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…..