electronic Palliative Care Summary (ePCS)

1. electronic Palliative Care Summary (ePCS) Grampian ECC 16th September 2010 Dr Gillian Brewis GP, Inverurie & Palliative Care Lead Aberdeenshire Central CHP Dr Peter Kiehlmann GP, Aberdeen & National Clinical Lead Palliative Care eHealth peter.kiehlmann@scotland.gsi.gov.uk http://www.scotland.gov.uk/LivingandDyingWell http://www.ecs.scot.nhs.uk/epcs.html

3. The maze of trees

4. “How we care for the dying must surely be an indicator of how we care for all our sick and vulnerable patients. Care of the dying is urgent care – with only one opportunity to get it right, to create a potential lasting memory for relatives and carers…” Professor Mike Richards CBE

5. The aim of the work is to leave families with what can only be described as a “good enough” memory of the life, dying and death of their child or in some cases children...

6. Questions? What is ePCS? Who can use it? How does it help Patients & carers Staff In-hours Out of hours? Rollout Future Developments

7. Living and Dying Well • “ to ensure a comprehensive approach to palliative care based on clinical need and not diagnosis, age, post code, creed or ethnicity” • Outputs from many expert groups • GMC Guidance on End of Life Treatment and care • How to help Clinical staff to have confidence to deliver quality Pall & End of Life Care

8. ePCS - What is it? An electronic Palliative Care Summary • An extension to Emergency Care Summary (ECS) & • Gold Standards Framework Scotland (GSFS) • For use both In Hours & OOH • ePCS replaces current faxed communications • Allows GPs & Nurses to record in one place Diagnosis, Rx, Pt Understanding & Wishes, Anticipatory Care Plans, review dates, lists for meetings

9. NHS 24 OOH clinician ePCS display A&E ePCS update Ambulance ECSStore 1. During consultation 2. Due to prescription 3. Team meeting or other contact Practice Admin. Staff Audit trail TBD… ePCS Overview GP /DN consultation

10. ePCS Dataset • Consent - Palliative care data transfer • Carer details and key professionals • Diagnosis – as agreed by patient by pt & GP • Current Rx –Rpt, 30/7 Acute, Allergies; • Patient wishes • Preferred Place of Care [PPoC] ) • DNA CPR decision ) Anticipatory • Patient’s & Carer’s understanding of ) Care diagnosis/prognosis ) Plan • Just in Case – Rx & equipment ) • Advice for OOH care ) • GP Mobile no., death expected? Cert. etc )

12. Use in Secondary Care As routine some admitting units Take consent from patient Print off ECS – Current Drugs and Allergies from GP Attach to Hospital Notes as 1st part of record If ePCS present, seen in same way as ECS Medical History – summarised, relevant Preferred Place of Care DNACPR Status

13. EMIS - Summary

14. screenshots • Showing std EMIS screen • EMIS Screen ePCS record • NHS24 call handler screen • Adastra – used in GMED – centre & car • SAME DATA seen in all places • available in any acute admitting Unit

15. ePCS no diagnosis added yet

16. Diagnosis agreed with pt & added

17. Patient/Carer Wishes

18. New ECS build screenshots Access to PCS Information

19. Base ePCS –view in Adastra

20. Mobile ePCS - Adastra

21. Increasing use ePCS Apr-Aug 2010

22. Board % use ePCS Aug 2010

23. Current ePCS use Aug 2010 Board Practices % using Live Total Remaining ePCS Lothian 74 126 52 59% Grampian 24 83 59 29% Dumfries & Galloway 10 35 25 29% Western Isles 2 12 10 17% Gtr Glasgow & Clyde 42 272 230 15% Forth Valley 8 58 50 14% Ayrshire & Arran 5 59 54 8% Orkney 1 14 13 7% Lanarkshire 5 98 93 5% Borders 0 24 24 0% Fife 0 57 57 0% Highland 0 102 102 0% Shetland 0 10 10 0% Tayside 0 69 69 0% Grand Total 171 1019 848 17%

24. Using ePCS in practice –a continuing process Does this pt have Palliative Care Needs? Add to Pall Care Register, Once Consents to send ePCS ->OOH, agree Medical History, set review date Once consented any new info goes automatically Not expected to complete in one go! Complete pt wishes and Understanding, DNA CPR, record “Just in case” Rx and Equipment as appropriate Regular review at PHCT Keep updating!

25. UK1900 / Age at death 46 Top 3 causes Infectious diseases Accident Childbirth Disability before death Not much UK 2000 Age at death 78 Top 3 causes Cancer Organ failure Frailty/ dementia Disability before death Months - many years Profile of People who die

26. Function Function High High Death Death Low Low Months or years Weeks, months, years Organ failure Cancer Function 5 High 6 7 2 Death Low Acute Many years Dementia, frailty and decline How to deliver End of Life care for all? GP has 20 deaths per list of 2000 patients per year

27. Palliative Care DES (1 of 26!) 1. Put pt on Palliative Care Register • Clinical, Pt choice, Surprise Question • From Prognostic Indicator Guidance 2. Send OOH form/ePCS within 2w 3. Make Anticipatory Care Plan – as ePCS inc. Preferred Place of Care/death 4. When dying use LCP /locally agreed pathway Aim- encourage anticipatory care, for all diagnoses

28. ePCS – Benefits • Natural progression from GSFS & ECS • Fits into day to day work of GPs & DNs • Aims to identify patients “upstream” ie last 6-12 months, not just last days/weeks • Encourages Anticipatory Care Planning • Prompts to remind to ask about “difficult” issues • “Just in Case”, DNA CPR, PPoC • Shares critical info. on vulnerable patients at important times. • OOH & Secondary Care say it transforms care • Patients & carers reassured • Safer, better experience

29. Questions? How best to roll out in your Board? Lothian Pall Care/Oncology Discharge letters Benefits to Sec Care EPS /ePCS Meetings planned with key stakeholders Primary Care / Palliative Care / OOH / eHealth/ LTCs Awareness Raising/Training Websites – LDW and ECS PIL, PIG, 1st Steps Clinical Systems Training material Nov 2nd pm Workshop – all Board leads for ePCS Living and Dying Well delivery 2010 Assessment Tools Anticipatory Care Plans Palliative Care DES ongoing Communication Training National Resuscitation Policy – DNA CPR “Public awareness Death, Dying & Bereavement”

31. NHS 24 OOH clinician ePCS display A&E ePCS update Ambulance ECSStore 1. During consultation 2. Due to prescription 3. Team meeting or other contact Practice Admin. Staff Audit trail TBD… ePCS Overview GP /DN consultation