Kirklees and CalderdaleKirklees and CalderdalePrimary Care TrustsPrimary Care Trusts

Integrated Care Pathway Integrated Care Pathway for the dying patientfor the dying patient

Barbara BurkeEnd of Life Pathway Facilitator

C7 – Care of the Dying(Terminal Phase)

Patients in last few days of life need to be cared for appropriately.

WHY?

To enable patients to die well and peacefully.To enable relatives and carers to provide care, be kept informed, and have positive lasting memories if possible.Staff involved have sense of satisfaction that a ‘good death’ has been achieved.

OTHERWISE?

If Terminal Phase not well addressed, there is dissatisfaction with care from both carers and staff involved.

‘What might have been’

HOW?

Using Integrated Care Pathway (based on the Liverpool Integrated Care Pathway) (Devised by Dr John Ellershaw & Team)

What is anIntegrated Care

Pathway?

A map/tool of a patient’s planned care for a specific clinical problemUsed by the multidisciplinary teamProvides a method of coordinating and standardising care – reducing practice variations

What is anIntegrated Care Pathway?

A Legal document, incorporating guidelines for symptom control which reflect current best practiceProvides a mechanism for continually monitoring and evaluating processes, practices and outcomes of care

Advantages of anIntegrated Care Pathway

Facilitates Clinical GovernanceClinical guidelines/protocolsAuditable data/demonstrable outcomesChanges practiceEnhances communicationReduces paperwork/time writing care plansEffective learning tool

Pathways are NOT:

A criticism of current practiceTotally prescriptiveJUST a nursing documentUndermining of professional knowledge, skill or competencyComplicatedWritten in stone!

Why implement ICP in care homes

Promotes high- quality, efficient, effective, and equitable carePatient and carer focused/definite plan of actionReduces crisis admissions to hospital in the dying phaseIncreases % of deaths occurring within the care home

Why implement ICP in care homes

ProactiveEnhances communicationGives permission to discontinue regimesInforms on symptom controlEmpowers staffSensitive – one record – up to date/ demonstrates care given

Criteria for ICP(Signs of Terminal Phase)

Multi-professional team agree patient is

dying and two of the following apply:

Patient bed boundOnly able to take sips of fluidNo longer able to take tabletsSemi-comatoseSTOP CURRENT DOCUMENTATION

USE ICP INSTEAD

Structure of the Integrated Care Pathway

Three Sections:Incorporate physical,social, psychological,spiritual/religiousaspects 1. Initial Assessment2. On Going Care and

Assessment3. Care After Death

Outcome measures (Goals) for each section

Goal Achieved

Goal Not Achieved = ‘V’ (Variation)

Integrated Care Pathway

VARIATIONIs deviation in patient’s plan of careIt does not necessarily denote failure in careVARIATIONS enable individualised care to be given to the dying patient, whilst maintaining continuity of careVariations recorded separately (what, why, action taken)

Variables as an Audit Tool

TREATMENT IS AUDITED BY MEANS OF A VARIATION ANALYSISA variation is NOT a failure, but a deviation from the expected pathVariations can provide auditable dataLead to modifications in treatmentImprove practice

Kirklees and Calderdale Integrated Care Pathway

SYMPTOM CONTROLGUIDELINES ATTACHED TO

EVERY PATHWAY

Calderdale: Palliative Care Team - 01422 222710 Overgate Hospice - 01422 379151

Huddersfield: Palliative Care Team - 01484 342965 Kirkwood Hospice - 01484 557900