1. electronic Palliative Care Summary (ePCS) Dr Peter Kiehlmann GP, Aberdeen & National Clinical Lead Palliative Care eHealth peter.kiehlmann@scotland.gsi.gov.uk http://www.scotland.gov.uk/Topics/Health/NHS-Scotland/LivingandDyingWell http://www.ecs.scot.nhs.uk/epcs.html

2. Questions? How best to roll out in your Board? Lothian Pall Care/Oncology Discharge letters Benefits to Sec Care EPS /ePCS Meetings planned with key stakeholders Primary Care Palliative Care OOH eHealth LTCs Living and Dying Well delivery 2010 Assessment Tools Anticipatory Care Plans Palliative Care DES ongoing Communication Training National Resuscitation Policy – DNA CPR “Public awareness Death, Dying & Bereavement”

3. ePCS - What is it? An electronic Palliative Care Summary An extension to Emergency Care Summary (ECS) & Gold Standards Framework Scotland (GSFS) For use both In Hours & OOH ePCS replaces current faxed communications Allows GPs & Nurses to record in one place Diagnosis, Rx, Pt Understanding & Wishes, Anticipatory Care Plans, review dates, lists for meetings

4. ePCS Overview OOH clinician ePCS display ePCS update 1. During consultation 2. Due to prescription 3. Team meeting or other contact Audit trail ECS Store NHS 24 A&E Ambulance TBD… Practice Admin. Staff GP /DN consultation

5. ePCS Dataset Consent - Palliative care data transfer Carer details and key professionals Diagnosis – as agreed by patient by pt & GP Current Rx –Rpt, 30/7 Acute, Allergies; Patient wishes Preferred Place of Care [PPoC] ) DNA CPR decision ) Anticipatory Patient’s & Carer’s understanding of ) Care diagnosis/prognosis ) Plan Just in Case – Rx & equipment ) Advice for OOH care ) GP Mobile no., death expected? Cert. etc )

6. EMIS - Summary

7. ePCS no diagnosis added yet

8. Diagnosis agreed with pt & added

9. Patient/Carer Wishes

10. GP View – ePCS on Gpass Dr Brown Dalmellington Live document Easily updatable Can be filled in by any member of team Out of hours only need notified when initially commenced.

12. New ECS build screenshots Access to PCS Information

13. Base ePCS –view in Adastra

14. Mobile ePCS - Adastra

15. Using ePCS in practice – a continuing process Does this pt have Palliative Care Needs? Does this pt have Palliative Care Needs? Add to Pall Care Register, Add to Pall Care Register, Once Consents to send ePCS ->OOH, Once Consents to send ePCS ->OOH, agree Medical History, set review date agree Medical History, set review date Once consented any new info goes automatically Once consented any new info goes automatically Not expected to complete in one go! Not expected to complete in one go! Complete pt wishes and Understanding, DNA CPR, record “Just in case” Rx and Equipment as appropriate Complete pt wishes and Understanding, DNA CPR, record “Just in case” Rx and Equipment as appropriate Regular review at PHCT Regular review at PHCT Keep updating! Keep updating!

16. Palliative Care DES (1 of 26!) 1. Put pt on Palliative Care Register Clinical, Pt choice, Surprise Question From Prognostic Indicator Guidance 2. Make Anticipatory Care Plan – as ePCS 3. Send OOH form/ePCS within 2w 4. When dying use LCP /locally agreed pathway Aim- encourage anticipatory care, for all diagnoses

17. When will it be available? Pilots completed Aug 09 EMIS, Vision – Grampian, Gpass – A&A, Lothian Issues addressed included acceptability & ease of use, improving the consultation & communication, anticipatory care planning, NHS Lothian Rollout Sep 09 Vision more user-friendly March 2010 Evaluation, national rollout early 2010 Link with Board Leads for timings Palliative Care, eHealth,OOH

18. ePCS – Benefits Natural progression from GSFS & ECS Fits into day to day work of GPs & DNs Aims to identify patients “upstream” ie last 6-12 months, not just last days/weeks Encourages Anticipatory Care Planning Prompts to remind to ask about “difficult” issues “Just in Case”, DNA CPR, PPoC Shares critical info. on vulnerable patients at important times. OOH & Secondary Care say it transforms care Patients & carers reassured Safer, better experience

19. Questions? How best to roll out in your Board? Lothian Pall Care/Oncology Discharge letters Benefits to Sec Care EPS /ePCS Meetings planned with key stakeholders Primary Care Palliative Care OOH eHealth LTCs Living and Dying Well delivery 2010 Assessment Tools Anticipatory Care Plans Palliative Care DES ongoing Communication Training National Resuscitation Policy – DNA CPR “Public awareness Death, Dying & Bereavement”

20. ePCS Overview OOH clinician ePCS display ePCS update 1. During consultation 2. Due to prescription 3. Team meeting or other contact Audit trail ECS Store NHS 24 A&E Ambulance TBD… Practice Admin. Staff GP /DN consultation