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END OF LIFE PLANNING. INTRODUCTION. Paula-Jane Marrett. GP Registrar – ST4. Fowey River Practice. INTRODUCTION. ST4 with a Dementia Focus. INTRODUCTION. Beverley Chapman Clinical Nurse Specialist. BACKGROUND. Bev Chapman and Fiona Boyd An audit 2009 Looked at admissions. BACKGROUND.
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INTRODUCTION Paula-Jane Marrett GP Registrar – ST4 Fowey River Practice
INTRODUCTION ST4 with a Dementia Focus
INTRODUCTION Beverley Chapman Clinical Nurse Specialist
BACKGROUND Bev Chapman and Fiona Boyd An audit 2009 Looked at admissions
BACKGROUND Unnecessary admissions Avoidable admissions Where did people die?
BACKGROUND • 220 Notes – Patients from nursing homes • 71 patients admitted for end of life care • 58 patients died in hospital • 59% of patients did not require acute care
BACKGROUND Can we change this?
BACKGROUND • 7 % patients die within one month of admission • 20 % by three months • 27 % by six months • 34 % after one year • 53 % by two years
BACKGROUND Admissions in the last 6 months of life average cost £5651 - £9955 Haringey 2009
BACKGROUND Factors related to hospitalization cost each acute hospital £6 million a year NAO
Mental Capacity Act 2005 • Protects those who lack capacity • Express wishes about how they want to be treated • Better Legal protection to vulnerable adults • Clarity on who can make decisions
Mental Capacity Act 2005 PRINCIPLES • Assume they have capacity unless established otherwise
Mental Capacity Act 2005 A person is not treated as unable to make a decision unless all practicable steps to help him/her to do so have been taken without success
Mental Capacity Act 2005 A person is not to be treated as unable to make a decision merely because he/she makes an unwise decision
Mental Capacity Act 2005 An act done, or a decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made, in his/her best interests
Mental Capacity Act 2005 Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can effectively be achieved in a way that is less restrictive of the person’s rights and freedom of action
Mental Capacity Act 2005 • UNDERSTAND • RETAIN • WEIGH UP • COMMUNICATE
Mental Capacity Act 2005 • PARTICULAR DECISION • PARTICULAR TIME
Best Interest Assessment • Allows those who know the person well to express written statement of known wishes
Gold Standards Framework Introduced in 2004 For people with capacity
END OF LIFE PILOT Nursing homes in East Cornwall Number = 7
END OF LIFE PILOT Meeting with General Practitioners Meeting with Nursing Home staff
END OF LIFE PILOT Organize any training as necessary
END OF LIFE PILOT Invite carers and all staff to a meeting Invite discussion about end of life care
END OF LIFE PILOT Invite the relatives to a best interest meeting with the staff
BEST INTEREST MEETING Cardiopulmonary Resuscitation Admission to Hospital Other active interventions
END OF LIFE PILOT Lasting power of Attorney for WELFARE Legally binding advance directives
END OF LIFE PILOT Signed by legal decision maker – GP Supporting evidence for the AND form Information shared with on call service
END OF LIFE PILOT Aim to reduce inappropriate admission Avoid crisis Better patient care
END OF LIFE PILOT Results so far 120 Best interest forms completed 1 Refused – Nominated GP
END OF LIFE PILOT 12 Deaths All of them in the Nursing Homes 11 had Liverpool Care Pathway
END OF LIFE PILOT Roll out to Residential Homes Roll out across Cornwall
END OF LIFE PILOT Our first residential Home
END OF LIFE PILOT Thank you!
