day 1. housekeeping introductions ground rules
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5 PRIORITIES OF CARE
Day 1
WELCOME
Housekeeping
Introductions
Ground rules
OUR VIEWS
Factors which influence and impact on us
EMPATHY
Hearing what THEY hear
Seeing what THEY see
Feeling what THEY feel
Would you do it differently?
HISTORY IN RELATION TO DOCUMENTATION
LCP
Baroness Neuberger (July 2013)
There is no doubt that, in the right hands, the Liverpool Care Pathway supports people to experience high quality and compassionate care in the last hours and days of their life
HOWEVER……But evidence given to the review has revealed too many serious cases of
unacceptable care where the LCP has been incorrectly implemented.
Examples include leaving patients without adequate nutrition, hydration
and inappropriately sedated
This is not only awful for the patients, but it is deeply
distressing to their relatives and carers.
BIGGER PICTURE
What we have also exposed in this Review is a range of far wider, fundamental problems with care for the dying – a lack of care and compassion, unavailability of suitably trained staff, no access to proper palliative care
advice outside of 9-5 Monday to Friday.
LEADERSHIPS ALLIANCE FOR THE CARE OF DYING PEOPLE Set up to lead and provide a focus for
improving the care for this group of people and their families and carers
Followed the publication of the “More Care Less Pathway” report
Care Quality Commission (CQC) NICE (National Institute for Health and Care Excellence)
College of Health Care Chaplains (CHCC)
NHS England
Department of Health (DH) NHS Trust Development Authority (NTDA)
General Medical Council (GMC) NHS Improving Quality (NHS IQ)
General Pharmaceutical Council Nursing and Midwifery Council (NMC)
Health and Care Professions Council (HCPC)
Public Health England (PHE)
Health Education England (HEE) Royal College of GPs
Macmillan Cancer Support Royal College of Nursing (RCN)
Marie Curie Cancer Care Royal College of Physicians (RCP)
National Institute for Health Research (NIHR)
Sue Ryder Care
PURPOSE Develop advice for professionals on
individual care plans and other arrangements in place of the Liverpool Care Pathway;
MAPPING Looking at existing guidance, training
and development, then consider how these impact on the
care of dying people and the circumstances that might affect the adoption of good practice
WORKSHOPSAS PART OF ITS WORK, A SERIES OF WORKSHOPS IS BEING HELD TO SHARE THE ALLIANCE’S THINKING AROUND PROVIDING CONSISTENT, HIGH QUALITY CARE FOR DYING PEOPLE IN THEIR LAST DAYS AND HOURS OF LIFE AND TO INVOLVE AND ENGAGE CLINICIANS AND THE PUBLIC, IN HELPING TO DETERMINE WHAT THE BEST WAY FORWARD IS.
THE WORKSHOPS WILL FOCUS ON THE PROPOSALS FOR A SET OF DESIRED OUTCOMES FOR PEOPLE WHO ARE DYING WHICH, SUPPORTED BY GUIDING PRINCIPLES FOR CLINICIANS, SHOULD BE THE BASIS OF CARE IN DIFFERENT SETTINGS AND CIRCUMSTANCES
ONE CHANCE TO GET IT RIGHT 5 priorities of care …
Recognise
Communicate
Involve Support
Plan and do
The possibility that a person may die within the next few days or
hours is recognised and communicated clearly, decisions
made and actions taken in accordance with the person’s
needs and wishes, and these are regularly reviewed and decisions
revised accordingly.
RECOGNISE
Sensitive communication takes place between staff
and the dying person, and those identified
as important to them.
COMMUNICATE
The dying person, and those identified as
important to them, are involved in decisions
about treatment and care to the extent that the dying person wants.
INVOLVE
The needs of families and others identified as
important to the dying person are actively
explored, respected and met as far as possible.
SUPPORT
An individual plan of care, which includes food and
drink, symptom control and psychological, social and
spiritual support, is agreed, co-ordinated and delivered
with compassion.
PLAN AND DO
THE END OF LIFE CARE PATHWAY
Discussionsas the end of life approaches
Assessment, care planning and review
Coordination of care
Delivery of high quality services in different settings
Care in the last days of life
Care after death
Open, honestcommunication
• Identifyingtriggers fordiscussion
Agreed careplan andregular review
of needs andpreferences• Assessing
needs ofcarers
Strategic coordination
• Co-ordination
of individualpatient care
• Rapidresponseservices
High qualitycare
provisionsin all settings
• Acutehospitals,
community,care homes,extra carehousing
hospices,communityhospitals,prisons, secure
hospitals andhostels
• Ambulanceservices.
Identificationof the dying
phase• Review ofneeds and
preferencesfor place of
death• Support forboth patient
and carer• Recognition
of wishesregarding
resuscitationand organdonation.
Recognition thatend of life caredoes not stopat the point of
death• Timely
verification andcertification of
death or referralto coroner• Care and
supportof carer and
family, includingemotional
and practicalbereavement
support
ACHIEVING PRIORITIES OF CARE
PRINCIPLES OF ACP
Advance statement
Advance decision
Lasting power of attorney
Funeral arrangements
ADVANCE CARE PLANNINGAdvance care planning
Advance statement
What they do want
Advance decision
What they do not want
ADVANCE STATEMENT
A requesting statement reflecting an individuals
preferences and aspirations
Formalise what the patients and their family do wish to
happen, allowing them to fill clearer in their own mind
Can be useful to clinicians in planning of patients
individual care knowing how a person would like to be
treated
Not legally binding but can/should be used within best
interest decisions
May also need advanced decision and DNACPR
WRITTEN ON ANYTHING!
DECISION MAKING TOOLS
Preferred Priorities of Care (PPC)
Say it once: my advance care plan
“Thinking ahead”
My Voice
This is me……..
Advanced decision from specific groups such as MND
Eliciting preferences form
ADVANCE DECISION
An advance decision must relate to a specific
treatment and specific circumstances
Formalises what patients do not wish to happen
giving them control
It will only come into affect when capacity lost
Legally binding document
Related to capacity of decision making, mental
capacity act
LASTING POWER OF ATTORNEY
Check. Lasting power of attorney? In health and welfare? Can make decisions in life sustaining treatment? Is it registered with the office of the Public
guardian?
They maybe a deputy under the court of protection if they do not have capacity to appoint a lasting power of attorney.
They may have been appointed an agent by the department of work and pensions for bills etc.
A lasting power of attorney (LPA) is a legal document that lets you (the ‘donor’) appoint one or more people (known as ‘attorneys’) to help you make decisions or make decisions on your behalf.
This gives you more control over what happens to you if, for example, you have an accident or an illness and can’t make decisions at the time they need to be made (you ‘lack mental capacity’).
https://www.gov.uk/power-of-attorney/overview
DOES NOT WANT CPR
Be careful not to offer CPR as a
treatment if not considered successful.
You are only getting preferences
If does not want CPR = ADRT or
support process of uDNACPR with GP.
UDNACPR
Purple Form- Who completes it?- Who owns it?- Where it is stored?- Document in patient’s notes
Ensure it is communicated to all that needs to know
THE DECISION
1.A CPR is unlikely to be successful Clinician may fill would not benefit at all and
could look at Elsie’s prognosis and situation as a 1A decision
1.B CPR may be successful……… Elsie has made it clear that she does not want
CPR through ACP discussion so could be a 1b decision.
1.C DNACPR is in accord ……… Elsie could have a 1c decision if he completes
his ADRT.
QUIZ
When could you consider starting an
advance care planning conversation?
What does an ADRT stand for?
Is an advance statement legally binding?
Do we have to prove we have capacity?
Is advanced care planning voluntary?
Who can complete a uDNACPR?
I DIDN’T KNOW THAT Surprises you? Frustrates you? Worries you? Comforts/ reassures you?
In groups consider…what can we learn from this?Can we change practice or even policy to support diversity or even individuality?
I DIDN’T KNOW THAT
Support
Involve
ACHIEVING PRIORITIES OF CARE Thoughts of the paperwork Considerations…..
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