1. Education resource to support introduction of All Wales Care Decisions for the Last Days of Life All Wales palliative care education group © All Wales Palliative Care Education Group 2015 1

2. Aims of the session To describe the new supporting tool ‘ Care Decisions for the last days of life’ to help deliver care in the last days of life Improve your confidence in understanding the new document © All Wales Palliative Care Education Group 2015 2

3. VIDEO © All Wales Palliative Care Education Group 2015 3

4. Learning outcomes By the end of the session you should be able to: Describe the new tool ‘ Care decisions for the last days of life ‘ to a colleague Effectively explain the rationale for its use to patients and those important to them Describe, to a more junior colleague, the 5 priorities of care that support effective care in the last days of life © All Wales Palliative Care Education Group 2015 4

5. The story so far…. 1990’s in UK, a need to extend the gold standard of palliative care and ‘ hospice’ care into general hospitals and for non cancer patients resulted in the development of the Liverpool Care Pathway (LCP) in NHS England Wales – pathway developed into ‘Care priorities ‘ with annual quality and monitoring review 2012 first concerns in NHS England about use of LCP 2013 major review of LCP and its withdrawal in England 2013 Neuberger report – ‘ More care less pathway’ 2014 ‘ One chance to get it right’ NHS Leadership Alliance for care of the dying person recommendations for England 2014 in Wales – major review of the Integrated Priorities of care for the last days of life – review of documentation, and survey of use in generalist setting 2015 in Wales - launch of Care Decisions for the last days of life © All Wales Palliative Care Education Group 2015 5

6. Group discussion What information do families need to know when a patient is thought to be in the last days of their life ? Who is best placed to give this information ? How does this process currently work in practice? © All Wales Palliative Care Education Group 2015 6

7. Priorities as outlined in ‘One Chance to get it right’ NHS England © All Wales Palliative Care Education Group 2015 7

8. Key priorities of care in the last days of life Good Communication – good communication with patient and those important to them is essential. Good Symptom control – first priority for 85% of patients is to be pain free. Holistic care – need to consider all aspects of caring i.e. physical, psychological, social, and spiritual needs – for patient and those important to them. Individualised care – everyone has different priorities and concerns. Implicit in these, is the goal of involvement of patient and those important to them.involvement of patient and those important to them © All Wales Palliative Care Education Group 2015 8

9. 9 Page 1

10. © All Wales Palliative Care Education Group 2015 10 Page 2

11. © All Wales Palliative Care Education Group 2015 11 Page 3 NB, don’t forget the DNACPR form

12. © All Wales Palliative Care Education Group 2015 12 Page 4

13. © All Wales Palliative Care Education Group 2015 13 Symptom Assessment Sheet

14. © All Wales Palliative Care Education Group 2015 14 Individual case review sheet

15. © All Wales Palliative Care Education Group 2015 15 Symptom guidance is also provided

16. Care Decisions Community PRN chart

17. © All Wales Palliative Care Education Group 2015 17 Subcutaneous syringe driver chart

18. Aims of the session To describe the new supporting tool ‘ Care Decisions for the last days of life’ to help deliver care in the last days of life Improve your confidence in understanding the new document Consider how the document could be utilized in your area © All Wales Palliative Care Education Group 2015 18

19. Learning outcomes By the end of the session you should be able to: Describe the new tool ‘ Care Decisions for the last days of life ‘ to a colleague Effectively explain the rationale for its use to patients and those important to them Describe, to a more junior colleague, the 5 priorities of care that support effective care in the last days of life © All Wales Palliative Care Education Group 2015 19

20. Summary Care Decisions tool is to help support decision making about effective and compassionate care in the last days of life It is not a substitute for clinical assessment, decision making and review by the team looking after the patient © All Wales Palliative Care Education Group 2015 20

21. How will your practice change or develop as a result of today? © All Wales Palliative Care Education Group 2015 21

22. Thank you WWW Search for: Dying matters More care less pathway ( 2013) One chance to get it right ( 2014) www.pallcare.info Your local palliative care team © All Wales Palliative Care Education Group 2015 22