Kirklees and Calderdale Primary Care Trusts

1. Kirklees and CalderdalePrimary Care Trusts Integrated Care Pathway for the dying patient Barbara Burke End of Life Pathway Facilitator

2. C7 – Care of the Dying(Terminal Phase) • Patients in last few days of life need to be cared for appropriately.

3. WHY? • To enable patients to die well and peacefully. • To enable relatives and carers to provide care, be kept informed, and have positive lasting memories if possible. • Staff involved have sense of satisfaction that a ‘good death’ has been achieved.

4. OTHERWISE? • If Terminal Phase not well addressed, there is dissatisfaction with care from both carers and staff involved. • ‘What might have been’

5. HOW? • Using Integrated Care Pathway (based on the Liverpool Integrated Care Pathway) (Devised by Dr John Ellershaw & Team)

6. What is anIntegrated Care Pathway? • A map/tool of a patient’s planned care for a specific clinical problem • Used by the multidisciplinary team • Provides a method of coordinating and standardising care – reducing practice variations

7. What is anIntegrated Care Pathway? • A Legal document, incorporating guidelines for symptom control which reflect current best practice • Provides a mechanism for continually monitoring and evaluating processes, practices and outcomes of care

8. Advantages of anIntegrated Care Pathway • Facilitates Clinical Governance • Clinical guidelines/protocols • Auditable data/demonstrable outcomes • Changes practice • Enhances communication • Reduces paperwork/time writing care plans • Effective learning tool

9. Pathways are NOT: • A criticism of current practice • Totally prescriptive • JUST a nursing document • Undermining of professional knowledge, skill or competency • Complicated • Written in stone!

10. Why implement ICP in care homes • Promotes high- quality, efficient, effective, and equitable care • Patient and carer focused/definite plan of action • Reduces crisis admissions to hospital in the dying phase • Increases % of deaths occurring within the care home

11. Why implement ICP in care homes • Proactive • Enhances communication • Gives permission to discontinue regimes • Informs on symptom control • Empowers staff • Sensitive – one record – up to date/ demonstrates care given

12. Criteria for ICP(Signs of Terminal Phase) Multi-professional team agree patient is dying and two of the following apply: • Patient bed bound • Only able to take sips of fluid • No longer able to take tablets • Semi-comatose STOP CURRENT DOCUMENTATION USE ICP INSTEAD

13. Structure of the Integrated Care Pathway Outcome measures (Goals) for each section Goal Achieved Goal Not Achieved = ‘V’ (Variation) Three Sections: Incorporate physical, social, psychological, spiritual/religious aspects • Initial Assessment • On Going Care and Assessment • Care After Death

14. Integrated Care Pathway • VARIATION • Is deviation in patient’s plan of care • It does not necessarily denote failure in care • VARIATIONS enable individualised care to be given to the dying patient, whilst maintaining continuity of care • Variations recorded separately (what, why, action taken)

15. Variables as an Audit Tool • TREATMENT IS AUDITED BY MEANS OF A VARIATION ANALYSIS • A variation is NOT a failure, but a deviation from the expected path • Variations can provide auditable data • Lead to modifications in treatment • Improve practice

16. Kirklees and Calderdale Integrated Care Pathway SYMPTOM CONTROL GUIDELINES ATTACHED TO EVERY PATHWAY • Calderdale: Palliative Care Team - 01422 222710 Overgate Hospice - 01422 379151 • Huddersfield: Palliative Care Team - 01484 342965 Kirkwood Hospice - 01484 557900