Anticipatory Care Planning & DNACPR

August 2010

Dr Peter KiehlmannGP, Aberdeen & National Clinical Lead

Palliative Care eHealth

peter.kiehlmann@scotland.gsi.gov.uk

www.scotland.gov.uk/LivingandDyingWellwww.ecs.scot.nhs.uk/epcs.html

National DNACPR policyNational DNACPR policy

Consensus by National Steering GroupConsensus by National Steering Group

– Single NHS Scotland policy & fromSingle NHS Scotland policy & from– ““DNA CPR” rather than DNARDNA CPR” rather than DNAR

Education strategy (via NES) to support Education strategy (via NES) to support implementation and ongoing information needsimplementation and ongoing information needs

– Training for trainers (incl Resus Officers)Training for trainers (incl Resus Officers)– Web based resourceWeb based resource– Learning “pack” including scenario DVDLearning “pack” including scenario DVD– Engagement with national LDW education Engagement with national LDW education

champions and facilitators champions and facilitators

The Policy

Recommended in “Living and Dying Well” the Scottish Govt. Action Plan for Palliative & End of Life Care

Requested by Public Audit Committee Based on revised Joint BMA/RCN/RC(UK)

Statement 2007 All Boards contributed, based on Lothian Fully integrated between 1’ and 2’ care services Supported by Scottish Ambulance Service

Why does it have to be integrated?

Patient with DNACPR form whilst in-patient discharged home to die

Patient collapsed & died more suddenly than expected Sat afternoon

Family panicked – 999 called Ambulance crew attempted CPR Police attended, confiscated patients drugs,

body removed to police mortuary GP from out-of-hours service attended but

unable to prevent this

Core elements of DNACPR policy 1

Clarify what CPR is and what it is not Support identification of patients who are

terminally ill Support identification of those who do not

wish CPR Uphold ethical principles - GMC Guidance Comply with legislation e.g. Adults with

Incapacity Act (Scotland)

Core elements of DNACPR policy 2 Support SAS End-of-life Care Plan Ensure patients/ relatives have written

information Promote open discussion without burdening

patients /relatives with having to make decisions where CPR won’t work

Apply across all care settings DNACPR form to reflect the policy + flow

chart to guide decisions Regular review

ePCS Overview

OOH clinician ePCS display

ePCS update 1. During

consultation

2. Due to prescription

3. Team meeting or other contact

Audit

trail

ECSStore

NHS 24

A&E

Ambulance

TBD…

Practice Admin. Staff

PracticeServer

GP /DN

consultation

NHS Scotland DNACPR policy

Single, high visibility, self-explanatory DNACPR form to follow the patient with all info needed by community, acute & SAS

Decision-making framework to assist staff in all settings

Training packages - Web, DVD presentation aid Boards rollout

Patient Information booklet to aid awareness & assist discussions

Thank you for listening

Advance/anticipatory care planning and the DNACPR

Integrated Adult Policy