Education resource to support introduction of All Wales

Care Decisions for the Last Days of Life

All Wales palliative care education group

© All Wales Palliative Care Education Group 2015 1

Aims of the session

• To describe the new supporting tool ‘ Care Decisions for the last days of life’ to help deliver care in the last days of life

• Improve your confidence in understanding the new document

© All Wales Palliative Care Education Group 2015 2

VIDEO

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Learning outcomes

By the end of the session you should be able to:•Describe the new tool ‘ Care decisions for the last days of life ‘ to a colleague•Effectively explain the rationale for its use to patients and those important to them•Describe, to a more junior colleague, the 5 priorities of care that support effective care in the last days of life

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The story so far…. • 1990’s in UK , a need to extend the gold standard of palliative care and ‘ hospice’

care into general hospitals and for non cancer patients resulted in the development of the Liverpool Care Pathway (LCP) in NHS England

• Wales – pathway developed into ‘Care priorities ‘ with annual quality and monitoring review

• 2012 first concerns in NHS England about use of LCP• 2013 major review of LCP and its withdrawal in England • 2013 Neuberger report – ‘ More care less pathway’• 2014 ‘ One chance to get it right’ NHS Leadership Alliance for care of the dying

person recommendations for England • 2014 in Wales – major review of the Integrated Priorities of care for the last days

of life – review of documentation, and survey of use in generalist setting• 2015 in Wales - launch of Care Decisions for the last days of life

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Group discussion

• What information do families need to know when a patient is thought to be in the last days of their life ?

• Who is best placed to give this information ?• How does this process currently work in

practice?

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Priorities as outlined in ‘One Chance to get it right’ NHS England

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Key priorities of care in the last days of life

• Good Communication – good communication with patient and those important to them is essential.

• Good Symptom control – first priority for 85% of patients is to be pain free.

• Holistic care – need to consider all aspects of caring i.e. physical, psychological, social, and spiritual needs – for patient and those important to them.

• Individualised care – everyone has different priorities and concerns.

• Implicit in these, is the goal of involvement of patient and those important to them.

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Page 1

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Page 2

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Page 3

NB, don’t forget the DNACPR form

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Page 4

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Symptom Assessment Sheet

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Individual case review sheet

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Symptom guidance is also provided

Care Decisions Community PRN chart

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Subcutaneous syringe driver chart

Aims of the session

• To describe the new supporting tool ‘ Care Decisions for the last days of life’ to help deliver care in the last days of life

• Improve your confidence in understanding the new document

• Consider how the document could be utilized in your area

© All Wales Palliative Care Education Group 2015 18

Learning outcomes

By the end of the session you should be able to:•Describe the new tool ‘ Care Decisions for the last days of life ‘ to a colleague•Effectively explain the rationale for its use to patients and those important to them•Describe, to a more junior colleague, the 5 priorities of care that support effective care in the last days of life

© All Wales Palliative Care Education Group 2015 19

Summary

• Care Decisions tool is to help support decision making about effective and compassionate care in the last days of life

• It is not a substitute for clinical assessment , decision making and review by the team looking after the patient

© All Wales Palliative Care Education Group 2015 20

How will your practice change or develop as a result of today?

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Thank you

WWW Search for:• Dying matters• More care less pathway ( 2013)• One chance to get it right ( 2014)

www.pallcare.info

Your local palliative care team © All Wales Palliative Care Education Group

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