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 Consider how the document could be utilized in your area © 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. Priorities of care- 1 Possibility of death occurring in the next few days or hours is recognized and communicated clearly, decisions made and actions taken in accordance with the person’s needs & wishes, and these are regularly reviewed and decisions revised accordingly Leadership Alliance for the care of dying people June 2014 One Chance to get it right

9. Priorities of care – 2 Sensitive communication takes place between staff and the dying person, and those identified as important to them Leadership Alliance for the care of dying people June 2014 One Chance to get it right

10. Priorities of care – 3 The dying person, and those identified as important to them are involved in decisions about treatment, and care to the extent that the dying person wants. Leadership Alliance for the care of dying people June 2014 One Chance to get it right

11. Priorities of care – 4 The needs of families and others identified as important to the dying person are actively explored, respected and met as far as possible Leadership Alliance for the care of dying people June 2014 One Chance to get it right

12. Priorities of care – 5 An individual plan of care which includes food and drink, symptom control and psychological, social and spiritual support, is agreed, coordinated and delivered with compassion Leadership Alliance for the care of dying people June 2014 One Chance to get it right

13. 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. © All Wales Palliative Care Education Group 2015 13

14. © All Wales Palliative Care Education Group 2015 14 Page 1

15. © All Wales Palliative Care Education Group 2015 15 Page 2

16. © All Wales Palliative Care Education Group 2015 16 Page 3 NB, don’t forget the DNACPR form

17. © All Wales Palliative Care Education Group 2015 17 Page 4

18. © All Wales Palliative Care Education Group 2015 18 Symptom Assessment Sheet

19. © All Wales Palliative Care Education Group 2015 19 Symptom guidance is also provided

20. © All Wales Palliative Care Education Group 2015 20 Individual case review sheet

21. Care Decisions Community PRN chart

22. © All Wales Palliative Care Education Group 2015 22 Subcutaneous syringe driver chart

23. Case discussion

24. 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 24

25. 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 25

26. 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 26

27. How will your practice change or develop as a result of today? © All Wales Palliative Care Education Group 2015 27

28. 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 28