Choices and decisions towards the end of life Annual Conference 2014 RCPE-WIFI Password: chiron1681 #sppc2014

Guidelines will be available in October at:

Guidelines can currently be viewed at:

 Evidence-based clinical guidelines supports the provision of high quality palliative care by both specialists and general staff.

 All Health Boards to ensure that guidance on all core topics is made available  NHS QIS to work with Boards and SPPC to agree a national guideline for each core topic and a robust mechanism for reviewing and updating.

 National Palliative Care Guideline project started  Supported by Scottish Partnership Palliative Care (SPPC) and Healthcare Improvement Scotland (HIS)  Co-chairs: Dr Paul Baughan, GP, Dollar and clinical lead NHS FV Dr David Gray, Consultant in Palliative Medicine Accord Hospice, Paisley  Aim to include a mix of professionals including pharmacy, primary care and public representation

Choosing the Project Steering Group:

The Guideline Project Steering Group:

Not aiming for 29 sets of these:

 HIS agreed to provide methodological advice  NES agreed to provide librarian support

June – August 2012 – 628 responses: - highlighted many things liked in existing guidelines - some areas that would like to see developed - suggestions about formatting / accessibility

 Pain Assessment  Pain Management  Neuropathic Pain Management  Choosing and Changing Opioids

 Anorexia/Cachexia  Bowel Obstruction  Constipation  Diarrhoea  Hiccups  Nausea and Vomiting  Oral Care

 Care in last few days of life  Complex discharge for end of life care  SC hydration  Emergencies – fits/ MSCC/Bleeding  OOH Handover Information  Uncontrolled severe distress  Last days of life - Renal Disease

 Delirium  Depression  Hyercalcaemia  Pruritis  Sweating  Syringe pumps

 Breathlessness  Weakness/Fatigue  Cough

Produced with support of Scottish Palliative Care Pharmacists Association  Alfentanil  Fentanyl Patches  Fentanyl Nasal Spray (Pecfent)  Fentanyl Sublingual (Abstral)  Fentanyl Buccal (Effentora)  Ketamine  Levomepromazine  Lidocaine  Methadone  Methylnaltrexone  Midazolam  Naloxone  Octreotide  Oxycodone  Phenobarbital (Phenobarbitone)

 Internal review of initial guidelines  Each subgroup reviewed other subgroups’ work  Steering group meetings held at GMC

Outcome of Internal Review of Guidelines

 Supported by Scottish Health Council / SIGN User Involvement Officer  Meeting in Edinburgh with carers and members of public  Helped to ensure focus and balance was right

 Co-ordinated independently by Dr Paul Keeley  Experts identified from around UK  Comments to subgroups  Each comment logged and considered  Final drafts to Medical Writers for readability

 Paper presented to national Directors of Pharmacy  Letter sent to each health board ADTC recommending adoption of guidelines  Some Health Boards have already approved, others still to discuss

 HIS will take ownership of the guidelines  SHOW will host  App

 HIS is developing a light touch process to ensure the currency of the guidelines in the future  Patient Information update – a separate project with dedicated funding and resources?  Electronic teaching modules for medical staff Fiona Downs

out-the-guidelines/contributors.aspx

 Familiarise yourself with the guidelines  Discuss them with colleagues  Refer to them for clinical advice or when teaching  Ask your health board / MCN how they are promoting them

Choices and decisions towards the end of life Annual Conference 2014 RCPE-WIFI Password: chiron1681 #sppc2014