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Induction : 2012

Induction : 2012. End of Life Care. Introduction. Discussion of EOLC may stir up unresolved bereavement issues – personal or professional. Varying levels of expertise/experience Palliative Care Link Nurses/LCP Champions E-ELCA. End of Life Learning for all.

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Induction : 2012

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  1. Induction : 2012 End of Life Care

  2. Introduction • Discussion of EOLC may stir up unresolved bereavement issues – personal or professional. • Varying levels of expertise/experience • Palliative Care Link Nurses/LCP Champions • E-ELCA. End of Life Learning for all.

  3. Transforming End of Life Care in Acute Hospitals – The Route to Success – ‘how to’ • Advance Care Planning (ACP) • Electronic Palliative Care Co-Ordination Systems (EPaCCS) • Rapid Discharge Home to Die Pathway • AMBER Care Bundle • The Liverpool Care Pathway for the Dying Patient (LCP)

  4. There are approx 2000 deaths per year in Ports Hospital – approx 6 deaths per day. • Many receive good care. Unfortunately a minority receive less than optimal care. • We must strive to give the end of life care that we would want for our loved ones & ourselves. • ‘Good death?’

  5. ‘How people die remains in the memory of those who live on’ Cicely Saunders

  6. “ 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.” Prof Mike Richards

  7. What is Palliative Care? • Active total care of patients & families – when disease is non curative • Provides relief from pain & other symptoms • Aim is to achieve best quality of life • Responds to physical, psychological, social & spiritual needs • Extends to support in bereavement

  8. Barriers to Diagnosing Dying? • Groups & feedback

  9. Barriers to Diagnosing Dying • Hope that patient may get better • No definitive diagnosis • Pursuance of unrealistic or futile interventions • Disagreement about patients condition • Failure to recognise key symptoms & signs • Lack of knowledge on how to prescribe

  10. Barriers (cont) • Poor ability to communicate with family & patient • Concerns about withdrawing/with-Sholding treatment/resuscitation status • Fear of foreshortening life • Cultural & spiritual barriers • Medico legal issues • Lack of time/business of the ward

  11. Overcoming Barriers to Diagnosing Dying • Sensitive communication around death & dying • Team working • Appropriate prescribing & rationale • Recognising key signs & symptoms • Appreciate cultural & religious traditions • Be aware of medical/legal issues • Refer to specialist palliative care – when necessary

  12. The Liverpool Care Pathway is: • An evidence based framework which provides guidelines for care in the last days of life & empowers doctors & nurses to deliver optimum care to dying patients & their families – wherever they are being cared for. • It is underpinned by the principles of palliative care

  13. The Research Evidence To date there is evidence that the LCP: • Improves confidence for nurses who are using the LCP • Demonstrates reduced symptom burden • Improves anticipatory prescribing of meds for the 5 key symptoms that may develop in last days/hours of life • Improves MDT working • Improves documentation of care delivery. www.mcpcil.org.uk

  14. Version 12 LCP • Was launched end January 2012 • Used in every setting • Significant differences from version 11 • LCP facilitator appointed & has now started work. • Find out who your Palliative Care Link nurse is.

  15. Specialist/General Palliative Care • A significant proportion of people with advanced disease experience range of complex problems: • Unresolved symptoms – pain; nausea • Complex psychosocial issues • Complex end of life issues – hospice admit • Complex bereavement issues

  16. Palliative Care • End of Life Team – bleep 1384 – hands on nursing care; patient & family support. For patients 65 yrs & over. Based in Elderly Medicine. • Specialist Palliative Care Team: Room 11 Quad centre - Ext 6132. Referrals on intranet – under cancer service centre. Fax to 3332.

  17. Case example

  18. Factors influencing pain thresholds PHYSICAL Other symptoms Adverse effects of treatment Insomnia SOCIAL Worry about family & finance Loss of -income -social position -role in family PSYCHOLOGICAL Anger Disfigurement Fear Helplessness TOTAL PAIN (clinical pain) SPIRITUAL Why me? How can God allow me to suffer like this? What’s the point?

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