs?
 Add to Pall Care Register,
 Once Consents to send ePCS ->OOH,
agree Medical History, set review date
 Once consented any new info goes automatically
 Not expected to complete in one go!
 Complete pt wishes and Understanding, DNA CPR, record
“Just in case” Rx and Equipment as appropriate
 Regular review at PHCT
 Keep updating!
Outline
Journeys
Context
What is ePCS?
Why is it needed?
Timescale
Benefits
Palliative Care DES (1 of 26!)
1. Put pt on Palliative Care Register
 Clinical, Pt choice, Surprise Question
 From Prognostic Indicator Guidance
2. Make Anticipatory Care Plan – as ePCS
3. Send OOH form/ePCS within 2w
4. When dying use LCP /locally agreed pathway
Aim- encourage anticipatory care, for all diagnoses
When will it be available?
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Pilots completed Aug 09
 EMIS, Vision – Grampian, Gpass – A&A, Lothian
Issues addressed included
 acceptability & ease of use,
 improving the consultation & communication,
 anticipatory care planning,
NHS Lothian Rollout Sep 09
Vision more user-friendly late 09
Evaluation, national rollout late 09
Link with Board Leads for timings
 GP,Palliative Care, eHealth,OOH
ePCS – Benefits
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Natural progression from GSFS & ECS
Fits into day to day work of GPs & DNs
Aims to identify patients “upstream”
ie last 6-12 months, not just last days/weeks
Encourages Anticipatory Care Planning
Prompts to remind to ask about “difficult” issues
 “Just in Case”, DNA CPR, PPoC
Shares critical info. on vulnerable
patients at important times.
OOH & Secondary Care say
it transforms care
Patients & carers reassured
Safer, better experience
ePCS Overview
GP /DN
consultation ePCS
OOH
clinician
NHS
24
ePCS display
A&E
update
ECS
Store
Ambulance
1. During consultation
Practice Admin.
Staff
Audit
2. Due to prescription
trail 3. Team meeting or other
contact
TBD…