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Transforming End of Life Care in Acute Hospitals AM Workshop 4: Advance Care Planning, sharing perspectives

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Transforming End of Life Care in Acute Hospitals AM Workshop 4: Advance Care Planning, sharing perspectives presented by Dr David Howlett, Dilan Joshi, Sarah French, Sherree Fagge, Brighton and Sussex University Hospitals NHS Trust and Dr Karen Groves, Queens Court Hospice

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Transforming End of Life Care in Acute Hospitals AM Workshop 4: Advance Care Planning, sharing perspectives

  1. 1. Advance Care Planning process here at BSUH Transforming End of Life Care in Acute Hospitals Conference 18 November 2015
  2. 2. David Howlett Foundation Year 1 Doctor Dilan Joshi Medical Student Sarah French Theatre Sister Sherree Fagge Chief Nurse
  3. 3. The Route to success in end of life care – achieving quality in acute hospitals  Transforming End of Life Care in Acute Hospitals
  4. 4. Five key enablers 1. Advance Care Planning process 2. ShareMyCare our Electronic Palliative Care Coordination System (EPaCCS) 3. AMBER care bundle 4. Rapid Discharge Pathway for the dying patient who would like to die at home 5. The Priorities of Care of the Dying Person
  5. 5. What are we doing? Major focus at BSUH for all staff on a personal and professional level
  6. 6. Advance Care Planning process I didn’t want that video (Dying Matters 2012)
  7. 7. Dying Matters Coilition
  8. 8. Advance Care Planning in Kent, Surrey and Sussex: A Report and Recommendations from the South East Coast Clinical Senate
  9. 9. Five key enablers 1. Advance Care Planning process 2. ShareMyCare our Electronic Palliative Care Coordination System (EPaCCS) 3. AMBER care bundle 4. Rapid Discharge Pathway for the dying patient who would like to die at home 5. The Priorities of Care of the Dying Person
  10. 10. • Engagement & Networking – End of Life Care Links for all clinical areas • Education – End of Life Care Education Series – End of Life Care Study Days – End of Life Care Link Workshops – End of Life Care Newsletter – End of Life Care Intranet Site – End of Life Care Conference
  11. 11. Sharing wishes and preferences Starts with YOU! YOU?
  12. 12. v Future Care Planning Dr Karen Groves West Lancs, Southport & Formby
  13. 13. FO SOUTHPORT West Lancs, Southport & Formby WL,S&FWL,S&F 1 bed/69 people WL,S&FWL,S&F 1 bed/69 people WL,U.K.U.K. 1 bed/150 people WL,U.K.U.K. 1 bed/150 people River Ribble M6 M58 • 235,000 pop • 1 NHS Trust - ICO •2 hospitals • 110 care homes •+4 unregistered • 3429 reg. CH beds
  14. 14. Place of Death ONS 2014
  15. 15. Place of Death ONS 2014
  16. 16. • Integrated Specialist Palliative Care Services • Hospital & Community SPCT in one NHS base • Hospice inpatient, outpatient, day & ‘at home’ services • Six Steps to Success Care Homes Programme • Acute Hospitals GSF Pilot • Acute Hospitals Transform Programme 2nd wave Background
  17. 17. Hospital Transform Facilitator WL Six Steps Facilitator Hospital EoL Facilitator S&F Six Steps Facilitator Terence Burgess Education Centre Manager Amber Care Bundle Facilitator Advance Care Planning Facilitator
  18. 18. Hospital Transform Facilitator WL Six Steps Facilitator Hospital EoL Facilitator S&F Six Steps Facilitator Terence Burgess Education Centre Manager Amber Care Bundle Facilitator Advance Care Planning Facilitator
  19. 19. Hospital Transform Lead TBEC Manager & Transform Care Home Lead Community Transform Lead Transform Facilitator Transform Support Transform Facilitator
  20. 20. transform@nhs.net
  21. 21. Care of DyingCare of Dying GenogramsGenograms Co-ordinationCo-ordination Rapid End of Life Transfer Rapid End of Life Transfer Communicati on Skills Communicati on Skills Simple Skills Secrets Simple Skills Secrets Future Care Planning Future Care Planning Consistent Practical Relevant Memorable On site
  22. 22. Advance Care Planning Best Interests Decisions Anticipatory Clinical Management
  23. 23. Hospital & Community staff 397 Care Home staff 294 Public 578 Total 1672
  24. 24. • Same team members working in all settings • Education is the same whether in hospital, hospice, community or care home • Processes are the same across all boundaries • Documentation similar across all settings • Consistent messages and vocabulary Cross Boundary Consistency
  25. 25. Future Care Planning Does person have capacity? Does person have capacity? yes no Advance Care Planning Advance Care Planning Anticipatory Clinical Planning Anticipatory Clinical Planning Is there a previous ACP? Is there a previous ACP? no respect wishes previously expressed respect wishes previously expressed yes Best Interests Decisions Best Interests Decisions Advance Care Planning Advance Care Planning
  26. 26. Recording a Conversation
  27. 27. I Lasting Power of Attorney (for health & welfare) Lasting Power of Attorney (for health & welfare) Advance Decision to Refuse Treatment Advance Decision to Refuse Treatment Statement of wishes, beliefs & preferences Statement of wishes, beliefs & preferences Named Spokespers on Named Spokespers on Clinical Decisions Clinical Decisions Anticipatory Clinical Managemen t Anticipatory Clinical Managemen t CLINICAL FUTURE CARE PLANNING Talk about it Share it Think about it ADVANCE CARE PLANNING AdvanceCarePlanning AnticipatoryClinical ManagementPlanning
  28. 28. Introducing a framework to manage care for those approaching end of life promoted discussion & documentation of wishes & preferences by district nurses 3 cycles of audit demonstrated improvement from 0% to 100% !
  29. 29. Audit Recording ACP conversations & questionnaire survey of DN practice demonstrated lack of standard location of information in notes Outcome: new discussion record with prompts now also introduced into acute & care home settings
  30. 30. Communication
  31. 31. Recorded ACP Discussions • Multiple HPs having discussions • Recorded in different places (new section in acute clinical records) • Lack of interoperability of electronic systems 72 71 89 80 112 124 0 10 20 30 40 50 60 70 80 90 100 110 120 130 140 Qu1 Qu2 Qu3 Qu4 Qu 1 Qu2 2014-152014-15 2015-162015-16
  32. 32. • Documenting conversations in a way that • they can be shared • they can be counted • Sharing & updating wishes & preferences • Using previously identified wishes & preferences in the acute setting (trial of WR proforma) • Educating every staff member & the public Challenges

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