transforming end of life care in acute hospitals am workshop 4: advance care planning, sharing...
TRANSCRIPT
Advance Care Planning
process here at BSUH
Transforming End of Life Care in
Acute Hospitals Conference
18 November 2015
David Howlett Foundation Year 1 Doctor
Dilan Joshi Medical Student
Sarah French Theatre Sister
Sherree Fagge Chief Nurse
The Route to
success in end of
life care –
achieving quality in
acute hospitals
Transforming End
of Life Care in
Acute Hospitals
Five key enablers
1. Advance Care Planning process
2. ShareMyCare our Electronic Palliative
Care Coordination System (EPaCCS)
3. AMBER care bundle
4. Rapid Discharge Pathway for the dying
patient who would like to die at home
5. The Priorities of Care of the Dying Person
What are we doing?
Major focus at BSUH
for all staff on a
personal and professional level
Advance Care Planning
process
I didn’t want that video
(Dying Matters 2012)
Dying Matters Coilition
Advance Care Planning in Kent,
Surrey and Sussex:
A Report and Recommendations
from the South East Coast Clinical
Senate
Five key enablers
1. Advance Care Planning process
2. ShareMyCare our Electronic Palliative
Care Coordination System (EPaCCS)
3. AMBER care bundle
4. Rapid Discharge Pathway for the dying
patient who would like to die at home
5. The Priorities of Care of the Dying Person
• Engagement & Networking
– End of Life Care Links for all clinical areas
• Education
– End of Life Care Education Series
– End of Life Care Study Days
– End of Life Care Link Workshops
– End of Life Care Newsletter
– End of Life Care Intranet Site
– End of Life Care Conference
Sharing wishes and
preferences
Starts with YOU!
YOU?
v
Future Care Planning
Dr Karen GrovesWest Lancs, Southport & Formby
FO
SOUTHPORT
West Lancs, Southport & Formby
WL,S&FWL,S&F1 bed/69 people
WL,S&FWL,S&F1 bed/69 people
WL,U.K.U.K.1 bed/150 people
WL,U.K.U.K.1 bed/150 people
River Ribble
M6
M58
• 235,000 pop
• 1 NHS Trust - ICO• 2 hospitals
• 110 care homes• +4 unregistered
• 3429 reg. CH beds
Place of Death ONS 2014
Place of Death ONS 2014
• Integrated Specialist Palliative Care Services
• Hospital & Community SPCT in one NHS base
• Hospice inpatient, outpatient, day & ‘at home’ services
• Six Steps to Success Care Homes Programme
• Acute Hospitals GSF Pilot
• Acute Hospitals Transform Programme 2nd wave
Background
Hospital Transform Facilitator
WL Six Steps Facilitator
Hospital EoL
Facilitator
S&F Six Steps Facilitator
Terence Burgess
Education Centre
ManagerAmber
Care Bundle Facilitator
Advance Care Planning
Facilitator
Hospital Transform Facilitator
WL Six Steps Facilitator
Hospital EoL
Facilitator
S&F Six Steps Facilitator
Terence Burgess
Education Centre
Manager
Amber Care Bundle
Facilitator
Advance Care Planning
Facilitator
Hospital Transform
Lead
TBEC Manager & Transform
Care Home Lead
Community Transform
Lead
Transform Facilitator
Transform Support
Transform Facilitator
Care of DyingCare of Dying
GenogramsGenograms
Co-ordinationCo-ordination Rapid End of Life TransferRapid End of Life Transfer
Communication Skills
Communication Skills
Simple Skills Secrets
Simple Skills Secrets
Future Care Planning
Future Care Planning
Consistent Practical
Relevant Memorable
On site
Advance Care
Planning
Best Interests Decisions
Anticipatory Clinical
Management
Hospital & Community staff
397
Care Home staff
294
Public
578
Total
1672
• Same team members working in all settings
• Education is the same whether in hospital, hospice, community or care home
• Processes are the same across all boundaries
• Documentation similar across all settings
• Consistent messages and vocabulary
Cross Boundary Consistency
Future Care PlanningDoes person have
capacity?Does person have
capacity?
yes
no
Advance Care Planning
Advance Care Planning
Anticipatory Clinical Planning
Anticipatory Clinical Planning
Is there a previous ACP?
Is there a previous ACP?
no
respect wishes previously expressed
respect wishes previously expressed
yes
Best Interests Decisions
Best Interests Decisions
Advance Care Planning
Advance Care Planning
Recording a Conversation
I
Lasting Power of Attorney(for health &
welfare)
Lasting Power of Attorney(for health &
welfare)
Advance Decision to
Refuse Treatment
Advance Decision to
Refuse Treatment
Statement of wishes, beliefs &
preferences
Statement of wishes, beliefs &
preferences
Named Spokespers
on
Named Spokespers
on
Clinical DecisionsClinical
Decisions
Anticipatory Clinical
Management
Anticipatory Clinical
Management
CLINICAL
FUTURE CAREPLANNING
Talk about
it
Share it
Think about
it
ADVANCE CAREPLANNING
Adv
ance
Car
e P
lann
ing
Ant
icip
ator
y C
linic
al
Man
agem
ent P
lann
ing
Introducing a framework to manage care for those approaching end of life promoted discussion &
documentation of wishes & preferences by district
nurses
3 cycles of audit demonstrated
improvement from 0% to 100% !
Audit Recording ACP conversations
& questionnaire survey of
DN practice demonstrated lack of standard location of information in notes
Outcome:new discussion record
with prompts
now also introduced into acute & care home
settings
Communication
Recorded ACP Discussions
• Multiple HPs having discussions
• Recorded in different places (new section in acute clinical records)
• Lack of interoperability of electronic systems
72 7189 80
112124
0102030405060708090
100110120130140
Qu1 Qu2 Qu3 Qu4 Qu 1 Qu2
2014-152014-15 2015-162015-16
• Documenting conversations in a way that
• they can be shared
• they can be counted
• Sharing & updating wishes & preferences
• Using previously identified wishes & preferences in the acute setting (trial of WR proforma)
• Educating every staff member & the public
Challenges