Hospice Palliative Care – Tips for Primary care A Babber GPST - Windsor VTS 3rd July 2018
1. Hospice Palliative care support Inpatient unit End of Life Care (EoLC) Symptomatic Control (SC) Respite Care (RC) - support for family and carers Day therapy unit (DTU) Weekly activities – 6 week program Respite for carer, symptom review by specialists and sign-posting Complementary therapies Physiotherapy
2. Community Palliative care support District nurse Clinical Nurse Specialist (CNS) Macmillan Cancer Support Services Marie Curie Cancer Care Rapid Response Team (RRT) Help the Hospices Hospice UK
3. Proactive Indicator Guidance – GSF PC 1% population die/yr (30% hospital pts, 80% care home pts) Unexpected deaths: 10% Tool for early identification of patients nearing end of life (EoL) Surprise question – prognosis likely death within 12 months If unsure - General/Specific indicators of decline Cancer and non-cancer diseases GSF Process Identfy – Assess – Plan Advance Care Planning (ACP) GSF PIG 2016 online link
4. Common Symptoms Pain Nausea and vomiting Shortness of breath Agitation/anxiety or Confusion Constipation dysphagia Disease progression, treatment or medication side effects related Refer difficult to control symptoms for specialist palliative input
5. Palliative Emergencies Likely to need hospital specialist and/or palliative care input Spinal cord compression Neutropenic sepsis / Pancytopenic crisis Bone fractures Hypercalceamia Superior Vena Cava Obstruction (SVCO) Major Haemorrhage
6. Complementary therapies Holistic approach to patient-centred care Massage – pain, lymphoedema, anxiety, Acupuncture – emotional/physical stress, pain, N&V, breathlessness Reiki – energy healing Reflexology – pain, N&V, anxiety, constipation
7. DS1500 and continuing care DS 1500 Continuing care Doctors report for Disability Allowance, Attendance Allowance or Incapacity Benefit under special rules Prognosis <6 months Fast track - override qualifying periods tax free benefits due to terminal illness at higher rates Continuing care Application requires doctors report on disease and expected progression Package of care arranged/funded by NHS for adults NOT Local Authority For priority patients (terminal phase of illness) Initial screening process and full assessment Fast track process preventing delay
8. Useful guidance - links Gold Standards Framework in Palliative Care Proactive Identification Guidance 2016 – RCGP supported document Advanced Care Planning Discussion from – GSF GMC Guidance on End of Life Care NICE quality standards for End of Life Care Palliative Care Assessment Tools – CAGE, MMSE, Performance Status, Constipation score GMC Mental Capacity Aseessment Online Tool