Kirklees and Calderdale Primary Care Trusts Integrated Care Pathway for the dying patient Barbara Burke End of Life Pathway Facilitator

C7 – Care of the Dying (Terminal Phase) Patients in last few days of life need to be cared for appropriately.

WHY ? To enable patients to die well and peacefully. To enable relatives and carers to provide care, be kept informed, and have positive lasting memories if possible. Staff involved have sense of satisfaction that a ‘good death’ has been achieved.

OTHERWISE ? If Terminal Phase not well addressed, there is dissatisfaction with care from both carers and staff involved. ‘What might have been’

HOW? Using Integrated Care Pathway (based on the Liverpool Integrated Care Pathway) (Devised by Dr John Ellershaw & Team)

What is an Integrated Care Pathway ? A map/tool of a patient’s planned care for a specific clinical problem Used by the multidisciplinary team Provides a method of coordinating and standardising care – reducing practice variations

What is an Integrated Care Pathway ? A Legal document, incorporating guidelines for symptom control which reflect current best practice Provides a mechanism for continually monitoring and evaluating processes, practices and outcomes of care

Advantages of an Integrated Care Pathway Facilitates Clinical Governance Clinical guidelines/protocols Auditable data/demonstrable outcomes Changes practice Enhances communication Reduces paperwork/time writing care plans Effective learning tool

Pathways are NOT : A criticism of current practice Totally prescriptive JUST a nursing document Undermining of professional knowledge, skill or competency Complicated Written in stone!

Why implement ICP in care homes Promotes high- quality, efficient, effective, and equitable care Patient and carer focused/definite plan of action Reduces crisis admissions to hospital in the dying phase Increases % of deaths occurring within the care home

Why implement ICP in care homes Proactive Enhances communication Gives permission to discontinue regimes Informs on symptom control Empowers staff Sensitive – one record – up to date/ demonstrates care given

Criteria for ICP (Signs of Terminal Phase) Multi-professional team agree patient is dying and two of the following apply: Patient bed bound Only able to take sips of fluid No longer able to take tablets Semi-comatose STOP CURRENT DOCUMENTATION USE ICP INSTEAD

Structure of the Integrated Care Pathway Three Sections: Incorporate physical, social, psychological, spiritual/religious aspects 1.Initial Assessment 2.On Going Care and Assessment 3.Care After Death Outcome measures (Goals) for each section Goal Achieved Goal Not Achieved = ‘V’ (Variation )

Integrated Care Pathway VARIATION Is deviation in patient’s plan of care It does not necessarily denote failure in care VARIATIONS enable individualised care to be given to the dying patient, whilst maintaining continuity of care Variations recorded separately (what, why, action taken)

Variables as an Audit Tool TREATMENT IS AUDITED BY MEANS OF A VARIATION ANALYSIS A variation is NOT a failure, but a deviation from the expected path Variations can provide auditable data Lead to modifications in treatment Improve practice

Kirklees and Calderdale Integrated Care Pathway SYMPTOM CONTROL GUIDELINES ATTACHED TO EVERY PATHWAY Calderdale: Palliative Care Team Overgate Hospice Huddersfield: Palliative Care Team Kirkwood Hospice