Gold Standards Framework Dr Mohammed Javid. Aims Deaths – Why, where, how End Of Life Care –...
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Transcript of Gold Standards Framework Dr Mohammed Javid. Aims Deaths – Why, where, how End Of Life Care –...
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Gold Standards Framework
Dr Mohammed Javid
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Aims
• Deaths– Why, where, how
• End Of Life Care– EoLC, ACP, PPC, PPD, GSF, LCP
• Gold Standards Framework– 3 steps– 5 goals– 7 Key tasks
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Deaths
• 500, 000 per year in the UK• 1% of the population dies each year• Cause of death
- 25% cancer- 20% heart disease- 15% respiratory disease- 10% strokes and related disorders- 30% other
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Place of Death
• Where do people want to die ?– 55% Home– 25 % Hospice– 10 % Hospital– 5 % Care Home
• Where do people die ?– 55 % Hospital– 20% Care Home– 20% Home– 5% Hospice
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End Of Life Care
supportive andpalliative care
deterioration death/bereavement
ACP / PPC LCPOne year Last days
ACP Advanced care PlanPPC Preferred priorities of care PPD Preferred place of deathGSF Gold standards FrameworkLCP Liverpool Care PathwayEoLC End of Life Care
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Gold Standards Framework
IdentifyWhich patients may be in the last year of life + their stage?
Use of register+ planning meeting (PIG, NB Coding ) .
AssessCurrent and Future Clinical needs and Personal needs
(assessment tools, Advance care planning )
Plan Planning care in line with needs -cross boundary Plan care in final days (eg LCP) + action plans
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Cancer
Dementiaand
decline
Organ
failure
Sudden death
GSF Step 1: Identify
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Assess• Symptom assessment• Personal needs• Preferred priorities of care
– Place of care– Place of death– Advanced Care planning
• Statement of wishes and preferences• Advance decisions• Power of attorney
• Patient focussed – Needs based– Voluntary
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Plan
• Communication• Out of hours handover• Drugs in home
– What drugs– DN prescribing– Pharmacy– Syringes, diluents
• OOH bypass number• Crisis prevention
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5 GoalsPatients are enabled to have a ‘good death’
1) Symptoms controlled2) Preferred place of care 3) Safe + secure with fewer crises4) Carers feel supported, involved, empowered, and satisfied.5) Staff confidence, teamwork, satisfaction, co-working with specialists and communication better.
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7 CC1 Communication
Register, PHCT Meetings, care plan Advanced care planning (ACP) eg PPC
C2 Co-ordinationIdentified co-ordinator for GSF, keyworker for patient
C3 Control of SymptomsAssessment tools,
C4 Continuity Out of HoursHandover form + OOH protocol
C5 Continued LearningLearning about conditions on patients seen, SEA / reflective practice
C6 Carer SupportPractical, emotional, bereavement, National Carer’s Strategy
C7 Care in dying phase- Protocol LCP / ICP
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What should we do ?
Level 1 – register, PHCT meeting, co-ordinator C1,2
Level 2 – Assessment tools, OOHs handover, education, audit and reflective practice
C3,4,5Level 3 – Carer/family support, bereavement plan and
protocol for final daysC6,7
Level 4 – Sustain and build on developments, practice protocol, extend
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Indicator Points
Payment stage
s
Palliative Care (PC1)The practice has a complete register available of all
patients in need of palliative care/support.
3 —
Palliative Care (PC2)The practice has regular (at least 3 monthly) multidisciplinary
case review meetings where all patients on the palliative care register are discussed.
3 —
Cancer (Cancer 1)The practice can produce a register of all cancer patients
defined as a 'register of patients with a diagnosis of cancer excluding non-melanotic skin cancers from 1 April 2003'.
5 —
Cancer (Cancer 3)The percentage of patients with cancer, diagnosed within
the last 18 months, who have a patient review recorded as occurring within 6 months of the practice receiving confirmation of the diagnosis.
6 40–90%
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Records and information (Records 13)There is a system to alert the out-of hours service or duty doctor
to patients dying at home.
2 —
Practice management (Management 9)The practice has a protocol for the identification of carers and a
mechanism for the referral of carers for social services assessment.
3 —
Education and training (Education 7)The practice has undertaken a minimum of 12 significant event
reviews in the past 3 years which could include:New cancer diagnosesDeaths where terminal care has taken place at home
4 —
Education and training (Education 10)The practice has undertaken a minimum of 3 significant event
reviews within the last year.
6 —
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Mr W death • GP and DN ad hoc arrangements - no PPoD
discussed or anticipated• Problems with symptom control - high anxiety• Crisis call OOHs - no plan or drugs available in the
home• Admitted to hospital • Dies in hospital • Carer given minimal support in grief• No reflection by PHCT team on care given• ? Inappropriate use of hospital bed?
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Mr W with GSF• On GSF Register - discussed at PHCT meeting (C1)• DS1500 and info given to pt + carer (home pack) (C1,
C6)• Regular support, visits phone calls - proactive (C1, C2) • Assessment of symptoms, partnership with SPC -
customised care to pt and carer needs (C3)• Carer assessed incl psychosocial needs (C3, C6)• Preferred place of care noted and organised (C1, C2)• Handover form issued – care plan and drugs issued for
home (C4)• End of Life pathway/LCP/minimum protocol used (C7)• Pt dies in preferred place - bereavement support Staff
reflect-SEA, audit gaps improve care, learn (C5, C6)
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Take Home message
• Identify patients in last year of life– Prognostic indicators
• Assess needs– GSF tools
• Plan for deterioration and death
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Any Questions
• http://www.endoflifecareforadults.nhs.uk/
• http://www.goldstandardsframework.nhs.uk