1. 5 Priorities of Care Liz Thomas Lead Nurse, Palliative Care Team

4. Criticisms of the LCP Tick box exercise A long time on the LCP caused distress Excuse to kill? Pts were denied food and drink or drugs caused drowsiness so pt were unable to ask LCP=morphine LCP=DNAR=shortened a pts life LCP=withdrawal of care Inadequate communication with relatives Decisions to start LCP not always made by senior clinicians Associated with payment Not an independent tool/Insufficient prospective testing

6. 5 Priorities of Care Recognising dying Communicating about dying Pt/Family involvement in decision making Needs of family Planning care

7. Priority 1 Recognising dying Recognising that the patient is likely to die in next few hours/days. Communicating this clearly to pts if conscious and families. Explaining why and the uncertainties involved. Consider reversible causes. Continue with food and drink as able.

8. Priority 2 Communication Open, honest and sensitive communication between pt/families and staff. 2 way conversation, listening to pt/family concerns. Check understanding. If there are problems with this find ways of managing this ie language issues or no family nearby etc

9. Priority 3 Involvement Involve patient and families in decision-making wherever possible around food and drink and care needs, how this is delivered as well as treatment decisions. Patients should know who their senior doctor and nurse is (in line with the Francis enquiry). Decisions should be made in a timely fashion, by the right people. Mental capacity should be considered Advanced decisions should be respected. Lasting power of attorney consulted.

10. Priority 4 Needs of Families Needs of families and those important to the patient are explored, respected and met as far as possible. Acknowledge they may be tired and strained emotionally and physically and also fearful. Listen, support and inform. Explain the decision-making processes.

11. Priority 5 Plan and Do Individual care plan to include: Identifying and communicating patients wishes including preferred place of care and death. Good symptom control. Careful consideration and explanation about switching oral to s/c medication. Access specialist palliative care where needed Food and drink. Consider pros and cons of risk feeding/sc fluids Offer psychological/spiritual and social support. Coordinate and deliver care with compassion.

12. Hospital care Plans Excellent Care in the Last Days of Life/ medical document Excellent Nursing Care in Last Days of Life Bundle

13. Community best practice guide How do we take this forward?

14. Foundations Training Palliative care – the current picture Pain Symptom assessment and control Mental Health issues in palliative care Family concerns Ethics in palliative care Last 48 hrs of life Bereavement Communication skills in palliative care Community services for palliative care