Sarah Bogle: TEPs Project Manager Treatment Escalation Plans (TEPs): Recording Decision-making for an emergency Prof Alison Richardson: Clinical Professor of Cancer Nursing and End of Life Cafe Sarah Bogle: TEPs Project Manager Collaboration for Leadership in Applied Health Research and Care (Wessex)

Why is TEP needed? DNACPR process has its limitations: a negative withholding of treatment not an overall plan for treatment Decisions and plans made too late in the day for many Encourage and trigger an important conversation earlier Only 4% have treatment plans when they die currently Importance of shared decision-making between patient (and next of kin) and the clinician Local TEPs have been generated, e.g. Devon TEP since 2006, Cambridge UFTO Many national reports and committees recommending action Court judgments, e.g. Tracey, Winspear Mentions some reports

What is TEP? My wishes are respected if I my health deteriorates Treatment plan in an emergency Avoid confusion and distress in emergency situations Capture priorities and goals of care Ceilings of treatment at end of life Shared decision-making A difficult but important conversation between patient and clinician A summary record for all care settings

National Working Group Emergency Care and Treatment Plan (ECTP) – the title may change National form and process for all of UK and all age groups Treatment options that include decision on CPR Co-chaired by Resuscitation Council (UK) and Royal College of Nursing Formed in February 2015 Consultation January-February 2016 Current activities: review of consultation feedback, communications planning, further engagement, pilots in different settings Plan to launch by November 2016 Implementation approach most likely to be ‘over to you’ to lead locally

Questions for you Who might need one? Who might start the conversation? What should happen when it is completed?