Anticipatory Care Planning & DNACPR August 2010  Dr Peter Kiehlmann GP, Aberdeen & National Clinical Lead  Palliative Care...
National DNACPR policy   <ul><li>Consensus by National Steering Group </li></ul><ul><ul><li>Single NHS Scotland policy & f...
The Policy <ul><li>Recommended in “Living and Dying Well” the Scottish Govt. Action Plan for Palliative & End of Life Care...
Why does it have to be integrated? <ul><li>Patient with DNACPR form whilst in-patient discharged home to die </li></ul><ul...
Core elements of DNACPR policy  1  <ul><li>Clarify what CPR is and what it is not </li></ul><ul><li>Support identification...
Core elements of DNACPR policy  2 <ul><li>Support SAS End-of-life Care Plan </li></ul><ul><li>Ensure patients/ relatives h...
 
 
 
 
ePCS Overview GP /DN consultation OOH clinician ePCS display ePCS  update 1. During consultation 2. Due to prescription 3....
NHS Scotland DNACPR policy <ul><li>Single, high visibility,  self-explanatory DNACPR form to follow the patient with all i...
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Anticipatory Care Planning & DNACPR

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Anticipatory Care Planning & DNACPR

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Anticipatory Care Planning & DNACPR

  1. 1. Anticipatory Care Planning & DNACPR August 2010 Dr Peter Kiehlmann GP, Aberdeen & National Clinical Lead Palliative Care eHealth [email_address] www.scotland.gov.uk/LivingandDyingWell www.ecs.scot.nhs.uk/epcs.html
  2. 2. National DNACPR policy <ul><li>Consensus by National Steering Group </li></ul><ul><ul><li>Single NHS Scotland policy & from </li></ul></ul><ul><ul><li>“ DNA CPR” rather than DNAR </li></ul></ul><ul><li>Education strategy (via NES) to support implementation and ongoing information needs </li></ul><ul><ul><li>Training for trainers (incl Resus Officers) </li></ul></ul><ul><ul><li>Web based resource </li></ul></ul><ul><ul><li>Learning “pack” including scenario DVD </li></ul></ul><ul><ul><li>Engagement with national LDW education champions and facilitators </li></ul></ul>
  3. 3. The Policy <ul><li>Recommended in “Living and Dying Well” the Scottish Govt. Action Plan for Palliative & End of Life Care </li></ul><ul><li>Requested by Public Audit Committee </li></ul><ul><li>Based on revised Joint BMA/RCN/RC(UK) </li></ul><ul><li>Statement 2007 </li></ul><ul><li>All Boards contributed, based on Lothian </li></ul><ul><li>Fully integrated between 1’ and 2’ care services </li></ul><ul><li>Supported by Scottish Ambulance Service </li></ul>
  4. 4. Why does it have to be integrated? <ul><li>Patient with DNACPR form whilst in-patient discharged home to die </li></ul><ul><li>Patient collapsed & died more suddenly than expected Sat afternoon </li></ul><ul><li>Family panicked – 999 called </li></ul><ul><li>Ambulance crew attempted CPR </li></ul><ul><li>Police attended, confiscated patients drugs, body removed to police mortuary </li></ul><ul><li>GP from out-of-hours service attended but unable to prevent this </li></ul>
  5. 5. Core elements of DNACPR policy 1 <ul><li>Clarify what CPR is and what it is not </li></ul><ul><li>Support identification of patients who are terminally ill </li></ul><ul><li>Support identification of those who do not wish CPR </li></ul><ul><li>Uphold ethical principles - GMC Guidance </li></ul><ul><li>Comply with legislation e.g. Adults with Incapacity Act (Scotland) </li></ul>
  6. 6. Core elements of DNACPR policy 2 <ul><li>Support SAS End-of-life Care Plan </li></ul><ul><li>Ensure patients/ relatives have written information </li></ul><ul><li>Promote open discussion without burdening patients /relatives with having to make decisions where CPR won’t work </li></ul><ul><li>Apply across all care settings </li></ul><ul><li>DNACPR form to reflect the policy + flow chart to guide decisions </li></ul><ul><li>Regular review </li></ul>
  7. 11. ePCS Overview GP /DN consultation OOH clinician ePCS display ePCS update 1. During consultation 2. Due to prescription 3. Team meeting or other contact Audit trail ECS Store NHS 24 A&E Ambulance TBD… Practice Admin. Staff
  8. 12. NHS Scotland DNACPR policy <ul><li>Single, high visibility, self-explanatory DNACPR form to follow the patient with all info needed by community, acute & SAS </li></ul><ul><li>Decision-making framework to assist staff in all settings </li></ul><ul><li>Training packages - Web, DVD presentation aid Boards rollout </li></ul><ul><li>Patient Information booklet to aid awareness & assist discussions </li></ul>
  9. 13. Thank you for listening <ul><li>Advance/anticipatory care planning and the DNACPR Integrated Adult Policy </li></ul>
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