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
The document summarizes a health camp that was held in the village of Helmatpora. An 11 member health team conducted examinations and provided treatment, immunizations, health education, and referrals for 197 patients. Key activities included medical exams, obstetrics/gynecology, dental, immunization, pharmacy services, and health education. 4 families were referred for further care and the camp concluded after debriefing and analyzing feedback to improve future camps.
The health care industry consists of sectors that provide medical services to treat patients. It is one of the largest industries worldwide, consuming over 10% of GDP in developed nations. The industry is divided into areas like hospitals, medical practices, and other human health services. It is further divided into health care equipment and services, and pharmaceuticals and biotechnology. The health care industry has unique characteristics like intangibility, perishability, and inseparability of services. The 7Ps of marketing - product, place, promotion, price, people, process, and physical evidence - are important factors for health care industry marketing.
This document provides guidance on starting a Rural Health Clinic (RHC). It begins with an introduction that describes the RHC program's goals of improving access to primary care in rural underserved areas through a team-based care delivery model. It then provides overviews of the major RHC requirements, including being located in a rural and underserved area, staffing requirements, services provided, and recordkeeping. The document guides readers through determining if a site is eligible and conducting a financial feasibility analysis to determine if the RHC program and payment methodology would be suitable. It aims to help health care practitioners and organizations understand the process for becoming a Federally-certified RHC.
This document provides a summary of a guideline on person-centred care in cancer care. It includes 29 recommendations focused on knowing the patient as an individual, ensuring essential requirements of care like respect, managing symptoms, and tailoring care to individual needs. The recommendations emphasize developing an understanding of each patient, respecting their preferences, and involving family/caregivers with patient consent. The goal is to establish standardized recommendations for providing person-centred care across adult oncology services in Ontario.
This document is Monica Deitz's resume. She has over 6 years of experience as a registered nurse, specializing in trauma and critical care nursing. Her experience includes roles as a trauma program manager, trauma nurse coordinator, and critical care nurse. She is highly educated, with a BSN from Texas A&M University, and has numerous certifications in areas such as ACLS, PALS, and TNCC. She is seeking a position as a reliable and ethical healthcare provider where she can utilize her critical thinking and relationship building skills.
When a person dies: guidance for professionals on developing bereavement services
The National End of Life Care Programme has supported the Bereavement Services Association and Primary Care Commissioning in the production of 'When a person dies: guidance for professionals on developing bereavement services.'
The manner in which professionals and volunteers respond to those who are bereaved can have a long term impact on how they grieve, their health and their memories of the individual who has died.
The publication covers the principles of bereavement services, along with bereavement care in the days preceding death, at the time of death and in the days following death. It also includes guidance on workforce and education and the commissioning and quality outcomes of bereavement care.
NHS Trusts, community providers and commissioners will wish to consider the guidance when developing policies and services relating to bereavement.
This document provides an overview of hospitals and the healthcare delivery system. It discusses the evolution of hospitals from places where people went to die to modern multiservice institutions. Hospitals are classified by type, ownership, size and services provided. Trends include consolidation, outpatient care replacing inpatient care, and increased partnerships between hospitals and other providers. Challenges include rising costs, physician decision making, and ensuring access to care.
The document discusses the changing role of hospitals. It notes that hospitals are evolving within a new framework of healthcare management in response to internal and external changes. Some of the challenges hospitals face include uncertainties around future patient needs due to an aging population and the progression of chronic diseases. Hospitals also have to balance emergency care with planned management of patients. The role of hospitals is gradually shifting from cure-focused to more emphasis on healthcare, community care, prevention, and public health. The changing role requires hospital management approaches to also adapt.
The document summarizes a health camp that was held in the village of Helmatpora. An 11 member health team conducted examinations and provided treatment, immunizations, health education, and referrals for 197 patients. Key activities included medical exams, obstetrics/gynecology, dental, immunization, pharmacy services, and health education. 4 families were referred for further care and the camp concluded after debriefing and analyzing feedback to improve future camps.
The health care industry consists of sectors that provide medical services to treat patients. It is one of the largest industries worldwide, consuming over 10% of GDP in developed nations. The industry is divided into areas like hospitals, medical practices, and other human health services. It is further divided into health care equipment and services, and pharmaceuticals and biotechnology. The health care industry has unique characteristics like intangibility, perishability, and inseparability of services. The 7Ps of marketing - product, place, promotion, price, people, process, and physical evidence - are important factors for health care industry marketing.
This document provides guidance on starting a Rural Health Clinic (RHC). It begins with an introduction that describes the RHC program's goals of improving access to primary care in rural underserved areas through a team-based care delivery model. It then provides overviews of the major RHC requirements, including being located in a rural and underserved area, staffing requirements, services provided, and recordkeeping. The document guides readers through determining if a site is eligible and conducting a financial feasibility analysis to determine if the RHC program and payment methodology would be suitable. It aims to help health care practitioners and organizations understand the process for becoming a Federally-certified RHC.
This document provides a summary of a guideline on person-centred care in cancer care. It includes 29 recommendations focused on knowing the patient as an individual, ensuring essential requirements of care like respect, managing symptoms, and tailoring care to individual needs. The recommendations emphasize developing an understanding of each patient, respecting their preferences, and involving family/caregivers with patient consent. The goal is to establish standardized recommendations for providing person-centred care across adult oncology services in Ontario.
This document is Monica Deitz's resume. She has over 6 years of experience as a registered nurse, specializing in trauma and critical care nursing. Her experience includes roles as a trauma program manager, trauma nurse coordinator, and critical care nurse. She is highly educated, with a BSN from Texas A&M University, and has numerous certifications in areas such as ACLS, PALS, and TNCC. She is seeking a position as a reliable and ethical healthcare provider where she can utilize her critical thinking and relationship building skills.
When a person dies: guidance for professionals on developing bereavement services
The National End of Life Care Programme has supported the Bereavement Services Association and Primary Care Commissioning in the production of 'When a person dies: guidance for professionals on developing bereavement services.'
The manner in which professionals and volunteers respond to those who are bereaved can have a long term impact on how they grieve, their health and their memories of the individual who has died.
The publication covers the principles of bereavement services, along with bereavement care in the days preceding death, at the time of death and in the days following death. It also includes guidance on workforce and education and the commissioning and quality outcomes of bereavement care.
NHS Trusts, community providers and commissioners will wish to consider the guidance when developing policies and services relating to bereavement.
This document provides an overview of hospitals and the healthcare delivery system. It discusses the evolution of hospitals from places where people went to die to modern multiservice institutions. Hospitals are classified by type, ownership, size and services provided. Trends include consolidation, outpatient care replacing inpatient care, and increased partnerships between hospitals and other providers. Challenges include rising costs, physician decision making, and ensuring access to care.
The document discusses the changing role of hospitals. It notes that hospitals are evolving within a new framework of healthcare management in response to internal and external changes. Some of the challenges hospitals face include uncertainties around future patient needs due to an aging population and the progression of chronic diseases. Hospitals also have to balance emergency care with planned management of patients. The role of hospitals is gradually shifting from cure-focused to more emphasis on healthcare, community care, prevention, and public health. The changing role requires hospital management approaches to also adapt.
This document provides frequently asked questions (FAQs) on telemedicine practice guidelines from both patient and registered medical practitioner (RMP) perspectives. Some key points addressed include:
- Patients can contact any RMP registered with a medical council for a telemedicine consultation with mutual consent. Nurses can consult on behalf of patients with patient consent.
- RMPs have the right to refuse or discontinue a teleconsultation. Prescriptions provided via teleconsultation must contain the RMP's registration number and digital signature.
- RMPs are authorized to charge fees for teleconsultations and must maintain records of interactions like phone/video logs and prescriptions. They can advise to the best of
BOARD OF GOVERNORS In supersession of the Medical Council of India
Telemedicine Practice Guidelines Enabling Registered Medical Practitioners to Provide Healthcare Using Telemedicine
These Guidelines have been prepared in partnership with NITI Aayog
This document discusses telenursing, which is defined as using telehealth technology to deliver nursing care virtually. It outlines several key points about telenursing:
1) Telenursing helps address healthcare needs by expanding access to remote areas and reducing travel costs and time. It allows nurses to treat more patients efficiently.
2) Common applications of telenursing include home care, case management, and telephone triage. It also has implications for improving patient access and outcomes, as well as considerations for providers and the healthcare system.
3) Successful telenursing requires addressing issues like legal and ethical responsibilities, licensing across jurisdictions, patient privacy and safety, and obtaining informed consent through technology. Training and infrastructure are also
The document discusses telehealth, which uses technology to provide healthcare services from a distance. It defines telehealth and compares it to telemedicine. Telehealth requires equipment like computers, cameras and monitors connected via the internet. It provides benefits like increased access to care and specialists. Legal issues around licensing, reimbursement and privacy must be addressed. Nursing can be provided via telehealth, known as telenursing. The future of telehealth is expected to further change healthcare delivery models.
The 10-step marketing plan proposes opening a hemodialysis center called Kidney Aid that targets wealthy patients in Manila. It will differentiate itself by offering additional comfort services during treatments like massages and pedicures. The plan identifies chronic kidney disease patients as the target market, outlines competitors like hospitals and standalone centers, and establishes a service niche with pampering. Key elements of the marketing mix include operating in Greenhills, pricing competitively with top hospitals, and promoting through TV, magazines and sponsorships. The winning strategy is to be the only center focusing on both medical care and patients' comfort lifestyles.
This document provides a literature review on studies related to the service quality of public and private sector hospitals. It summarizes 25 studies conducted between 2004-2013 that evaluated patient perceptions and assessments of various dimensions of hospital service quality in India. The studies examined factors like infrastructure, personnel quality, clinical care processes, communication, and relationships that influence patient satisfaction. Some findings indicated private hospitals performed better than public hospitals in most quality dimensions except reliability. The review concludes that further research is needed evaluating service quality in the understudied regions of Indore and Ujjain cities in Madhya Pradesh, India.
This document provides an overview of telemedicine, including its origins, definitions, types, equipment, staffing, benefits, and future directions. Telemedicine allows for the delivery of healthcare services via technology where distance is a factor, including video conferencing between patients and doctors, monitoring patient vitals remotely, and transferring medical data between hospitals. It has various applications like tele-radiology, cardiology, and psychiatry. Establishing telemedicine departments requires equipment like telescopes, ECG machines, digital cameras, and IT infrastructure. Staff typically include doctors, technicians, and administrators. Telemedicine provides benefits like increased access to expertise, cost savings, and opportunities for education and research. Its future expansion may include more robotics and remote
This document provides background information and context for a case study about implementing lean principles at HomeCare, a large Canadian home health care organization. It summarizes that HomeCare was facing issues like poor service, long scheduling times, and low employee satisfaction due to siloed processes and lack of coordination. HomeCare leadership brought in consultants to redesign the entire service process from a lean perspective. The consultants conducted interviews and surveys, and recommended piloting redesigned processes in two districts before expanding organization-wide. The pilots were very successful, dramatically improving key metrics like scheduling times. This provided proof and momentum to redesign additional districts using the lean methodology.
Alan Manning, Executive Vice President, PlanetreeInvestnet
This document outlines a hierarchy of patient-centered care practices across multiple domains. It includes over 50 specific criteria across areas like leadership and governance, staff engagement, patient and family involvement, communication of information, and visitation policies. Compliance is measured through ongoing focus groups, staff surveys, and regular reporting to stakeholders. The goal is to empower patients and include their needs, choices, and input at every level of care delivery and organizational decision making.
This document discusses a cancer support program and insurance solutions. The program aims to empower consumers by providing innovative solutions to their problems, delivering real value, and making data-driven decisions. The program focuses on various elements of the cancer continuum including prevention, early detection, treatment, and recovery management. It provides personalized cancer coaching, symptom tracking, daily cancer management activities over 12 weeks, and daily educational content to help patients manage their condition and improve clinical outcomes.
This document discusses various legal concepts relevant to nursing practice including:
1. The ethical and legal rights of individuals and communities which nurses must respect.
2. The legal limits of nursing practice including standards of care, registration requirements, and nursing council acts.
3. Potential legal liabilities nurses face including negligence, assault, and malpractice. Defenses against liability include dedication, demeanor, and thorough documentation.
4. Guidelines that establish nurses' legal responsibilities and lists of dos and don'ts to ensure safe nursing practice.
This document provides an overview of long-term care options and nursing roles. It describes the long-term care continuum, various long-term care settings like nursing facilities and assisted living facilities, and the principles of rehabilitative nursing. It also compares institutional and community-based long-term care and discusses how nurses can help families choose nursing homes.
Patient engagement and Hospital Marketing Solutions from Healtho5Dr Neelesh Bhandari
We offer turnkey medical marketing and Patient engagement solutions for single and multi-specialty hospitals in India. Our specialties include Diabetes, Antenatal and postnatal care, Cardiac, Arthritis, Oncology, COPD and related disorders, etc.
Hospitals get a self branded mobile app for their patients and doctors.
Our digital marketing team works closely with our support call center to generate medical leads and enable clinical encounter between genuine patients and hospital.
Post encounter/Discharge, we followup the patients on Hospital's behalf via monthly calls and emails, twice a month SMS, chat-support and updates via app, etc.
Our followup Protocols are built on best evidence backed guidelines and can be customized by hospitals.
Contact info@healtho5.com to know more
The document discusses reforms to Ukraine's healthcare system in market conditions. It proposes dividing healthcare into three subsystems: state, public, and private. The state subsystem would provide a basic level of care for all citizens. Those dissatisfied could use the public or private options. Factors like costs, pricing, competition between providers, and the economic roles of medical workers are discussed at different levels of the system. Budgets for medical institutions would be divided into accounts for salaries, current expenses, capital expenses, and other costs. The social, medical, and economic effectiveness of the healthcare system are also addressed.
Presentation 202 jennifer kennedy hospice and pallative care for a patient...The ALS Association
This document discusses palliative care and hospice care options for patients diagnosed with ALS. It provides an overview of palliative care which focuses on symptom management and quality of life, versus hospice care which provides support for terminal illnesses in the last 6 months of life. The document reviews Medicare eligibility guidelines for hospice, common ALS symptoms addressed by palliative and hospice care, and barriers to referring patients to these services like late discussions around end-of-life care planning.
The document discusses improving provider access to patient advance directives (ADs) at Providence Hospitals. Currently, only about 10% of patients have documented ADs, and the information is tied to specific visits rather than the overall patient record. To address this, palliative care data from the past year was analyzed and staff were interviewed. It was found that the low completion rate and provider unfamiliarity with the EMR system were issues. Meetings were held to create a streamlined process for accessing AD documents. The solution was to record the date documents are received in the EMR, allowing searches by date. Educational trainings will be provided to nurses to implement the new process in April 2016.
This document discusses the key components and factors influencing health care systems. It outlines that health care systems aim to promote, restore, and maintain health for populations. The document then discusses the historical development of health care, from only being accessible to the wealthy to reforms that aimed to provide services to wider groups. Modern health care systems reflect the values of their societies, and are influenced by changing disease patterns, demographics, technology advances, and government policies. The quality of health care systems can be evaluated based on criteria like effectiveness, efficiency, accessibility, and equity of services provided.
The Nurse's Bill of Rights outlines 10 rights that nurses should have in their practice and work environment. These include the rights to practice nursing according to professional standards and fulfill obligations to patients, work in a safe environment that supports ethical practice, advocate for patients without fear of retaliation, receive fair compensation, negotiate employment conditions, refuse unsafe assignments, and not be abused or exploited.
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
The document provides guidance on identifying patients who are approaching the end of life. It outlines general indicators like deteriorating health and weight loss. It emphasizes the importance of early identification so patients can access appropriate end of life care and support. Only 25% of patients who die have end of life plans in place, so identifying patients earlier allows for conversations about preferences and advanced care planning.
This document provides frequently asked questions (FAQs) on telemedicine practice guidelines from both patient and registered medical practitioner (RMP) perspectives. Some key points addressed include:
- Patients can contact any RMP registered with a medical council for a telemedicine consultation with mutual consent. Nurses can consult on behalf of patients with patient consent.
- RMPs have the right to refuse or discontinue a teleconsultation. Prescriptions provided via teleconsultation must contain the RMP's registration number and digital signature.
- RMPs are authorized to charge fees for teleconsultations and must maintain records of interactions like phone/video logs and prescriptions. They can advise to the best of
BOARD OF GOVERNORS In supersession of the Medical Council of India
Telemedicine Practice Guidelines Enabling Registered Medical Practitioners to Provide Healthcare Using Telemedicine
These Guidelines have been prepared in partnership with NITI Aayog
This document discusses telenursing, which is defined as using telehealth technology to deliver nursing care virtually. It outlines several key points about telenursing:
1) Telenursing helps address healthcare needs by expanding access to remote areas and reducing travel costs and time. It allows nurses to treat more patients efficiently.
2) Common applications of telenursing include home care, case management, and telephone triage. It also has implications for improving patient access and outcomes, as well as considerations for providers and the healthcare system.
3) Successful telenursing requires addressing issues like legal and ethical responsibilities, licensing across jurisdictions, patient privacy and safety, and obtaining informed consent through technology. Training and infrastructure are also
The document discusses telehealth, which uses technology to provide healthcare services from a distance. It defines telehealth and compares it to telemedicine. Telehealth requires equipment like computers, cameras and monitors connected via the internet. It provides benefits like increased access to care and specialists. Legal issues around licensing, reimbursement and privacy must be addressed. Nursing can be provided via telehealth, known as telenursing. The future of telehealth is expected to further change healthcare delivery models.
The 10-step marketing plan proposes opening a hemodialysis center called Kidney Aid that targets wealthy patients in Manila. It will differentiate itself by offering additional comfort services during treatments like massages and pedicures. The plan identifies chronic kidney disease patients as the target market, outlines competitors like hospitals and standalone centers, and establishes a service niche with pampering. Key elements of the marketing mix include operating in Greenhills, pricing competitively with top hospitals, and promoting through TV, magazines and sponsorships. The winning strategy is to be the only center focusing on both medical care and patients' comfort lifestyles.
This document provides a literature review on studies related to the service quality of public and private sector hospitals. It summarizes 25 studies conducted between 2004-2013 that evaluated patient perceptions and assessments of various dimensions of hospital service quality in India. The studies examined factors like infrastructure, personnel quality, clinical care processes, communication, and relationships that influence patient satisfaction. Some findings indicated private hospitals performed better than public hospitals in most quality dimensions except reliability. The review concludes that further research is needed evaluating service quality in the understudied regions of Indore and Ujjain cities in Madhya Pradesh, India.
This document provides an overview of telemedicine, including its origins, definitions, types, equipment, staffing, benefits, and future directions. Telemedicine allows for the delivery of healthcare services via technology where distance is a factor, including video conferencing between patients and doctors, monitoring patient vitals remotely, and transferring medical data between hospitals. It has various applications like tele-radiology, cardiology, and psychiatry. Establishing telemedicine departments requires equipment like telescopes, ECG machines, digital cameras, and IT infrastructure. Staff typically include doctors, technicians, and administrators. Telemedicine provides benefits like increased access to expertise, cost savings, and opportunities for education and research. Its future expansion may include more robotics and remote
This document provides background information and context for a case study about implementing lean principles at HomeCare, a large Canadian home health care organization. It summarizes that HomeCare was facing issues like poor service, long scheduling times, and low employee satisfaction due to siloed processes and lack of coordination. HomeCare leadership brought in consultants to redesign the entire service process from a lean perspective. The consultants conducted interviews and surveys, and recommended piloting redesigned processes in two districts before expanding organization-wide. The pilots were very successful, dramatically improving key metrics like scheduling times. This provided proof and momentum to redesign additional districts using the lean methodology.
Alan Manning, Executive Vice President, PlanetreeInvestnet
This document outlines a hierarchy of patient-centered care practices across multiple domains. It includes over 50 specific criteria across areas like leadership and governance, staff engagement, patient and family involvement, communication of information, and visitation policies. Compliance is measured through ongoing focus groups, staff surveys, and regular reporting to stakeholders. The goal is to empower patients and include their needs, choices, and input at every level of care delivery and organizational decision making.
This document discusses a cancer support program and insurance solutions. The program aims to empower consumers by providing innovative solutions to their problems, delivering real value, and making data-driven decisions. The program focuses on various elements of the cancer continuum including prevention, early detection, treatment, and recovery management. It provides personalized cancer coaching, symptom tracking, daily cancer management activities over 12 weeks, and daily educational content to help patients manage their condition and improve clinical outcomes.
This document discusses various legal concepts relevant to nursing practice including:
1. The ethical and legal rights of individuals and communities which nurses must respect.
2. The legal limits of nursing practice including standards of care, registration requirements, and nursing council acts.
3. Potential legal liabilities nurses face including negligence, assault, and malpractice. Defenses against liability include dedication, demeanor, and thorough documentation.
4. Guidelines that establish nurses' legal responsibilities and lists of dos and don'ts to ensure safe nursing practice.
This document provides an overview of long-term care options and nursing roles. It describes the long-term care continuum, various long-term care settings like nursing facilities and assisted living facilities, and the principles of rehabilitative nursing. It also compares institutional and community-based long-term care and discusses how nurses can help families choose nursing homes.
Patient engagement and Hospital Marketing Solutions from Healtho5Dr Neelesh Bhandari
We offer turnkey medical marketing and Patient engagement solutions for single and multi-specialty hospitals in India. Our specialties include Diabetes, Antenatal and postnatal care, Cardiac, Arthritis, Oncology, COPD and related disorders, etc.
Hospitals get a self branded mobile app for their patients and doctors.
Our digital marketing team works closely with our support call center to generate medical leads and enable clinical encounter between genuine patients and hospital.
Post encounter/Discharge, we followup the patients on Hospital's behalf via monthly calls and emails, twice a month SMS, chat-support and updates via app, etc.
Our followup Protocols are built on best evidence backed guidelines and can be customized by hospitals.
Contact info@healtho5.com to know more
The document discusses reforms to Ukraine's healthcare system in market conditions. It proposes dividing healthcare into three subsystems: state, public, and private. The state subsystem would provide a basic level of care for all citizens. Those dissatisfied could use the public or private options. Factors like costs, pricing, competition between providers, and the economic roles of medical workers are discussed at different levels of the system. Budgets for medical institutions would be divided into accounts for salaries, current expenses, capital expenses, and other costs. The social, medical, and economic effectiveness of the healthcare system are also addressed.
Presentation 202 jennifer kennedy hospice and pallative care for a patient...The ALS Association
This document discusses palliative care and hospice care options for patients diagnosed with ALS. It provides an overview of palliative care which focuses on symptom management and quality of life, versus hospice care which provides support for terminal illnesses in the last 6 months of life. The document reviews Medicare eligibility guidelines for hospice, common ALS symptoms addressed by palliative and hospice care, and barriers to referring patients to these services like late discussions around end-of-life care planning.
The document discusses improving provider access to patient advance directives (ADs) at Providence Hospitals. Currently, only about 10% of patients have documented ADs, and the information is tied to specific visits rather than the overall patient record. To address this, palliative care data from the past year was analyzed and staff were interviewed. It was found that the low completion rate and provider unfamiliarity with the EMR system were issues. Meetings were held to create a streamlined process for accessing AD documents. The solution was to record the date documents are received in the EMR, allowing searches by date. Educational trainings will be provided to nurses to implement the new process in April 2016.
This document discusses the key components and factors influencing health care systems. It outlines that health care systems aim to promote, restore, and maintain health for populations. The document then discusses the historical development of health care, from only being accessible to the wealthy to reforms that aimed to provide services to wider groups. Modern health care systems reflect the values of their societies, and are influenced by changing disease patterns, demographics, technology advances, and government policies. The quality of health care systems can be evaluated based on criteria like effectiveness, efficiency, accessibility, and equity of services provided.
The Nurse's Bill of Rights outlines 10 rights that nurses should have in their practice and work environment. These include the rights to practice nursing according to professional standards and fulfill obligations to patients, work in a safe environment that supports ethical practice, advocate for patients without fear of retaliation, receive fair compensation, negotiate employment conditions, refuse unsafe assignments, and not be abused or exploited.
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
The document provides guidance on identifying patients who are approaching the end of life. It outlines general indicators like deteriorating health and weight loss. It emphasizes the importance of early identification so patients can access appropriate end of life care and support. Only 25% of patients who die have end of life plans in place, so identifying patients earlier allows for conversations about preferences and advanced care planning.
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
A guide to workforce development to support social care and health workers to apply the common core principles and competences for end of life care
23 February 2012 - National End of Life Care Programme / Skills for Care / Skills for Health
The National End of Life Care Programme has worked alongside Skills for Health and Skills for Care to ensure that workers involved in supporting someone who is at the end of their life are properly trained to be able to undertake their work effectively and appropriately.
Each section gives an explanation of the area of work and includes important links to further information and resources. There is also a 'practice scenario' to show how the competences are connected and how they can be used to help in developing services and ensuring that workers are appropriately trained and skilled.
This guide completely replaces the 2010 A framework of National Occupational Standards to support common core principles for health and social care workers working with adults at the end of life and should be read alongside the Common Core Competences and Principles: A guide for health and social care workers working with adults at the end of life.
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
Holistic common assessment of supportive and palliative care needs for adults requiring end of life care - 17 March 2010 - National End of Life Care Programme
This document provides guidance for holistic common assessment of the supportive and palliative care needs of adults requiring end of life care. It highlights five core areas or domains for holistic common assessment and sets out the content within each of these, so that teams can benchmark their local processes and tools. It sets out the main features of the process - including the who, when, where and how - of holistic common assessment.
It also highlights a range of existing assessment and planning tools, guidance and relevant policy, signposting to other resources where appropriate.
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
Discussion paper
06 October 2010 - National End of Life Care Programme / Department of Health
This discussion paper focuses on the current context of practices and policies that impact on end of life, including those that need to be explored with people who have a personal health budget.
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
Learning outcome 1The chronicity of COPD allows for self manage.docxaryan532920
Learning outcome 1
The chronicity of COPD allows for self management by sufferers. (Spencer & Barcomb 2014). The self management goal is reduced hospital admissions and improved life quality (Bedra et al 2013). Sufferers should have access to a wide range of skills available from the multidisciplinary team. Those include exacerbation limitation, respiratory failure, chronic productive cough and anxiety and depression.
Symptom Recognition.
Patients discharged from hospital are susceptible to readmission (Bedra et al 2013). Understanding the condition and knowing when they are having an exacerbation is imperative for self management, and what to do in the given circumstances, and when and what medication to take, or realise they need hospital treatment.
Treatment.
The main form of treatments comes from inhaled therapies and explained below would be when they would be administered and their understandings are a major factor in self management.
For breathlessness and exercise limitations: A short acting Beta2 agonist (as required) or short acting muscarinic antagonist (as required).
For exacerbations or persistent breathlessness: A long acting beta2 agonist, long acting muscarinic antagonist, to – long acting beta2 agonist + inhaled corticosteroid (Combination Inhaler) OR a long acting muscarinic antagonist (must discontinue short acting antagonist once this is commenced).
(Remember if using Corticosteroids, this has no evidence of long terms benefits).
If experiencing persistent exacerbations or breathlessness. Long acting Muscarinic antagonist + long acting beta2 agonist and inhaled corticosteroid (combined inhaler).
Niesters et al, (2012) describe how oxygen therapy can also be used, but awareness of inappropriate oxygen therapy with COPD patients is imperative as this can cause respiratory depression.
Self Monitoring.
The British Thoracic Society (BTS) have identified five high impact actions that can improve outcomes for people being discharged after an acute exacerbation of COPD. The form is a quick way of identifying patients need for those interventions, ensuring their needs are met. The aim is for lessened hospital readmission rates with self monitoring patients. The five actions are;
Review of medication and demonstration of inhalers they will be using.
Provide a written Self Management plan and Emergency drug pack.
Asses and offer referral for smoking sensation.
Assess for suitability for pulmonary rehab.
Arrange a follow up call within 72 hours of discharge.
Educational Interventions.
Reardon et al, (2005) explain pulmonary rehabilitation as programs which work with patients to help manage their condition, muscle strength, ability to cope with their disease, help with social requirements as people can become quite isolated.
Test includes incremental shuttle walk a 10 metre course, consecutive runs, each time getting faster, measured how far they got, will give idea of what they can endure on the exercise programme th ...
Five priorities for care of the dying personMarie Curie
Dr Bill Noble, Medical Director of Marie Curie Cancer Care, speaks at the end of life sesion with Dr Adam Firth (RCGP Clinical Support Fellow for End of Life Care).
This session was chaired by Dr Peter Nightingale, Marie Curie and RCGP End of life lead at the RCGP Annual Conference, ACC Liverpool, 2-4 October, 2014.
For more information visit: mariecurie.org.uk/rcgp
Promoting the safe management of people with Severe Mental Illness by trainin...Mental Health Partnerships
This project, led by Dr Fiona Nolan, Camden and Islington NHS Foundation Trust, developed training for practice nurses and carried out research on the physical health needs of patients with Severe Mental Illness.
Previous research undertaken by Dr Sheila Hardy, Education Fellow, University College London Partners and Visiting Fellow for Primary Care, University of Northampton, found that contrary to popular belief, patients with serious mental illness will attend health checks, and proper training in this area for practice nurses increases the level of screening and lifestyle advice given.
Find out more at http://mentalhealthpartnerships.com/?p=13113
Risk profiling, multiple long term conditions & complex patients, integrated ...Dr Bruce Pollington
Dr Bruce Pollington web-ex presentation to LTC QIPP programme
Utilising risk profiling, and risk stratification to identify patients with multiple long term conditions requiring complex care through integrated care teams.
This document discusses end of life care and provides definitions and guiding principles. It notes that end of life care aims to help those with advanced illnesses live as well as possible until death, through management of pain and other symptoms as well as psychological, social, spiritual and practical support for both patients and families. The document also outlines key policies and guidance related to end of life care in the UK, and discusses considerations around strategic planning, community engagement, and positioning an organization to provide high quality end of life care services.
A care home 'is' someone's home, one day it could be yours too … best practice in end of life care in care homes. Presentation from Eleanor Sherwen, Elaine Owen and Caroline Flynn from England's National End of Life Care Programme as part of the Department of Health's QIPP end of life care workstream seminar series at Healthcare Innovation Expo 2011
Using models-of-care-to-understand-the-impact-of-networks-of-care-for-lt csNHS Improving Quality
The document discusses using models of care to understand the impact of networks of care for long term conditions. It describes a patient-centered "House of Care" framework for delivering coordinated care to people with long term conditions. The House of Care aims to provide person-centered care that addresses all of a patient's needs at both the local level, through integrated systems involving health, social care and other services, and at the personal level through care planning and self-management support. Implementing the House of Care framework could save the NHS money by reducing unplanned hospital admissions and empowering patients.
06 July 2011 - National End of Life Care Programme
The guide highlights the key nursing contributions within the six steps of the end of life care pathway.
It focuses predominantly on how nurses can and do contribute to planned (and unplanned) end of life care for adults in England.
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
23 September 2010 - National End of Life Care Programme
This guide is principally for professionals working in health and social care and allied professions. Its main aim is to provide links to information sources, resources and good practice in end of life care (EoLC) for people with dementia, particularly for those who work with people with dementia who are not EoLC experts and EoLC experts who are not particularly knowledgeable about dementia.
While the document is not principally written for patients and carers, some of the information will be relevant to them.
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
Communicating Palliative Care of Needs of Patients to Out Of Hours Services Irish Hospice Foundation
The document discusses communicating palliative care needs of patients to out-of-hours services. It describes the work of the Irish Hospice Foundation including their Primary Palliative Care Programme. It emphasizes the need for improved communication between primary care teams and out-of-hours services for patients with palliative care needs. The document proposes a GP to Out-of-Hours palliative care handover form to facilitate information transfer and continuity of care for patients outside regular hours. It outlines the development and piloting of this form.
Advancing Team-Based Care: Complex Care Management in Primary CareCHC Connecticut
This webinar investigated the ways that team members can contribute to the care of patients with complex medical and/or social needs. The focus was on developing the expanded care team and ensuring ready communication between the core and expanded care teams. Models for effective care management were presented.
This webinar was presented May 5, 2016 3:00 p.m. Eastern Time
This document provides information about a webinar on the Information Standards for End of Life Care (ISB150) that supports implementation of Electronic Palliative Care Coordination systems (EPaCCS). The webinar will introduce the standard and its core data requirements, how it supports care coordination and choice at end of life. Speakers include representatives from NHS Improving Quality, the Health and Social Care Information Centre, and a nurse leading the Long Term Conditions Programme.
CANCER PALLIATIVE CARE.pdf last resort eogMukhtarIrbad
The document provides an introduction to supportive and palliative care in cancer. It discusses what cancer is, what causes cancer, types of cancer, detecting cancer, cancer diagnosis and monitoring, cancer treatments including surgery, radiotherapy, chemotherapy and hormone therapy. It also discusses supportive and palliative care, cancer pain and symptoms, communication, dying and bereavement, and spirituality and equality. The document is intended to provide a common core of introductory information about cancer and palliative care to healthcare professionals.
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)
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
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.
PGx Analysis in VarSeq: A User’s PerspectiveGolden Helix
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
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.
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
2. Section 4
In this section you will be focusing on each of
the six steps of the end of life care pathway,
which is underpinned by good communication
skills to enable early identification of people
in your care who will be supported by the
pathway:
Step 1 – discussions as the end of life
approaches
Step 2 – assessment, care planning and
review
Step 3 – co-ordination of care
Step 4 – delivery of high quality care in
an acute setting
Step 5 – care in the last days of life
Step 6 – care after death
Who to involve
Multidisciplinary ward team
Specialist palliative care team
GPs, primary and community care staff
Ambulance services
Social care services
Generalist and specialist disease specific
staff
Support staff
Out of hours services
Discharge liaison co-ordinators
Hospices
Pharmacies
Equipment providers
Service managers
Commissioners and clinical
commissioning groups
Mortuary staff
Bereavement services
Volunteers.
This section will guide you through implementing systems to facilitate advance care planning and
care co-ordination, ultimately delivering high quality care.
Importantly, your service improvement activities will support you in developing good
communication systems both within your hospital teams and with partners working in the
community and social care services.
2
3. The route to success ‘how to’ guide
TOP TIP
ins
is guide conta
Section 7 of th specific end of life
links to disease es on:
uid
care resource g
idney disease
· Advanced k
· Dementia
· Heart failure
disease
· Neurological
3
4. Section 4
Step 1 – discussions as the end of life approaches
Discussions
as the
end of life
approaches
Assessment,
care
planning
and review
Co-ordination
of care
Challenge: One of the key barriers to
delivering good end of life care is a failure
to discuss things openly. Agreement is
needed on when discussions should occur,
who should initiate them and the skills and
competences staff need for this role.
Outcome: People receiving care and
their families and carers will be given
the opportunity for open and honest
discussions with staff that form the basis
for advance care planning and meets
individual choices wherever possible.
4
Delivery
of high
quality care
in an acute
setting
Care in the
last days of
life
Care after
death
What you need to do
1. Implement an identification model using
recognised good practice to ensure
generalist and specialist staff are trained
to recognise a dying person, for example
the Gold Standards Framework Prognostic
Indicator Guidance (see step 1 resources)
2. Ensure generalist and specialist staff have
capacity and are competent and confident
in communications skills, including breaking
bad news to individuals and their relatives
3. Check that your environment has safe,
private and appropriate places for having
these types of conversations with individuals
and their relatives
4. With your primary care and community
partners, work towards establishing an
Electronic Palliative Care Co-ordination
System (EPaCCS) and mechanisms for
keeping it up to date
5. Find out if your Trust has a recognised end
of life care pathway and whether staff are
trained in its use.
5. The route to success ‘how to’ guide
Practice example
clinical pathway group uses a whole systems
approach for all adults with a life limiting
disease, regardless of age and setting, moving
from recognition of need for end of life care, to
care after death.
In order to apply the model, staff across
organisations are required to understand the
needs and experiences of people and their
carers. The pathway model identifies five key
phases:
North West End of Life Care Model
The North West End of Life Care Clinical
Pathway Group included staff who are involved
in the care of people at the end of their life,
including social workers, ambulance services,
nurses, doctors, commissioners and faith
groups.
The model of delivery advocated by the
1
ADVANCING
DISEASE
1 YEAR
2
3
INCREASING
DECLINE
LAST DAYS
OF LIFE
6 MONTHS
4
5
FIRST DAYS
AFTER DEATH
DEATH
BEREAVEMENT
1 YEAR
Figure 1: the North West end of life care model (NHS North West)
1. Advancing disease – the person is placed on a supportive care register in GP practice/care
home. The person is discussed at monthly multidisciplinary practice/care home meetings
(Gold Standards Framework – GSF)
2. Increasing decline – DS1500 eligibility review of benefits, Preferred Priorities for Care
(PPC) noted, Advance Care Plan (ACP) in place and trigger for continuing healthcare
funding assessment
3. Last days of life – primary care team/care home inform community and out of hours
services about the person who should be seen by a doctor. End of life drugs prescribed
and obtained, and Liverpool Care Pathway (LCP) implemented
4. First days after death – prompt verification and certification of death, relatives being
given information on what to do after a death
(including D49 leaflet), how to register the death For further information please contact:
Elaine Owen
and how to contact funeral directors
Tel: 0151 201 4150 ext 6202
5. Bereavement – access to appropriate support
Email: elaine.owen@mccn.nhs.uk
and bereavement services if required.
5
6. Section 4
Resources
1. Electronic Palliative Care Co-ordination
System (see Section 3: plan)
2. AMBER Care Bundle
(see Section 3: plan)
3. Gold Standards Framework Prognostic
Indicator Guidance
Clinical prognostic indicators are an attempt
to estimate when people have advanced
disease or are in the last year or so of life.
This indicates to those in primary and
secondary care that people may be in need
of palliative/supportive care:
www.goldstandardsframework.org.uk
gold standards
4. Quick guide to identifying patients for
supportive and palliative care
Developed by Macmillan Cancer Support,
NHS Camden and NHS Islington to help
identify those needing end of life care
services: www.endoflifecareforadults.
nhs.uk/publications/quick-guide-toidentifying-patients-for-supportiveand-palliative-care
6
5. Dying Matters information resources
Numerous resources available to raise
awareness and promote conversations about
death, dying and bereavement:
www.dyingmatters.org/overview/
resources
MEDIA
CONTENT
To view this podcast please visit:
tinyurl.com/acute-rts-howtoguide
A Party for Kath is an award-winning, fiveminute film produced by the Dying Matters
Coalition to demonstrate the benefits of
greater openness around death and dying.
6. e-ELCA e-learning
Free to access for health and social care
staff and includes modules on initiating
conversations and communications skills:
www.e-lfh.org.uk/projects/e-elca/index.
html
7. The route to success ‘how to’ guide
7. Finding the Words
A workbook and DVD developed following
discussions with people who have life
limiting conditions or have experienced the
death of a loved one. The aim is to help staff
with end of life conversations:
www.endoflifecareforadults.nhs.uk/
publications/finding-the-words
MEDIA
CONTENT
To view this podcast please visit:
tinyurl.com/acute-rts-howtoguide
9. Case study – development of a
communication prompt
East Lancashire Hospice and NHS Blackburn
with Darwen’s communications prompt
aims to assist professionals in having
conversations and advance care planning
discussions:
www.endoflifecareforadults.nhs.
uk/case-studies/development-of-acommunication-prompt
10. Truth-telling and end of life care
In November 2011, Prof Rob George
was interviewed by BBC Radio 4 on
truth-telling and end of life care
MEDIA
CONTENT
To listen to this interview please visit:
tinyurl.com/acute-rts-howtoguide
This edit of Finding the Words focuses on the
importance of initial conversations about end
of life care and what it means to those who are
dying and their families.
8. Skills for Health Workforce Functional
Analysis Tool
Six workbooks which describe the workforce
skills required to ensure people receive
quality care in their last year of life:
www.endoflifecare-intelligence.org.
uk/end_of_life_care_models/skills_for_
health.aspx
Professor Rob George, consultant in palliative care
at Guy’s and St Thomas’ NHS Foundation Trust,
talks to BBC Radio 4’s One to One show about the
importance and implications of telling the truth
when people are at the end of life.
11. National End of Life Care Programme
support sheets
Support sheet 2 – Principles of good
communication:
www.endoflifecareforadults.nhs.uk/
publications/rtssupportsheet2
7
8. Section 4
Step 2 – assessment, care planning and review
Discussions
as the
end of life
approaches
Assessment,
care
planning
and review
Challenge: An early
assessment of an
individual’s needs and
an understanding of
their wishes is vital
to establish their
preferences and
choices and to identify
any areas of urgent
need. Too often an
individual’s needs and
those of their family
and carers are not
adequately assessed.
Outcome: Each
individual has a holistic
assessment resulting
in an agreed care plan
with regular review
of their needs and
preferences. The needs
of carers are assessed,
acted on and reviewed
regularly.
8
Co-ordination
of care
Delivery
of high
quality care
in an acute
setting
Care in the
last days of
life
Care after
death
What you need to do
5. Work with multidisciplinary
1. Utilising the AMBER Care
teams and social care
Bundle will trigger a
services to raise awareness
holistic needs assessment
and broaden understanding
and should provide the
of the issues related to
opportunity for initiating
end of life care in order to
Advance Care Planning
ensure that both health and
conversations as part of an
social care needs are met
ongoing process
6. Establish mechanisms
2. Establish a mechanism
for sharing results of
for checking whether an
assessments across teams
individual has an existing
and agencies that are
personal support plan or
meaningful but do not
social care assessment and
conflict with confidentiality,
whether a joint assessment
for example with GP out
might be appropriate
of hours and ambulance
3. Agree an appropriate
services
holistic assessment tool or
7. Ensure that appropriate
tools for your ward / Trust
training, which includes
4. Establish a system whereby
needs of carers are assessed, Advance Care Planning,
takes place for all
planned for and acted upon
professionals undertaking
assessments.
10. Section 4
Key principles in advance care planning
Advance care planning (ACP), when done
well, can achieve a number of important
outcomes. It can help:
Improve people’s wellbeing by
improving their understanding of their
illness
Help people to be involved in decisions
about their care
Enable communication between
individuals, families and clinical teams
Ensure that the care and treatment
people receive is informed by their own
decisions and preferences when they
become incapable of decision making
Improve the healthcare decision making
process by facilitating shared decision
making between the individual, their
family and clinical teams.
TOP TIP
ronment right
• Get the envi rson’s emotional state and
pe
• Consider the
ound
cultural backgr
an opening
like to include
• Create
who they would rvices
Ask the person
t se
•
ppor
appropriate su
• Arrange for h information and the
wit
• Be prepared
ns
prognosis/optio til the need for a decision is
it un
• Don’t avoid
urgent
r reflection.
• Allow time fo
10
One useful way of thinking about advance
care planning is to consider it as a series of
steps:
1. Assess the person’s understanding of
their illness
2. Determine how the person wants to
make decisions
3. Determine what the person’s
expectations are about their illness and
treatment
4. Determine if the person has any
important care preferences or
choices about their treatment and
care, including end of life care, that
they want to be taken into account
once they can’t make decisions for
themselves.
Helping staff to start advance care
planning conversations is crucial but can be
something that many find challenging
Advance care planning conversations
must be sensitively introduced and not
imposed on an unwilling person. However,
all individuals should be provided with the
opportunity to participate if they wish.
11. The route to success ‘how to’ guide
In addition, research-based suggestions include the following examples of better words to say:
Instead of:
Better words to say:
There is nothing more we can do
We want to find out how to help you
Would you like us to do everything possible?
How were you hoping we could help?
Withdrawal of treatment
Withdrawal of ventilation (or other specific
treatments) and making sure you are
comfortable
Davison S et al. (2010) Advance care planning in patients with end-stage renal disease. In: Chambers EJ, Germain MK, Brown EA (eds)
Supportive Care in the Renal Patient. Oxford: Oxford University Press (2nd Edition)
Pantilat, S (2009) Communicating With Seriously Ill Patients - Better Words to Say. JAMA, 301(12): 1279-181
11
12. Section 4
Practice example
Barnsley preferred priorities of care (PPC)
pilot study
NHS Barnsley launched the use of PPC in
June 2010 and it was decided:
To avoid using abbreviations within any
professional or user documentation or
information
To use a register to record details of
those who have completed a PPC
document
To attach a sticker with information
provided on the PPC and any advance
statements decisions documentation to
link each document to the other.
To introduce the PPC into practice, a project
plan was formulated and agreed with the
Barnsley end of life care strategy group. One of
the key milestones of the implementation plan
was to produce an audit report in July 20113
to review progress and present to relevant
governance groups.
To support the introduction of PPC a
significant amount of training was undertaken,
including a launch, study days, and community
workshops. In addition a leaflet to support the
use of the PPC was developed.
3
12
From June 2010 to June 2011 over 120 PPC
documents were completed. Early evidence
demonstrated that use of the PPC document
benefited care home residents by establishing
their preferred place of care and reducing
unnecessary hospital admissions and the
distress this causes.
The vast majority of people who had
completed a PPC died in their expressed
preferred place.
9%
15%
76%
Preferred place of care met
Preferred place of care not met
Preferred place of care not stated
Figure 2: Highlights from those who have
died, how many people died in their
preferred place of care? (South West Yorkshire
Partnership NHS Foundation Trust)
For further information please contact:
Suzanne Wise
Tel: 01226 433558
Email: suzannewise@nhs.net
www.endoflifecareforadults.nhs.uk/case-studies/barnsley-preferred-priorities-for-care-pilot-study-audit
13. The route to success ‘how to’ guide
Resources
1. AMBER Care Bundle
(see Section 3: plan)
MEDIA
CONTENT
To view this podcast please visit:
tinyurl.com/acute-rts-howtoguide
Dr Irene Carey and Dr Adrian Hopper,
consultants at Guy’s and St Thomas’ NHS
Foundation Trust, outline the AMBER Care
Bundle and its benefits to both staff and those
at the end of life.
2. Holistic common assessment
Guidance for holistic common assessment
of the supportive and palliative care
needs: www.endoflifecareforadults.
nhs.uk/publications/
holisticcommonassessment
3. Capacity, care planning and advance
care planning in life limiting illness
This guide covers the importance of
assessing capacity to make particular
decisions about care and treatment, and of
acting in the best interests of those lacking
capacity: www.endoflifecareforadults.
nhs.uk/publications/pubacpguide
4. Thinking and planning ahead: learning
from each other
This training pack is designed to help people
understand what advance care planning
is, how to do it, and how to assist others:
www.endoflifecareforadults.nhs.
uk/education-and-training/acp-forvolunteers
5. Advance decisions to refuse treatment
A guide to help understand and implement
the law relating to advance decisions to
refuse treatment:
www.endoflifecareforadults.nhs.uk/
publications/pubadrtguide
See also: www.ncat.nhs.uk/our-work/
living-with-beyond-cancer/holisticneeds-assessment
13
14. Section 4
6. Preferred Priorities for Care tools
Including documentation, an easy-read
version, leaflet, poster and support sheet:
www.endoflifecareforadults.
nhs.uk/tools/core-tools/
preferredprioritiesforcare
7. e-ELCA e-learning
Free to access for health and social care
staff and includes modules on advance
care planning and assessment, as well as a
secondary care learning pathway:
www.e-lfh.org.uk/projects/e-elca/index.
html
8. National End of Life Care Programme
support sheets
• Support sheet 3 – Advance care planning:
www.endoflifecareforadults.nhs.uk/
publications/rtssupportsheet3
MEDIA
CONTENT
To view this podcast please visit:
tinyurl.com/acute-rts-howtoguide
Jane Seymour, Sue Ryder Care professor in
palliative and end of life studies at the University
of Nottingham, talks through the principles of
advance care planning and its importance in a
hospital setting, providing practical top tips for
getting started.
14
• Support sheet 4 – Advance decisions to
refuse treatment:
www.endoflifecareforadults.nhs.uk/
publications/rtssupportsheet4
• Support sheet 6 – Dignity in end of life care:
www.endoflifecareforadults.nhs.uk/
publications/rtssupportsheet6
• Support sheet 12 – Mental Capacity Act
(2005): www.endoflifecareforadults.
nhs.uk/publications/rtssupportsheet12
• Support sheet 13 – Decisions made in a
person’s ‘Best Interests’:
www.endoflifecareforadults.nhs.uk/
publications/rtssupportsheet13
• Support sheet 16 – Holistic assessment:
www.endoflifecareforadults.nhs.uk/
publications/support-sheet-16-holisticassessment
• Support sheet 17 – Independent Mental
Capacity Advocates (IMCAs):
www.endoflifecareforadults.nhs.
uk/publications/support-sheet17-independent-mental-capacityadvocates
16. Section 4
Step 3 – co-ordination of care
Discussions
as the
end of life
approaches
Assessment,
care
planning
and review
Challenge: If a holistic
assessment has been
carried out and shared
appropriately it should be
possible to co-ordinate
care for the individual,
their family and carers.
This should cover primary,
community and acute
health providers, the
local hospice, transport
services and social care.
Electronic Palliative Care
Co-ordination Systems
(EPaCCS) provide the good
practice model.
Outcome: Systems
developed across local
primary, community,
secondary and social care
as well as ambulance
services will ensure coordinated care that is
responsive to individuals
and their carers’ needs
and choices.
16
Co-ordination
of care
Delivery
of high
quality care
in an acute
setting
Care in the
last days of
life
Care after
death
What you need to do
5. Establish a mechanism
1. Ensure there is a
for review of fast track
mechanism to identify a
discharge processes
cross agency key worker
for all people receiving
6. Establish a system to
end of life care
ensure access to specialist
palliative care services 24
2. Examine the systems and
hours a day
processes in place for
communicating across
7. Ensure the day to day coagencies and resolving
ordination of care for the
blockages
individual whilst they are
in hospital.
3. Establish a framework
for key agencies
to ensure
joint working,
carers.
including
der the needs of d
ember to consi
Rem
tails an
governance
orker contact de
Provide key w information and support
arrangements
to
signpost them
as:
4. Establish a system
services, such
htalkonline.
to ensure fast track
line: www.healt
• Healthtalkon d_bereavement/Caring_for_
discharge planning
org/Dying_an terminal_illness
a_
and access to
someone_with_ rt Services: be.macmillan.
po
Macmillan Sup information-for-carers.aspx
•
continuing care
s-330-
TOP TIP
ide:
org.uk/be/
d of life care gu
NHS Choices en ners/end-of-life-care/
•
an
www.nhs.uk/Pl e-care.aspx
-lif
Pages/End-of
17. The route to success ‘how to’ guide
Practice example
Integrated health and social care
community discharge planning in Essex
MEDIA
CONTENT
To view this podcast please visit:
tinyurl.com/acute-rts-howtoguide
Service manager Jill Catchpole and discharge
facilitator Claire Walker set out the steps taken
at NHS West Essex towards an integrated
health and social care rapid discharge pathway.
Partner organisations in West Essex had been
working to improve integrated management
of end of life care, but it was recognised
that more needed to be done, particularly
in relation to the discharge from hospital of
people with life-limiting conditions.
A discharge facilitator was appointed at
the start of the project which ran from March
to May 2011. The facilitator sought to raise
awareness of end of life care and the preferred
priorities for care, and encouraged referrals
from both the hospital and the community.
She worked with a range of agencies to
support discharges from hospital of those who
wished to die elsewhere and in some cases
accompanied the person home.
During the project 78 referrals were made
of which 87% were appropriate – making an
average of 7.5 referrals each week. Of these
64.6% were discharged within 48 hours of
referral and 47% of these were within 24
hours. Nearly 90% were discharged to their
preferred place of care.
The project has helped to dispel a number of
myths and engender greater trust between the
different sectors. It has also raised awareness
of the role of social care at the end of life and
the value of an integrated approach to service
delivery.
Adopting a holistic and integrated approach
can make a significant difference to the quality
and efficiency of discharge for people at the
end of life in a short space of time.
For further information please contact:
Claire Walker
Tel: 07989 204148
Email: claire.walker19@nhs.net
17
18. Section 4
Resources
1. NICE end of life care for adults quality
standard (2011)
The NICE standard consists of 16 quality
statements and measures to define high
quality end of life care: www.nice.
org.uk/guidance/qualitystandards/
endoflifecare/home.jsp
2. Electronic Palliative Care Co-ordination
Systems (see Section 3: plan)
MEDIA
CONTENT
4. End of life locality registers evaluation:
final report
This Ipsos MORI report (2009) presents the
findings from an evaluation of eight locality
register (now EPaCCS) pilot sites across
England and includes case studies:
www.endoflifecareforadults.nhs.uk/
publications/localities-registers-report
5. e-ELCA e-learning
Free to access for health and social care staff
and includes modules on integrated learning
and a unified DNACPR policy:
www.e-lfh.org.uk/projects/e-elca/index.
html
To view this podcast please visit:
tinyurl.com/acute-rts-howtoguide
Dr Julian Abel, medical director at Weston
Hospicecare, discusses Electronic Palliative Care Coordination Systems and how they benefit people
at the end of life in hospital. Practical steps and
challenges for implementation are also identified.
3. National end of life care information
standard
This national standard sets out the minimum
core content required to be recorded in
Electronic Palliative Care Co-ordination
Systems: www.endoflifecareforadults.
nhs.uk/strategy/strategy/coordinationof-care/end-of-life-care-informationstandard
18
6. NHS continuing healthcare
More information about continuing
healthcare is available on the NHS Choices
website, including frequently asked
questions: www.nhs.uk/CarersDirect/
guide/practicalsupport/Pages/
continuing-care-faq.aspx
7. The six steps to success programme for
care homes
This North West workshop style training
programme enables care homes to
implement the structured organisational
change required to deliver the best end
of life care, with a view to reducing
inappropriate admissions to hospital:
www.endoflifecumbriaandlancashire.
org.uk/six_steps.php
19. The route to success ‘how to’ guide
8. Unified Do Not Attempt CardioPulmonary Resuscitation (DNACPR)
principles
Several Strategic Health Authorities
across the country are working towards
implementing DNACPR policies:
www.endoflifecareforadults.
nhs.uk/case-studies/south-eastcoast-dnacprprinciples and www.
southcentral.nhs.uk/what-we-aredoing/end-of-life-care/do-not-attemptcardio-pulmonary-resuscitation/
MEDIA
CONTENT
To view this podcast please visit:
tinyurl.com/acute-rts-howtoguide
10. Lincolnshire discharge liaison nurse
The Marie Curie Cancer Care delivering
choice programme in Lincolnshire
developed the role of the discharge liaison
nurse and an independent evaluation
found that 61% of patients referred to the
service were transferred to their preferred
place of care. Download the Lincolnshire
evaluation reports: deliveringchoice.
mariecurie.org.uk/independent_
evaluation/
11. Safeguarding adults practitioners
guide
Developed by Birmingham Safeguarding
Adults Board, this guide promotes every
adult’s right to live in safety, be free from
abuse and live an independent lifestyle free
from discrimination: www.birmingham.
gov.uk/safeguardingadults
NHS South of England has produced an extensive
DVD on the subject of DNACPR. This edit focuses
particularly on achieving best practice through
the use of a universal DNACPR form.
9. Blackpool rapid discharge pathway
Blackpool Teaching Hospitals’ rapid
discharge pathway for people at
end of life aims to facilitate a safe,
smooth and seamless transition of care
from hospital to community: www.
endoflifecareforadults.nhs.uk/casestudies/blackpool-rapid-dischargepathway
12. National End of Life Care Programme
support sheets
Support sheet 1 – Directory of key contacts:
www.endoflifecareforadults.nhs.uk/
publications/rtssupportsheet1
19
20. Section 4
Step 4 – delivery of high quality care in an acute setting
Discussions
as the
end of life
approaches
Assessment,
care
planning
and review
Challenge:
Individuals and
their families and
carers may need
access to a complex
combination of
services. They should
expect the same
high quality of care
regardless of the
setting. Their care
should be informed
by senior clinical
assessment and
decision making.
Outcome: Each
individual will have
access to tailored
information,
specialist palliative
care advice 24/7
and access to
spiritual care
within a dignified
environment,
wherever that may
be.
20
Co-ordination
of care
Delivery
of high
quality care
in an acute
setting
Care in the
last days of
life
Care after
death
What you need to do
core principles and values,
1. Ensure a fully complemented
including after death care
specialist hospital palliative
care team is present, in line 7. Ensure appropriate staff
with NICE guidance
have communication
skills, assessment and
2. Gather information on
care planning, symptom
how you are doing from
management, and comfort
complaints, compliments,
and wellbeing training
suggestions and significant
events
8. Examine your ward
environment to ensure it is
3. When things go wrong
supportive of dignity and
identify what happened
respect for individuals and
and set up mechanisms for
carers. Ensure feedback,
remedial action
comments and complaints
4. Work through blockages
are acted upon to improve
across organisational
your ward environment.
boundaries and systems
5. Identify what has worked
well and set up mechanisms
to replicate for service
improvement
sical,
6. Ensure all staff are trained
dividual’s phy
Consider the in
and are confident and
iritual needs,
cultural and sp
g
competent in end of life care
e with learnin
TOP TIP
os
for example th
dementia.
disabilities or
21. The route to success ‘how to’ guide
Practice example
Analysing hospital complaints about end
of life care
In 2010 the National End of Life Care
Programme undertook a small scale exercise
looking at the number of complaints about
end of life care received by four hospital Trusts
over a six month period.
Working with Trusts from the North East and
Midlands, results showed that between 3-6%
of all complaints received were specifically
about end of life care.
The emerging complaint themes leaned
strongly towards communication issues and
appropriate clinical care, as interpreted by the
complainant. The analysis report suggests it
may be feasible to consider that improvements
in levels of communication and understanding
may also result in improvement of what is
considered to be good end of life care.
The report highlights the Solihull
Bereavement Pathway Project, which offers one
suggestion as a way of reducing complaints by
offering volunteer bereavement support and
guidance following a death in hospital.
This exercise provided some helpful
information to support hospitals in considering
end of life care complaints reporting. While it
does not provide evidenced based large scale
study findings, it may help you to consider
the current processes for review within your
hospital.
For further information please visit:
www.endoflifecareforadults.nhs.
uk/publications/an-analysis-of-thenumbers-of-hospital-complaintsrelating-to-end-of-life-care-over-a-sixmonth-period
21
22. Section 4
Resources
1. Route to success in end of life care:
achieving quality environments for
care at end of life
This guide identifies
a number of key
environmental principles to
help improve privacy and
dignity for individuals and
their families at the end of
life:
www.
endoflifecareforadults.
nhs.uk/publications/routes-to-successachieving-quality-environments-forcare-at-end-of-life
2. Nottingham information prescriptions
NHS Nottingham City piloted a scheme of
information prescriptions aimed at giving
people approaching the end of their life
more control over the management of
their care: www.endoflifecareforadults.
nhs.uk/case-studies/informationprescription-for-end-of-life-carein-nottingham-city-pct and www.
nottspct.nhs.uk/my-nhs-services/end-oflife-care.html
3. NHS Choices end of life care guide
This online guide is for people approaching
the end of life and their carers. It explains
what to expect from end of life care and
provides information on rights and choices:
www.nhs.uk/Planners/end-of-life-care/
Pages/End-of-life-care.aspx
22
4. e-ELCA e-learning
Free to access for health and social care
staff and includes modules on symptom
management and fast track discharge:
www.e-lfh.org.uk/projects/e-elca/index.
html
5. Royal College of Nursing’s dignity
resource
This resource aims to support everyone
working in the nursing team in the delivery
of dignified care:
www.rcn.org.uk/development/practice/
dignity
6. Social Care Institute for Excellence
(SCIE) – stand-up for dignity
This online resource features a wealth
of information about dignity in health
and social care: www.scie.org.uk/
publications/guides/guide15/
standupfordignity/index.asp
23. The route to success ‘how to’ guide
7. The Dignity in Care network
Hosted by SCIE, the network consists of
dignity champions across the country, as
well as the National Dignity Council:
www.dignityincare.org.uk/
8. The route to success in end of life care
– achieving quality for people with
learning disabilities
This practical guide supports anyone caring
for people with learning disabilities to
achieve high quality end of life care:
www.endoflifecareforadults.nhs.uk/
publications/route-to-success-peoplewith-learning-disabilities
9. National End of Life Care Programme
support sheets
• Support sheet 1 – Directory of key
contacts: www.endoflifecareforadults.
nhs.uk/publications/rtssupportsheet1
• Support sheet 6 – Dignity in end of life
care: www.endoflifecareforadults.nhs.
uk/publications/rtssupportsheet6
23
24. Section 4
Step 5 – care in the last days of life
Discussions
as the
end of life
approaches
Assessment,
care
planning
and review
Challenge: The point
comes when a person
enters the dying phase
(the last hours or
days). It is vital that
those caring for them
recognise that the
person is dying and
deliver the appropriate
care. How someone
dies remains a lasting
memory for families
and carers as well as
staff.
Outcome: The person
dying can be confident
that their wishes,
preferences and choices
will be reviewed and
acted upon and that
their families and carers
will be supported
throughout.
24
Co-ordination
of care
Delivery
of high
quality care
in an acute
setting
Care in the
last days of
life
Care after
death
What you need to do
intervals so that a person’s
1. Ensure generalist and
choices can be taken into
specialist staff are trained to
account and acted upon
recognise a dying person
wherever possible, for
2. Develop Trust guidelines
example Preferred Priorities
for the use of the Liverpool
for Care
Care Pathway, including
5. Establish a system for rapid
diagnosing dying
discharge identified through
3. Identify relevant staff and
advance care planning or
ensure they are trained
through discussion with the
in the use of prognostic
individual and their carers to
indicators and the Liverpool
enable the person to die in
Care Pathway, and skilled
a place of their choice.
in communicating the
implications to individuals 6. Re-examine your ward
environment to ensure it is
and their carers as
supportive of dignity and
appropriate
respect for individuals and
4. Establish a mechanism
carers throughout every
to initiate review of
stage of the end of life care
advance care planning
pathway.
documentation at regular
25. The route to success ‘how to’ guide
Practice example
The National Care of the Dying Audit –
Hospitals (NCDAH)
NCDAH is undertaken by the Marie
Curie Palliative Care Institute Liverpool in
collaboration with the Royal College of
Physicians. Specifically, it examines care
delivery in the last days or hours of life for
people who have died in acute hospital settings
supported by the Liverpool Care Pathway for
the Dying Patient.
In June 2011, the NCDAH was incorporated
within the Department of Health Quality
Accounts, which offers an important driver
for increased participation.
The audit consists of two major
components:
Organisational Data – pertinent
data from participating hospitals
are collected to provide important
contextual information. Such
information includes the number of
deaths, hospital size (wards/beds),
education and training provision and
staffing to support end of life care.
Patient Level Data – information
coded at the point of care delivery is
extracted from a consecutive sample
of completed Liverpool Care Pathways
used within participating hospitals
during the three month data collection
period.
The data is analysed descriptively to provide
an overall benchmark against each of the goals
for all individuals in the sample, compared to
performance within each hospital.
A series of regional workshops are held
to enable discussion of the results, sharing
of understanding and action planning for
improving care of the dying in individual
organisations.
The results of the third round audit
(2011/2012) were published on 1st December
2011. The audit included clinical data from
over 7,000 people (from 127 NHS Trusts) on
the Liverpool Care Pathway.
Findings highlighted that hospitals are
reaching high standards of care in a wide
variety of areas. However, while care was
of high quality overall concerns remained
regarding education and training, and the
limited availability of support services from
specialist palliative care teams.
For further information please visit:
www.mcpcil.org.uk/liverpool-carepathway/national-care-of-dying-audit.
htm
25
26. Section 4
Resources
1. The Liverpool Care Pathway for the
Dying Patient (see Section 3: plan)
MEDIA
CONTENT
3. Finding the Words
A workbook and DVD developed following
discussions with people who have life
limiting conditions or have experienced the
death of a loved one:
www.endoflifecareforadults.nhs.uk/
publications/finding-the-words
To view this podcast please visit:
tinyurl.com/acute-rts-howtoguide
MEDIA
CONTENT
To view this podcast please visit:
tinyurl.com/acute-rts-howtoguide
Deborah Murphy, national lead nurse for the
Liverpool Care Pathway (LCP) at the Marie Curie
Palliative Care Institute in Liverpool, provides an
overview of the LCP and its benefits to people at
the end of life in hospital.
2. e-ELCA e-learning
Free to access for health and social care
staff and includes modules on symptom
management and diagnosing dying:
www.e-lfh.org.uk/projects/e-elca/index.
html
This edit of Finding the Words focuses on the
care received by people in hospital during the
last days of life, as well as the long-lasting impact
that this can have on carers and relatives.
4. National End of Life Care Programme
support sheets
• Support sheet 8 – The dying process:
www.endoflifecareforadults.nhs.uk/
publications/rtssupportsheet8
• Support sheet 14 – NHS continuing care
fast track pathway tool:
www.endoflifecareforadults.nhs.uk/
publications/rtssupportsheet14
26
28. Section 4
Step 6 – care after death
Discussions
as the
end of life
approaches
Assessment,
care
planning
and review
Challenge: Good end of
life care does not stop at
the point of death. When
someone dies all staff need
to be familiar with good
practice for the care and
viewing of the body as
well as being responsive to
family wishes. The support
and care provided to carers
and relatives will help them
cope with their loss and are
essential to a ‘good death’.
Outcome: A system is
in place that ensures the
emotional and practical
needs of families and carers
are supported after death.
Verification and certification
of death is timely, including
notification to the coroner
where necessary as well as
appropriate and continuous
carer support throughout
bereavement.
28
Co-ordination
of care
Delivery
of high
quality care
in an acute
setting
Care in the
last days of
life
Care after
death
What you need to do
appropriate training to at
1. Develop guidelines for
least signpost to spiritual,
your Trust’s viewing
emotional, practical and
arrangements and facilities
to ensure they are sensitive financial support
to different needs, cultures 5. Identify and communicate
and faiths
the place and the process
for collection of official
2. Ensure communications
documentation and
skills training is in place
the deceased person’s
and undertaken for all
possessions
staff likely to be in contact
with carers immediately
6. Establish a system to send
post death
relatives a bereavement
3. Establish a system whereby questionnaire, such as
the National Bereavement
carers’ post bereavement
Survey (VOICES), and to
needs are assessed and
provide frontline staff
recorded as part of the
with feedback in order
carers assessment whilst
to support continuing
their loved one is still alive
improvement.
4. Ensure all staff likely
to be in contact with
bereaved people have
29. The route to success ‘how to’ guide
Practice example
Redesign of bereavement services and
mortuary viewing area
Staff at Salisbury District Hospital used to
refer to the journey relatives had to make
between the bereavement office and the
mortuary viewing facilities as the ‘walk of
shame’. It involved a long, gloomy walk along
a basement corridor populated by clinical
waste bins, with the ever-present possibility of
bumping into an undertaker.
In 2008 the Trust teamed up with The King’s
Fund’s Environments for Care at End of Life
programme. The first plan was a fairly modest
one to redecorate and introduce new furniture,
artwork and extra facilities.
But once the Salisbury team started
discussing the possibilities in more detail, their
thinking became more ambitious. They realised
this was a chance not only to improve the
environment but to integrate bereavement and
mortuary services within one building and raise
the profile of care after death within the Trust.
With a £30,000 grant from the Department
of Health, via The King’s Fund, topped up by
£10,000 from the Trust, the team managed to
secure an extra £100,000 from local hospices,
charities and other organisations.
Work on the major revamp of the mortuary
building was completed in October 2009. The
result is a new purpose-built structure that
incorporates the bereavement office, a waiting
area and the viewing room under one roof.
A light, airy reception area together with
dedicated parking makes the building both
welcoming and private. And the other rooms,
decorated with original artwork and textiles
and simply furnished, give a calm, noninstitutional feel.
The changes have transformed the
experience of many bereaved relatives and
friends. They can attend the bereavement
office in pleasant, private surroundings, collect
the death certificate and their loved one’s
belongings and then proceed to the viewing
suite if they wish.
For further information please contact:
Sam Goss
Email: samuel.goss@salisbury.nhs.uk
29
30. Section 4
Resources
1. Guidance for staff responsible for care
after death
This publication emphasises that the care
extends well beyond physically preparing the
body for transfer. It also covers privacy and
dignity, spiritual and cultural wishes, organ
and tissue donation, health and safety and
death certification procedures:
www.endoflifecareforadults.nhs.
uk/publications/guidance-for-staffresponsible-for-care-after-death
MEDIA
CONTENT
To view this podcast please visit:
tinyurl.com/acute-rts-howtoguide
Jo Wilson, Macmillan consultant nurse
practitioner at Heatherwood and Wexham
Park Hospitals, talks about care after death
guidance and the steps needed to implement it
successfully in hospitals.
30
2. When a person
dies: guidance
for professionals
on developing
bereavement
services
This covers the
principles of
bereavement
services and
guidance on
workforce
education and the commissioning and
quality outcomes of bereavement care:
www.endoflifecareforadults.nhs.uk/
publications/when-a-person-dies
3. National Bereavement Survey (VOICES)
The National Bereavement Survey aims to
capture the Views Of Informal Carers and
an Evaluation of Services (VOICES). It is a
postal questionnaire to measure satisfaction
with services received in the year before
death: www.ons.gov.uk/ons/aboutons/surveys/a-z-of-surveys/nationalbereavement-survey--voices-/index.html
31. The route to success ‘how to’ guide
4. Improving Environments for Care at
the End of Life
In 2006 a pilot programme was launched by
The King’s Fund across eight sites to improve
environments for care at end of life:
www.kingsfund.org.uk/publications/
care_at_end_of_life.html
MEDIA
CONTENT
To view this podcast please visit:
tinyurl.com/acute-rts-howtoguide
This edit of a National End of Life Care
Programme / King’s Fund DVD looks at the
importance of environments of care at the end of
life and gives examples of what can be achieved.
6. e-ELCA e-learning
Free to access for health and social care staff
and includes modules on care after death,
bereavement and spirituality:
www.e-lfh.org.uk/projects/e-elca/index.
html
7. National End of Life Care Programme
support sheets
• Support sheet 9 – What to do when
someone dies:
www.endoflifecareforadults.nhs.uk/
publications/rtssupportsheet9
• Support sheet 15 – Enhancing the healing
environment:
www.endoflifecareforadults.nhs.uk/
publications/rtssupportsheet15
5. Route to success in end
of life care: achieving
quality environments for
care at end of life
This guide identifies
a number of key
environmental principles to
help improve privacy and
dignity for individuals and
their families at the end of life:
www.endoflifecareforadults.nhs.
uk/publications/routes-to-successachieving-quality-environments-forcare-at-end-of-life
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