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Choice and control: ensuring patient involvement. Dr Simone Ali Consultant in Palliative Medicine South Downs Health NHS Trust / The Martlets Hospice. Choice and Control. What is Choice ? “option; alternative; selection; preference; variety; abundance” What is Control ? - PowerPoint PPT Presentation
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Choice and control: ensuring patient involvement
Dr Simone AliConsultant in Palliative MedicineSouth Downs Health NHS Trust /
The Martlets Hospice
Choice and Control
• What is Choice?– “option; alternative; selection; preference;
variety; abundance”
• What is Control?– “manage; organise; be in charge of; have
power over; be in command of; direct; rule”
• Is Choice/Control a good thing? Always?
Hobson’s Choice?
Referrals to MCT by Diagnosis (April 2007- March 2008) n=716
Cancer 79%
Systems failure14%
Progressiveneurological 3%
Other non-cancer4%
529
65
133
166
220
0
50
100
150
200
250
Actual Placeof Death 2007-8
(n=618)
Other 1%
Not known 5%
Care Home10%
Hospital 21%
Home 27%
Hospice 36%
Concordance with recorded Preferred Place of Care(April 2007-March 2008)
12%
19%
69%
Achieved
Unknown
NotAchieved
Concordance with recorded Preferred Place of Care for Non-
Cancer Referrals (2007-8)
83%
7%10% Achieved
Unknown
NotAchieved
Initiatives which have helped to enhance choice for dying patients in
Brighton and Hove
• Gold Standards Framework (GSF) for primary health care teams and some nursing homes
• Preferred Place of Care (PPC)• Liverpool Care Pathway (LCP) for the dying
patient used and audited by all District Nursing Teams
• Verification of Expected Death by District Nurses• Allow a Natural Death / Do Not Attempt
Resuscitation (DNAR) Policy
DNAR…do patients have a choice?
• Competent patients who don’t want CPR– Yes
• Competent patients who do want CPR– If futile, then no– No obligation to discuss with patient
• Incompetent patients who can’t tell us– Ascertain previous wishes of patient– Ascertain whether futile
Initiatives which have helped to enhance choice for dying patients in
Brighton and Hove
• Gold Standards Framework (GSF) for primary health care teams and some nursing homes
• Preferred Place of Care (PPC)• Liverpool Care Pathway (LCP) for the dying
patient used and audited by all District Nursing Teams
• Verification of Expected Death by District Nurses• Allow a Natural Death / Do Not Attempt
Resuscitation (DNAR) Policy• Statement of Patient’s Wishes (“Pink Sheet”)
STATEMENT OF PATIENT’S WISHES
Clinical Issue Details/DecisionAdvance Decision,Lasting Power of Attorney (LPA),Enduring Power of Attorney (EPA)
If any in place, when last updated and where are copies held?
Staff Signature Date
Cardiopulmonary Resuscitation (CPR)
If patient does not wish to be for CPR, has GP / Consultant signed DNAR form?
Staff Signature Date
Artificial Feeding & Hydration
Staff Signature DateAssisted Ventilation
Staff Signature DateTransfusion Of Blood Products
Staff Signature DateOther Scenarios Requiring Hospital Admission
Staff Signature DatePreferred Place of Care
Staff Signature Date
Help the Hospices and The St James’s Place Foundation Awards Programme:
“Care Beyond Cancer”
• “A patient led clinical directive proforma: development and dissemination”
• Supported by Brighton and Hove PCT and Out-Of-Hours (OOH) team
• Regular progress reports and audit
Impact of Pink Sheet
• Reduction in inappropriate hospital admissions
• Reduction in unwanted clinical interventions
• Better communication between patient, carers and professionals
• Especially helpful out of hours and when patient unable to express wishes
• PPC achieved for more patients