kirklees and calderdale primary care trusts
DESCRIPTION
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 ?. - PowerPoint PPT PresentationTRANSCRIPT
Kirklees and CalderdaleKirklees and CalderdalePrimary Care TrustsPrimary Care Trusts
Integrated Care Pathway Integrated Care Pathway for the dying patientfor the dying patient
Barbara BurkeEnd 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 anIntegrated Care
Pathway?
A map/tool of a patient’s planned care for a specific clinical problemUsed by the multidisciplinary teamProvides a method of coordinating and standardising care – reducing practice variations
What is anIntegrated Care Pathway?
A Legal document, incorporating guidelines for symptom control which reflect current best practiceProvides a mechanism for continually monitoring and evaluating processes, practices and outcomes of care
Advantages of anIntegrated Care Pathway
Facilitates Clinical GovernanceClinical guidelines/protocolsAuditable data/demonstrable outcomesChanges practiceEnhances communicationReduces paperwork/time writing care plansEffective learning tool
Pathways are NOT:
A criticism of current practiceTotally prescriptiveJUST a nursing documentUndermining of professional knowledge, skill or competencyComplicatedWritten in stone!
Why implement ICP in care homes
Promotes high- quality, efficient, effective, and equitable carePatient and carer focused/definite plan of actionReduces crisis admissions to hospital in the dying phaseIncreases % of deaths occurring within the care home
Why implement ICP in care homes
ProactiveEnhances communicationGives permission to discontinue regimesInforms on symptom controlEmpowers staffSensitive – 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 boundOnly able to take sips of fluidNo longer able to take tabletsSemi-comatoseSTOP CURRENT DOCUMENTATION
USE ICP INSTEAD
Structure of the Integrated Care Pathway
Three Sections:Incorporate physical,social, psychological,spiritual/religiousaspects 1. Initial Assessment2. On Going Care and
Assessment3. Care After Death
Outcome measures (Goals) for each section
Goal Achieved
Goal Not Achieved = ‘V’ (Variation)
Integrated Care Pathway
VARIATIONIs deviation in patient’s plan of careIt does not necessarily denote failure in careVARIATIONS enable individualised care to be given to the dying patient, whilst maintaining continuity of careVariations recorded separately (what, why, action taken)
Variables as an Audit Tool
TREATMENT IS AUDITED BY MEANS OF A VARIATION ANALYSISA variation is NOT a failure, but a deviation from the expected pathVariations can provide auditable dataLead to modifications in treatmentImprove practice
Kirklees and Calderdale Integrated Care Pathway
SYMPTOM CONTROLGUIDELINES ATTACHED TO
EVERY PATHWAY
Calderdale: Palliative Care Team - 01422 222710 Overgate Hospice - 01422 379151
Huddersfield: Palliative Care Team - 01484 342965 Kirkwood Hospice - 01484 557900