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

1. Advance Care Planning
process here at BSUH
Transforming End of Life Care in
Acute Hospitals Conference
18 November 2015

2. David Howlett
Foundation Year 1 Doctor
Dilan Joshi
Medical Student
Sarah French
Theatre Sister
Sherree Fagge
Chief Nurse

3. The Route to
success in end of
life care –
achieving quality in
acute hospitals

Transforming End
of Life Care in
Acute Hospitals

4. Five key enablers
1. Advance Care Planning process
2. ShareMyCare our Electronic Palliative
Care Coordination System (EPaCCS)
3. AMBER care bundle
4. Rapid Discharge Pathway for the dying
patient who would like to die at home
5. The Priorities of Care of the Dying Person

5. What are we doing?
Major focus at BSUH
for all staff on a
personal and professional level

6. Advance Care Planning
process
I didn’t want that video
(Dying Matters 2012)

10. Dying Matters Coilition

15. Advance Care Planning in Kent,
Surrey and Sussex:
A Report and Recommendations
from the South East Coast Clinical
Senate

16. Five key enablers
1. Advance Care Planning process
2. ShareMyCare our Electronic Palliative
Care Coordination System (EPaCCS)
3. AMBER care bundle
4. Rapid Discharge Pathway for the dying
patient who would like to die at home
5. The Priorities of Care of the Dying Person

17. • Engagement & Networking
– End of Life Care Links for all clinical areas
• Education
– End of Life Care Education Series
– End of Life Care Study Days
– End of Life Care Link Workshops
– End of Life Care Newsletter
– End of Life Care Intranet Site
– End of Life Care Conference

18. Sharing wishes and
preferences
Starts with YOU!
YOU?

19. v
Future Care Planning
Dr Karen Groves
West Lancs, Southport & Formby

20. FO
SOUTHPORT
West Lancs, Southport & Formby
WL,S&FWL,S&F
1 bed/69 people
WL,S&FWL,S&F
1 bed/69 people
WL,U.K.U.K.
1 bed/150 people
WL,U.K.U.K.
1 bed/150 people
River Ribble
M6
M58
• 235,000 pop
• 1 NHS Trust - ICO
•2 hospitals
• 110 care homes
•+4 unregistered
• 3429 reg. CH beds

22. Place of Death ONS 2014

23. Place of Death ONS 2014

24. • Integrated Specialist Palliative Care Services
• Hospital & Community SPCT in one NHS base
• Hospice inpatient, outpatient, day & ‘at home’ services
• Six Steps to Success Care Homes Programme
• Acute Hospitals GSF Pilot
• Acute Hospitals Transform Programme 2nd wave
Background

25. Hospital
Transform
Facilitator
WL
Six Steps
Facilitator
Hospital
EoL
Facilitator
S&F
Six Steps
Facilitator
Terence
Burgess
Education
Centre
Manager
Amber
Care Bundle
Facilitator
Advance
Care Planning
Facilitator

26. Hospital
Transform
Facilitator
WL
Six Steps
Facilitator
Hospital
EoL
Facilitator
S&F
Six Steps
Facilitator
Terence
Burgess
Education
Centre
Manager
Amber
Care Bundle
Facilitator
Advance
Care Planning
Facilitator

27. Hospital
Transform
Lead
TBEC
Manager &
Transform
Care Home
Lead
Community
Transform
Lead
Transform
Facilitator
Transform
Support
Transform
Facilitator

28. transform@nhs.net

29. Care of DyingCare of Dying
GenogramsGenograms
Co-ordinationCo-ordination
Rapid End of
Life Transfer
Rapid End of
Life Transfer
Communicati
on Skills
Communicati
on Skills
Simple Skills
Secrets
Simple Skills
Secrets
Future Care
Planning
Future Care
Planning
Consistent Practical
Relevant Memorable
On site

30. Advance
Care
Planning
Best
Interests
Decisions
Anticipatory
Clinical
Management

31. Hospital & Community staff
397
Care Home staff
294
Public
578
Total
1672

32. • Same team members working in all settings
• Education is the same whether in hospital, hospice,
community or care home
• Processes are the same across all boundaries
• Documentation similar across all settings
• Consistent messages and vocabulary
Cross Boundary
Consistency

33. Future Care Planning
Does person have
capacity?
Does person have
capacity?
yes
no
Advance Care
Planning
Advance Care
Planning
Anticipatory
Clinical Planning
Anticipatory
Clinical Planning
Is there a previous
ACP?
Is there a previous
ACP?
no
respect wishes
previously
expressed
respect wishes
previously
expressed
yes
Best Interests
Decisions
Best Interests
Decisions
Advance Care
Planning
Advance Care
Planning

35. Recording a Conversation

36. I
Lasting
Power of
Attorney
(for health &
welfare)
Lasting
Power of
Attorney
(for health &
welfare)
Advance
Decision to
Refuse
Treatment
Advance
Decision to
Refuse
Treatment
Statement of
wishes,
beliefs &
preferences
Statement of
wishes,
beliefs &
preferences
Named
Spokespers
on
Named
Spokespers
on
Clinical
Decisions
Clinical
Decisions
Anticipatory
Clinical
Managemen
t
Anticipatory
Clinical
Managemen
t
CLINICAL
FUTURE CARE
PLANNING
Talk
about
it
Share
it
Think
about
it
ADVANCE CARE
PLANNING
AdvanceCarePlanning
AnticipatoryClinical
ManagementPlanning

37. Introducing a framework
to manage care for those
approaching end of life
promoted discussion &
documentation of wishes
& preferences by district
nurses
3 cycles of audit
demonstrated
improvement from
0% to 100% !

38. Audit
Recording ACP
conversations
&
questionnaire survey of
DN practice
demonstrated lack of
standard location of
information in notes
Outcome:
new discussion record
with prompts
now also introduced into
acute & care home
settings

39. Communication

40. Recorded ACP
Discussions
• Multiple HPs having
discussions
• Recorded in different
places (new section in acute clinical records)
• Lack of interoperability
of electronic systems
72 71
89
80
112
124
0
10
20
30
40
50
60
70
80
90
100
110
120
130
140
Qu1 Qu2 Qu3 Qu4 Qu 1 Qu2
2014-152014-15 2015-162015-16

41. • Documenting conversations in a way that
• they can be shared
• they can be counted
• Sharing & updating wishes & preferences
• Using previously identified wishes & preferences in the
acute setting (trial of WR proforma)
• Educating every staff member & the public
Challenges