hot topics and advance care planning in a snap shot! dr ros taylor hospice director, hospice of st...
TRANSCRIPT
Hot Topics and Advance Care Planning in a snap
shot!Dr Ros Taylor
Hospice Director, Hospice of St Francis, Berkhamsted
Trustee, Help the [email protected] 07515747440
Sarah RussellDirector of Education and Research Hospice
of St Francis, Herts and Mount Vernon Cancer Network End of Life Education Project Lead in
Care Homes and GP [email protected] or
1
‘Are you prepared should one of you melt ?’
UK is the best place in the world
to die??
Economist Intelligence Unit 2010
But…..NHS Complaints Audit
50% of hospital complaints
………relate to the care of dying
Demographics
aaaaaaaaaaghhhhhh
What do you die of ??
• Cancer 25%
• Long term conditions 25%
• Fraility 25%
75% predictable deaths
3000 in West Herts
Palliative Medicine
MANAGING SUFFERING & UNCERTAINTY
New England Journal of Medicine
Live longer, feel better….
…..if palliative care introduced early !! N Engl J Med 2010;363:733-42 Temel
Themes
WHERE to die ?
WHEN to die?
HOW we die ??
Place - does it matter ??
?Home
?Hospice
?Hospital
Hospice of St Francis Beds x12 Doctors !
Education
Spring Centre – outpatients
Triage
01442 869550
Work with the Peace, NHS, Iain Rennie Grove House
Canada
• 80% patients want to die at home
• Only 50% of their relatives support this
• Only 5% of these relatives felt they had the skills and knowledge to care
Guberman
Family Care
…..Or is it
Family Scare
OR
Debbie died at home last week…..what made it possible ?
• Mac Nurse diagnosed ‘terminal phase”• Grove House OT …equipment• GP who visited…..DNA CPR in house• St Francis Hospice Doctor advised by phone• Texts and mobile to main carer• Just in Case meds for last hours• Advance care discussions recorded• Informed resilient carer….KEY
A good death in
the bed you die in
Barbara Monroe
CEO St Christophers Hospice
When we die ?
Assisted Suicide
Decision making
Ask the question
Is this patient dying
Should we still be actively treating ??
= DECISION POINT
= Transforming points
How we die ???
TERRORfear
panicdeath anxiety
www.dyingmatters.org
Advance Care Planning
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Health and social care parallel process of anticipating the advance
care planning needs of the patient/client
Advance Care Planning Theoretical ModelRussell 2012 (in press)
Advance Care PlanningThe Activity
The Advance Care PlanAdvance Advance Lasting PowerStatement Decision Attorney
To Refuse (Welfare)Treatment
1. GP End of Life Education and Resources Mapping Project in Beds, Herts and Luton identify the needs of individual practices
2. Community and Care Home End of Life Education Programme in Beds, Herts and Luton (increase in PPD from 51% to 77%)
3. 21st June 2012: Peace Hospice Watford ([email protected]) Practical Palliative Care: Mental Capacity Act
4. 10th July 2012: Hospice of St Francis, Berkhamsted ([email protected]) Case Studies in End of Life Care (Advance Care Planning, Assisted Suicide, Psychological Distress)
5. Homelessness and End of Life Care Workshop:
6. Case Studies in Non Malignant Palliative Care
7. Resources on MVCN websiteFor more info
[email protected] Or [email protected] 26
Whats going on...whats coming up across the area
Created Type Name Downloads
Feb01
Leaflet ACP - Planning for your future care Added: 10/04/2012
Download
Jul01
GuidanceACP - Dementia Added: 10/04/2012
Download
May03
GuidanceACP - Capacity care planning and advanced care planning Added: 10/04/2012
Download
Feb02
GuidanceACP - Concise guidance to good practice Added: 10/04/2012
Download
Dec01
FormsACP - Preferred priorities for care Added: 10/04/2012
Download
Jan01
FormsACP - Preferred priorities for care - easy read Added: 10/04/2012
Download
Jan01
FormsACP -Advance decision to refuse treatment Added: 10/04/2012
Download
Jul25
GuidanceACP A guide to making an advance decision to refuse treatment Added: 10/04/2012
Download
Jul01
GuidanceACP Guide to Advance Statement Dementia Added: 10/04/2012
Download
Dec01
FormsACP Guide to Prefered priorities for care Added: 10/04/2012
Download27
http://pro.mountvernoncancernetwork.nhs.ukSupportive and Palliative Care
GroupsEnd of Life Care
dying in the presence of people……
who know how to drop the professional role mask and relate to others simply and richly as a human being
Prof. D. Barnard
How we die ?
• Lots of help….• Guidelines…. • Pathways….LCP• Web sites• http://www.endoflifecareforadults.nhs.uk/
• Local training….eg 10th July
@St Francis
How can we fund it ?
70% - 90% paid for by the public
£550 million
10% - 30% paid for by the NHS
£150 million
You matter because you are you and you matter untill the last moments of your lifeDame Cicely Saunders
A good death in the bed you die
in….
Barbara MonroeCEO St Christophers
Things will improve with….
• Communication….?? IT and EPACCS
….sharing decisions re ACP, CPR, JIC…special patient notes etc
• Co-ordination…..a single point of contact
MarieCurie
St ALBANSBERKHAMSTED HEMEL
HOSPICE of St FRANCIS BEDS
St FRANCISDocs
Iain Rennie Hospiceat Home
Grove House Hospice at Home
CNS IRHH
CNSMac
CNS StFrancis
NHSDoc
DAYCAREHOSF GROVE HOUSE