This 'how to' guide builds upon the overarching framework set out in The route to success in end of life care - achieving quality in acute hospitals, published in 2010. The route to success highlighted best practice models developed by acute hospital Trusts, providing a comprehensive framework to enable hospitals to deliver high quality care to people at the end of life.
This 'how to' guide aims to help clinicians, managers and directors implement The route to success more effectively, drawing on valuable learning from the NHS Institute for Innovation and Improvement's Productive Ward: Releasing time to care™ series.
This guide contains individual sections that can be worked on in any given order, dependent upon the individual hospital and its current end of life care provisions. These can be downloaded below:
Introduction
Section 1: prepare
Section 2: assess and diagnose
Section 3: plan
Section 4: treat
Section 5: evaluate
Section 6: sustain
Section 7: further resources
Cover
It places emphasis on existing 'enabling' tools and models, which support and follow a person-centred pathway. These are Advance Care Planning, Electronic Palliative Care Co-ordination Systems (EPaCCS), AMBER Care Bundle, Rapid Discharge Home to Die Pathway, and the Liverpool Care Pathway.
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
This document provides guidance for health and social care staff on care planning and advance care planning for people with life-limiting illnesses. It discusses the importance of assessing capacity and acting in best interests for those lacking capacity. Care planning involves determining needs, preferences and goals of care through discussion to decide how to meet needs. Advance care planning is voluntary and allows those with capacity to record future care wishes, such as advance decisions to refuse treatment or appointing lasting power of attorney, to guide care if they lose capacity. The key principles emphasize the importance of communication, informed consent, acting in best interests when needed, and documenting and sharing plans appropriately.
The purpose of this briefing is to help you to identify the immediate priority actions to commission effective end of life care.
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
The route to success in end of life care - achieving quality in acute hospitals
20 June 2010 - National End of Life Care Programme
This guide aims to provide practical support for NHS managers and clinicians responsible for delivering end of life care.
It can help trusts re-shape how their staff work with each other, their patients, their community and their social care partners to improve care quality and meet the Quality, Innovation, Productivity and Prevention (QIPP) agenda.
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
This guide is for members of the public and explains advance care planning. It outlines the different options available to people when planning for their end of life care.
This publication is an Bengali translation of Planning for your future care, which was published in February 2012 in partnership with the University of Nottingham and the Dying Matters Coalition.
An evaluation of the Route to Success resources, related tools and frameworks covering four settings: acute, care homes, domiciliary care and hostels for the homeless
13 December 2012 - Institute of Healthcare Management / National End of Life Care Programme
The project set out to review how the Route to Success (RtS) series of publications and supporting tools, resource guides and frameworks developed and supported by the National End of Life Care Programme (NEoLCP) have been utilised within site-specific settings.
Four publications were included in the evaluation:
Acute Hospitals
Care Homes
Domiciliary Care; and
Hostels for the Homeless.
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
Deaths in Older Adults in England
19 October 2010 - National End of Life Care Intelligence Network (NEoLCIN)
This report looks at deaths in people aged 75 and over to examine differences in place and cause of death by age band, from old to extreme old age.
This Guide for Executives is aimed at senior healthcare leaders. It provides 31 practical tips for leaders
who want to contribute positively to the culture for innovation in their organisations and systems.
A more in-depth practitioners guide, Creating the Culture for Innovation, provides much more
detailed advice and guidance, a host of additional examples, and information about an online staff
survey that can be used to assess, benchmark and understand the culture for innovation.
The Sustainability Model is a diagnostic tool that will identify strengths and
weaknesses in your implementation plan and predict the likelihood of sustainability
for your improvement initiative.
The Sustainability Guide provides practical advice on how you might increase the
likelihood of sustainability for your improvement initiative.
This document provides guidance for health and social care staff on care planning and advance care planning for people with life-limiting illnesses. It discusses the importance of assessing capacity and acting in best interests for those lacking capacity. Care planning involves determining needs, preferences and goals of care through discussion to decide how to meet needs. Advance care planning is voluntary and allows those with capacity to record future care wishes, such as advance decisions to refuse treatment or appointing lasting power of attorney, to guide care if they lose capacity. The key principles emphasize the importance of communication, informed consent, acting in best interests when needed, and documenting and sharing plans appropriately.
The purpose of this briefing is to help you to identify the immediate priority actions to commission effective end of life care.
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
The route to success in end of life care - achieving quality in acute hospitals
20 June 2010 - National End of Life Care Programme
This guide aims to provide practical support for NHS managers and clinicians responsible for delivering end of life care.
It can help trusts re-shape how their staff work with each other, their patients, their community and their social care partners to improve care quality and meet the Quality, Innovation, Productivity and Prevention (QIPP) agenda.
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
This guide is for members of the public and explains advance care planning. It outlines the different options available to people when planning for their end of life care.
This publication is an Bengali translation of Planning for your future care, which was published in February 2012 in partnership with the University of Nottingham and the Dying Matters Coalition.
An evaluation of the Route to Success resources, related tools and frameworks covering four settings: acute, care homes, domiciliary care and hostels for the homeless
13 December 2012 - Institute of Healthcare Management / National End of Life Care Programme
The project set out to review how the Route to Success (RtS) series of publications and supporting tools, resource guides and frameworks developed and supported by the National End of Life Care Programme (NEoLCP) have been utilised within site-specific settings.
Four publications were included in the evaluation:
Acute Hospitals
Care Homes
Domiciliary Care; and
Hostels for the Homeless.
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
Deaths in Older Adults in England
19 October 2010 - National End of Life Care Intelligence Network (NEoLCIN)
This report looks at deaths in people aged 75 and over to examine differences in place and cause of death by age band, from old to extreme old age.
This Guide for Executives is aimed at senior healthcare leaders. It provides 31 practical tips for leaders
who want to contribute positively to the culture for innovation in their organisations and systems.
A more in-depth practitioners guide, Creating the Culture for Innovation, provides much more
detailed advice and guidance, a host of additional examples, and information about an online staff
survey that can be used to assess, benchmark and understand the culture for innovation.
The Sustainability Model is a diagnostic tool that will identify strengths and
weaknesses in your implementation plan and predict the likelihood of sustainability
for your improvement initiative.
The Sustainability Guide provides practical advice on how you might increase the
likelihood of sustainability for your improvement initiative.
The document provides information and guidance for patients on how to take an active role in their recovery process before and after a hospital operation or procedure. It emphasizes the importance of staying physically and mentally active before surgery, eating healthy foods, and making plans for support and transportation at home after being discharged from the hospital. Taking small, achievable steps each day toward recovery goals like walking, showering, and eating can help patients leave the hospital sooner and feel better faster.
This document discusses bringing social movement thinking to healthcare improvement by incorporating principles from successful social movements. It outlines five key principles for creating social movement dynamics within healthcare organizations: see change as a personal mission; frame issues to connect with core values; energize and mobilize individuals; organize for impact; and maintain forward momentum. The document argues that while traditional improvement approaches have had some success, social movement thinking can help deliver deeper, more sustainable changes to better serve patients. It provides several case studies of teams that have applied social movement ideas to spur healthcare improvements.
The 15 Steps Challenge provides a toolkit to help healthcare teams evaluate the quality of patient care from the patient's perspective. A 15 Steps Challenge team conducts ward walkarounds using the toolkit to assess four areas: Welcoming, Safe, Caring and Involving, and Well Organised and Calm. The team then provides feedback to the ward and trust sponsor to identify good practices and areas for improvement. Repeating the Challenge ensures continuous quality improvement by regularly incorporating the patient voice.
This document provides an overview of a toolkit aimed at helping NHS trusts reduce their Caesarean section rates. The toolkit was developed by the NHS Institute for Innovation and Improvement based on visits to maternity services with low C-section rates. It includes self-assessment tools covering key areas like first pregnancies, VBAC, and organizational characteristics. The goal is to help services evaluate their practices and develop action plans to promote normal birth and reduce C-section rates in a safe and sustainable way.
This document provides an introduction to thinking differently and why it is important, especially within the healthcare system. It discusses how thinking differently has led to innovations that have transformed various industries. Within healthcare, thinking differently created the NHS and has led to improvements like keyhole surgery. The document encourages readers to challenge traditional ways of doing things and consider new possibilities, like using interactive TV to book appointments. It argues that thinking differently is needed to achieve reforms and make significant gains in effectiveness and efficiency. Examples are given of projects that emerged from rethinking traditional models of service delivery.
If you are involved in treating patients, managing and/or improving health services or
managing or training those that do, you will understand the importance of providing the
best care possible for all our patients.
Great progress has been made in improving service standards and access and in reducing
waiting times, but there is still some way to go to ensure consistently high standards of
patient care across the NHS.
It is clear that we need to ensure we are getting it right first time, which means better care
and better value through the reduction of waste and errors and the prioritisation of effective
treatments. Quality, innovation, productivity and prevention (QIPP) is the mechanism through
which we can achieve this.
QIPP is about creating an environment in which change and improvement can flourish; it
is about leading differently and in a way that fosters a culture of innovation; and it is
about providing staff with the tools, techniques and support that will enable them to take
ownership of improving quality of care.
The Handbook of Quality and Service Improvement Tools from the NHS Institute brings
together a collection of proven tools, theories and techniques to help NHS staff design and
implement quality improvement projects that do not compromise on the quality and safety of
patient care but rather enhance the patient experience.
The ebd approach (experience based design) is a method of designing better experiences for patients, carers and staff. The approach captures the experiences of those involved in healthcare services. It involves looking at the care journey
and in addition the emotional journey people
experience when they come into contact with a particular pathway or part of the service. Staff work together with patients and carers to firstly understand these experiences and then to improve them.
This guide is an introduction to the ebd approach (experience based design).
This guide and toolkit has been produced as
a result of work that the NHS Institute for
Innovation and Improvement has undertaken in collaboration with NHS organisations and external agencies, using the experience of patients, carers and staff to design better
healthcare services.
- Slit lamp examination (including fundus)
- Perform biometry and focimetry
- Decide appropriateness for surgery
- Perform auto-refraction
- Discuss desired post-operative refractive status
with the patient (including current type of
spectacle correction) to enable the choice of lens
implant
- Perform ECG and blood tests
- Identify 2nd eye surgery where appropriate
Benefits
- reduces duplication of tasks
- reduces waiting time for patients
- frees up nursing time for other duties
- ensures all key tasks are completed in one visit
- improves patient experience
- reduces overall time in clinic
09
The Preferred Priorities for Care (PPC) is a tool that:
1. Facilitates discussions about end of life care wishes and preferences which can then be recorded.
2. Enables communication across care providers for care planning and decisions.
3. Acts as an advance statement if the person loses capacity, allowing their previously expressed wishes to inform best interest decisions about their care.
The PPC records an individual's end of life care preferences but these may change, so current views should take precedence. It is a voluntary and non-binding document but informs best interest decisions if capacity is lost.
The document discusses key principles for designing end-of-life care environments. It notes that the physical environment can directly impact patient experience and the memories of family and caregivers. Design should facilitate privacy, dignity, and respect. Key principles include being fit for purpose, providing comfort and connection to nature, use of natural light and materials, clarity of wayfinding, and enabling patient control and privacy. Improving environmental design can enhance patient and family experience through intuitive wayfinding, access to nature, consideration of heightened senses, provision of informal spaces, and co-located bereavement services. An environmental improvement project requires forming a multidisciplinary team to review needs, develop a plan and budget, and implement high quality design standards.
The Fast Track Tool is used to gain immediate access to funding for individuals who need urgent care packages due to rapidly deteriorating health conditions that may be terminal. It can be completed by nurses or doctors familiar with the patient's needs. The tool must be used when urgent continuing healthcare is required and replaces the regular assessment process. Patient consent is required unless they lack capacity, in which case clinicians make a best interests decision. Evidence of a completed Fast Track Tool is sufficient for eligibility and PCTs must accept and immediately action properly completed tools.
Support Sheet 13: Decisions made in a person's 'Best Interests'
This support sheet outlines the process for making decisions on behalf of someone who lacks capacity.
Support Sheet 12: Mental Capacity Act (2005)
This support sheet outlines the main provisions of the Mental Capacity Act the four tests essential for assessing capacity
Support Sheet 11: Quality Markers for Acute Hospitals
This support sheet outlines the quality markers by which acute hospitals can measure the standard of end of life care they provide.
Support Sheet 7: Models/Tools of Delivery
This support sheet outlines the key elements of
Advance Care Planning (ACP)
Gold Standards Framework (GSF)
Liverpool Care Pathway (LCP)
Dignity should be accorded to all people receiving end-of-life care, especially dying patients and their families. The Department of Health established ten principles for dignified care, including treating each person with respect, enabling independence and choice, listening to needs and wishes, and ensuring privacy. These principles involve holistic needs assessments, advance care planning, and engaging family members to plan care that maintains confidence and alleviates loneliness for those nearing the end of life.
Support Sheet 5: Quality Markers for Care Homes
This support sheet outlines the quality markers by which care homes can measure the standard of end of life care they provide.
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdfRahul Sen
Time-lapse embryo monitoring is an advanced imaging technique used in IVF to continuously observe embryo development. It captures high-resolution images at regular intervals, allowing embryologists to select the most viable embryos for transfer based on detailed growth patterns. This technology enhances embryo selection, potentially increasing pregnancy success rates.
The document provides information and guidance for patients on how to take an active role in their recovery process before and after a hospital operation or procedure. It emphasizes the importance of staying physically and mentally active before surgery, eating healthy foods, and making plans for support and transportation at home after being discharged from the hospital. Taking small, achievable steps each day toward recovery goals like walking, showering, and eating can help patients leave the hospital sooner and feel better faster.
This document discusses bringing social movement thinking to healthcare improvement by incorporating principles from successful social movements. It outlines five key principles for creating social movement dynamics within healthcare organizations: see change as a personal mission; frame issues to connect with core values; energize and mobilize individuals; organize for impact; and maintain forward momentum. The document argues that while traditional improvement approaches have had some success, social movement thinking can help deliver deeper, more sustainable changes to better serve patients. It provides several case studies of teams that have applied social movement ideas to spur healthcare improvements.
The 15 Steps Challenge provides a toolkit to help healthcare teams evaluate the quality of patient care from the patient's perspective. A 15 Steps Challenge team conducts ward walkarounds using the toolkit to assess four areas: Welcoming, Safe, Caring and Involving, and Well Organised and Calm. The team then provides feedback to the ward and trust sponsor to identify good practices and areas for improvement. Repeating the Challenge ensures continuous quality improvement by regularly incorporating the patient voice.
This document provides an overview of a toolkit aimed at helping NHS trusts reduce their Caesarean section rates. The toolkit was developed by the NHS Institute for Innovation and Improvement based on visits to maternity services with low C-section rates. It includes self-assessment tools covering key areas like first pregnancies, VBAC, and organizational characteristics. The goal is to help services evaluate their practices and develop action plans to promote normal birth and reduce C-section rates in a safe and sustainable way.
This document provides an introduction to thinking differently and why it is important, especially within the healthcare system. It discusses how thinking differently has led to innovations that have transformed various industries. Within healthcare, thinking differently created the NHS and has led to improvements like keyhole surgery. The document encourages readers to challenge traditional ways of doing things and consider new possibilities, like using interactive TV to book appointments. It argues that thinking differently is needed to achieve reforms and make significant gains in effectiveness and efficiency. Examples are given of projects that emerged from rethinking traditional models of service delivery.
If you are involved in treating patients, managing and/or improving health services or
managing or training those that do, you will understand the importance of providing the
best care possible for all our patients.
Great progress has been made in improving service standards and access and in reducing
waiting times, but there is still some way to go to ensure consistently high standards of
patient care across the NHS.
It is clear that we need to ensure we are getting it right first time, which means better care
and better value through the reduction of waste and errors and the prioritisation of effective
treatments. Quality, innovation, productivity and prevention (QIPP) is the mechanism through
which we can achieve this.
QIPP is about creating an environment in which change and improvement can flourish; it
is about leading differently and in a way that fosters a culture of innovation; and it is
about providing staff with the tools, techniques and support that will enable them to take
ownership of improving quality of care.
The Handbook of Quality and Service Improvement Tools from the NHS Institute brings
together a collection of proven tools, theories and techniques to help NHS staff design and
implement quality improvement projects that do not compromise on the quality and safety of
patient care but rather enhance the patient experience.
The ebd approach (experience based design) is a method of designing better experiences for patients, carers and staff. The approach captures the experiences of those involved in healthcare services. It involves looking at the care journey
and in addition the emotional journey people
experience when they come into contact with a particular pathway or part of the service. Staff work together with patients and carers to firstly understand these experiences and then to improve them.
This guide is an introduction to the ebd approach (experience based design).
This guide and toolkit has been produced as
a result of work that the NHS Institute for
Innovation and Improvement has undertaken in collaboration with NHS organisations and external agencies, using the experience of patients, carers and staff to design better
healthcare services.
- Slit lamp examination (including fundus)
- Perform biometry and focimetry
- Decide appropriateness for surgery
- Perform auto-refraction
- Discuss desired post-operative refractive status
with the patient (including current type of
spectacle correction) to enable the choice of lens
implant
- Perform ECG and blood tests
- Identify 2nd eye surgery where appropriate
Benefits
- reduces duplication of tasks
- reduces waiting time for patients
- frees up nursing time for other duties
- ensures all key tasks are completed in one visit
- improves patient experience
- reduces overall time in clinic
09
The Preferred Priorities for Care (PPC) is a tool that:
1. Facilitates discussions about end of life care wishes and preferences which can then be recorded.
2. Enables communication across care providers for care planning and decisions.
3. Acts as an advance statement if the person loses capacity, allowing their previously expressed wishes to inform best interest decisions about their care.
The PPC records an individual's end of life care preferences but these may change, so current views should take precedence. It is a voluntary and non-binding document but informs best interest decisions if capacity is lost.
The document discusses key principles for designing end-of-life care environments. It notes that the physical environment can directly impact patient experience and the memories of family and caregivers. Design should facilitate privacy, dignity, and respect. Key principles include being fit for purpose, providing comfort and connection to nature, use of natural light and materials, clarity of wayfinding, and enabling patient control and privacy. Improving environmental design can enhance patient and family experience through intuitive wayfinding, access to nature, consideration of heightened senses, provision of informal spaces, and co-located bereavement services. An environmental improvement project requires forming a multidisciplinary team to review needs, develop a plan and budget, and implement high quality design standards.
The Fast Track Tool is used to gain immediate access to funding for individuals who need urgent care packages due to rapidly deteriorating health conditions that may be terminal. It can be completed by nurses or doctors familiar with the patient's needs. The tool must be used when urgent continuing healthcare is required and replaces the regular assessment process. Patient consent is required unless they lack capacity, in which case clinicians make a best interests decision. Evidence of a completed Fast Track Tool is sufficient for eligibility and PCTs must accept and immediately action properly completed tools.
Support Sheet 13: Decisions made in a person's 'Best Interests'
This support sheet outlines the process for making decisions on behalf of someone who lacks capacity.
Support Sheet 12: Mental Capacity Act (2005)
This support sheet outlines the main provisions of the Mental Capacity Act the four tests essential for assessing capacity
Support Sheet 11: Quality Markers for Acute Hospitals
This support sheet outlines the quality markers by which acute hospitals can measure the standard of end of life care they provide.
Support Sheet 7: Models/Tools of Delivery
This support sheet outlines the key elements of
Advance Care Planning (ACP)
Gold Standards Framework (GSF)
Liverpool Care Pathway (LCP)
Dignity should be accorded to all people receiving end-of-life care, especially dying patients and their families. The Department of Health established ten principles for dignified care, including treating each person with respect, enabling independence and choice, listening to needs and wishes, and ensuring privacy. These principles involve holistic needs assessments, advance care planning, and engaging family members to plan care that maintains confidence and alleviates loneliness for those nearing the end of life.
Support Sheet 5: Quality Markers for Care Homes
This support sheet outlines the quality markers by which care homes can measure the standard of end of life care they provide.
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdfRahul Sen
Time-lapse embryo monitoring is an advanced imaging technique used in IVF to continuously observe embryo development. It captures high-resolution images at regular intervals, allowing embryologists to select the most viable embryos for transfer based on detailed growth patterns. This technology enhances embryo selection, potentially increasing pregnancy success rates.
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
Know the difference between Endodontics and Orthodontics.Gokuldas Hospital
Your smile is beautiful.
Let’s be honest. Maintaining that beautiful smile is not an easy task. It is more than brushing and flossing. Sometimes, you might encounter dental issues that need special dental care. These issues can range anywhere from misalignment of the jaw to pain in the root of teeth.
Pictorial and detailed description of patellar instability with sign and symptoms and how to diagnose , what investigations you should go with and how to approach with treatment options . I have presented this slide in my 2nd year junior residency in orthopedics at LLRM medical college Meerut and got good reviews for it
After getting it read you will definitely understand the topic.
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...Université de Montréal
“Psychiatry and the Humanities”: An Innovative Course at the University of Montreal Expanding the medical model to embrace the humanities. Link: https://www.psychiatrictimes.com/view/-psychiatry-and-the-humanities-an-innovative-course-at-the-university-of-montreal
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
2. Section 5
Core metrics
These core metrics have been developed to
inform the progress of implementation of The
route to success in end of life care – achieving
quality in acute hospitals and to support the
model of service improvement.
They have been developed following
consultation with the 26 first wave hospital
Trusts involved in the programme. Other locally
developed metrics may also be used to inform
and will contribute to overall reporting. Reports
are to be collected at the beginning, middle
and end of the implementation period.
The core metrics are designed to inform at
two levels within the organisation:
1. Reporting at ward level
2. Reporting at executive Trust Board level
Reporting at ward level
The core metrics developed at ward level
are those that link directly with the five key
enablers identified in Section 3 of this guide.
These are Advance Care Planning, Electronic
Palliative Care Co-ordination Systems (EPaCCS),
the Rapid Discharge Home to Die Pathway,
the AMBER Care Bundle and the Liverpool
Care Pathway. These enablers can most
inform the productive ward model of service
improvement.
Using the metrics in the first instance to
assess your baseline will enable wards to
develop a plan for service improvement
according to individual starting points,
priorities and agreed time scales.
2
Reporting at executive Trust Board
level
Metrics for the executive Trust Board level are
based firstly on the ward core metrics and
secondly are aligned with the hospital quality
markers from the National End of Life Care
Quality Assessment (ELCQuA) Tool:
www.elcqua.nhs.uk
How can the core metrics improve
care?
As a national programme to improve end of
life care in acute hospitals, these core metrics
can support improvement in care in two ways:
1. They can identify areas of best practice
which can then be highlighted within
the programme and disseminated to
speed up shared learning and service
improvement
2. It is anticipated that the aggregated data
from the participating sites will clearly
demonstrate service improvement over
time.
How often will the core metrics be
collected?
In order to keep in line with existing Trust
quarterly reporting processes as far as possible,
it is planned to collect metrics at ‘baseline’
(November 2011), ‘midpoint’ (June 2012) and
‘endpoint’ (November 2012). Any data that is
submitted into the national programme will
not be reported or published at an individual
Trust level.
3. The route to success ‘how to’ guide
Development of the core metrics
One of the outcomes of this initiative will be to
inform the development of the most relevant
metrics both at ward level, and at Trust Board
level. This will further inform the roll out of The
route to success. Alongside the NICE end of
life care for adults quality standard, it will also
influence the updating of the national ELCQuA
indicators for hospitals.
MEDIA
CONTENT
To view this podcast please visit:
tinyurl.com/acute-rts-howtoguide
Dr Julia Verne, director of the South West
Public Health Observatory, explains the
importance of the local data available via the
National End of Life Care Intelligence Network,
and how it can be used for developing and
monitoring services.
MEDIA
CONTENT
To view this podcast please visit:
tinyurl.com/acute-rts-howtoguide
Andy Pring, senior analyst at the South
West Public Health Observatory, provides a
demonstration of how the National End of Life
Care Intelligence Network’s online profiles can
be used to analyse local data and trends.
3
4. Section 5
Core metrics: Trust Board
Organisational baseline data:
Number
1. Number of beds in Trust
2. Number of adult wards in Trust
3. Number of eligible wards (e.g. more than
five deaths per year) for The route to success
improvement programme
4. Number of deaths per year in the Trust
5. Number of people who die in the Trust’s
catchment area per year
6. Number of people who die in their usual place
of residence in Trust catchment area (QIPP KPI)
7. Number of people in the Trust discharged on
the Rapid Discharge Home to Die Pathway in the
last 3 months
Please record or attach any end of life care CQUINS,
PROMS and KPIs currently in use in your Trust
Please record or attach any ‘best practice’ models
of end of life care education and training initiatives
in your Trust
Trust Boards may also wish to consider an additional proposed QIPP key performance indicator,
which is:
To reduce the number of hospital admissions which end in death of eight days or more.
This indicator must be based on clinical need, quality of care and individual’s preferences.
4
6. Section 5
Core metrics: Trust Board (continued)
Please complete below the number of eligible wards (e.g. more than five deaths per year) that
have implemented the five key enablers or equivalent and the number planning to implement
during the next 12 months.
Enablers:
Baseline
Midpoint
Endpoint
No. of wards
implemented
by Nov 2011
Planned
no. of wards
implemented
by June 2012
Planned no. of
wards
implemented
by Nov 2012
Advance Care Planning model (ACP)
Integration within an Electronic Palliative
Care Co-ordination Systems (EPaCCS)
AMBER Care Bundle
Rapid Discharge Home to Die Pathway
(e.g. anticipated prognosis – hours/days)
Liverpool Care Pathway (LCP)
1. The Trust has an action plan for the delivery of high quality end of life care, which
encompasses people with all diagnoses, and is reviewed for impact and progress
Baseline
Comment on next steps
6
Plan not
developed
Plan partially
developed
Plan in place
and post
implementation of
the strategic plan
for impact and
progress
RED
Numerical indicator:
The Trust has an end of life care action plan
which feeds into a locality wide strategic
plan for end of life care
AMBER
GREEN
7. The route to success ‘how to’ guide
Core metrics: Trust Board (continued)
2. Promote end of life care training opportunities and enable relevant workers to access or
attend appropriate programmes dependent on their needs
No curriculum
evidenced
Curriculum
being developed
against Trust
Training Needs
Analysis
Curriculum
evidenced based
on Trust Training
Needs Analysis
RED
Numerical indicator:
Identification of end of life care training
needs of staff and training is in place to
meet this
AMBER
GREEN
Baseline
Comment on next steps
3. Monitor the quality and outputs of end of life care and submit relevant information for
local and national audits
Minimal audit
and review
Infrequent audit
and review,
actions not
followed
Regular and
comprehensive
audit, including
participation in
National Care of
the Dying Audit –
Hospitals (NCDAH)
RED
Numerical indicator:
Identification of end of life care audit
programme in Trust
AMBER
GREEN
Baseline
Comment on next steps
7
8. Section 5
Core metrics: Ward
Baseline data:
Number of people
Number of admissions per year on the ward
Number of deaths per year on the ward
Red Level 0 Amber Level 1 Yellow Level 2 Blue Level 4 Green Level 5
1. Advance Care Planning (ACP)
Indicator:
Ward
implementation
of ACP model
Midpoint
Endpoint
8
The ward has
plans in place
to implement
ACP model
The ward has
an education
and training
programme
for
implementing
ACP model
The ward is able
to demonstrate
implementation
of ACP model
The ward has
embedded
and sustained
the use of
ACP model
RED
Baseline
The ward
has not
implemented
ACP model
AMBER
YELLOW
BLUE
GREEN
9. The route to success ‘how to’ guide
Core metrics: Ward (continued)
2. Electronic Palliative Care Co-ordination Systems (EPaCCS)
Indicator:
Ward
implementation
of EPaCCS
The ward
has not
implemented
EPaCCS
The ward has
plans in place
to implement
EPaCCS
The ward has
an education
and training
programme
for
implementing
EPaCCS
The ward is able
to demonstrate
implementation
of EPaCCS
The ward has
embedded
and sustained
the use of
EPaCCS
RED
AMBER
YELLOW
BLUE
GREEN
The ward
has not
implemented
AMBER
The ward has
plans in place
to implement
AMBER
The ward has
an education
and training
programme
for
implementing
AMBER
The ward is able
to demonstrate
implementation
of AMBER
The ward has
embedded
and sustained
the use of
AMBER
RED
AMBER
YELLOW
BLUE
GREEN
Baseline
Midpoint
Endpoint
3. AMBER Care Bundle
Indicator:
Ward
implementation
of AMBER
Baseline
Midpoint
Endpoint
9
10. Section 5
Core metrics: Ward (continued)
4. Rapid Discharge Home to Die Pathway (RDP)
Indicator:
Ward
implementation
of RDP
The ward
has not
implemented
RDP
The ward has
plans in place
to implement
RDP
The ward has
an education
and training
programme
for
implementing
RDP
RED
AMBER
YELLOW
BLUE
GREEN
The ward
has not
implemented
LCP
The ward has
plans in place
to implement
LCP
The ward has
an education
and training
programme
for
implementing
LCP
The ward is able
to demonstrate
implementation
of LCP
The ward has
embedded
and sustained
the use of
LCP
RED
AMBER
YELLOW
BLUE
GREEN
The ward is able
to demonstrate
implementation
of RDP
The ward has
embedded
and sustained
the use of
RDP
Baseline
Midpoint
Endpoint
5. Liverpool Care Pathway (LCP)
Indicator:
Ward
implementation
of LCP
Baseline
Midpoint
Endpoint
10