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electronic Palliative Care Summary (ePCS). SCIMP November 2009 Dr Peter Kiehlmann GP, Aberdeen & National Clinical Lead Palliative Care eHealth [email protected] http://www.scotland.gov.uk/Topics/Health/NHS-Scotland/LivingandDyingWell http://www.ecs.scot.nhs.uk/epcs.html.

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electronic palliative care summary epcs

electronic Palliative Care Summary (ePCS)

SCIMP November 2009

Dr Peter Kiehlmann

GP, Aberdeen & National Clinical Lead

Palliative Care eHealth

[email protected]

http://www.scotland.gov.uk/Topics/Health/NHS-Scotland/LivingandDyingWell

http://www.ecs.scot.nhs.uk/epcs.html

outline
Outline

Journeys

Context

What is ePCS?

Why is it needed?

Timescale

Benefits

3 steps in gold standards framework
3 Steps in Gold Standards Framework

3. Plan

2. Assess

+ communicate

1. Identify

gsfs key tasks 7 cs
GSFS - Key Tasks - 7 Cs
  • Cancer Register & Team Meetings, Pt info, Treatment cards, PHR
  • Key Person, Checklist
  • Assessment, body chart, SPC etc
  • Faxed Form
  • Learning about conditions on patients seen
  • Practical, emotional, bereavement, National Carer’s Strategy
  • C7 Care in dying phase

C1 Communication

C2 Co-ordinator

C3 Control of Symptoms

C4 Continuity Out of Hours

C5 Continued Learning

C6 Carer Support

reactive patient journey in last months of life
Reactivepatient journey:in last months of life
  • GP and DN ad hoc arrangements & no ACP in place

- was PPoC discussed or anticipated?

- what is pt/carer understanding of diagnosis /prognosis?

  • Problems of anxiety & symptom control
  • OOH Crisis call - no ACPor drugs available in the home
  • Admitted to and dies in hospital
  • Was Carer supported before/after loved one’s death?
  • Did OOH, PHCT or Hospital reflect on care given?
  • Was use of hospital bed appropriate?
gsfs proactive pt journey in last months of life
GSFS Proactivept journey: in last months of life
  • On Pall Care Register - reviewed at PHCT meeting (C1)
  • DS1500 and info given to pt + carer (home pack) (C1, C6)
  • Regular support, visits phone calls - proactive (C1, C2)
  • Assessment of symptoms, partnership with SPC - customised care to pt and carer needs (C3)
  • Carer assessed incl psychosocial needs (C3, C6)
  • Preferred Place of Care (PPoC) noted & organised (C1, C2)
  • OOH form sent – care plan & drugs in home (C4)
  • End of Life pathway/LCP/minimum protocol used (C7)
  • Pt dies in their preferred place - bereavement support
  • Staff reflect-SEA, audit gaps improve care, learn (C5, C6)
outline9
Outline

Journeys

Context

What is ePCS?

Why is it needed?

Timescale

Benefits

illness trajectories gp will have 20 pts die every year
Illness trajectories GP will have 20 pts die every year

A

Cancer

Organ

failure

Dementia

and

decline

Sudden death

B

C

palliative care for whom
diagnosis of a progressive or life-limiting illness

critical events or significant deterioration during the disease trajectory indicating the need for a change in care and management

significant changes in patient or carer ability to ‘cope’ indicating the need for additional support

the ‘surprise question’ (clinicians would not be surprised if the patient were to die within the next 12 months)

onset of the end of life phase –‘diagnosing dying’

Palliative Care for whom?
so by 2030 if current trends continue
So by 2030…if current trends continue
  • home deaths will reduce by 42.3%
  • Less than one in 10 (9.6%) will die at home
  • increase in institutional deaths of 20.3%.
slide15
Choice-preferred/actual place of death Higginson I (2003) Priorities for End of Life Care in England Wales and Scotland National Council

Place: Home Hospital Hospice Care Home

Preference 56% 11% 24% 4%

Cancer 25% 47% 17% 12%

All causes 20% 56% 4% 20%

slide16
Symptoms

Carer Breakdown

They don’t know they can

They don’t know they are dying

Home situation

Patient and family wishes

Lack of services

Admitted by out of hours doctor

What stops people dying at home?Susan Munroe, Marie Curie Cancer Care and Scott Murray, University of Edinburgh, & Scottish Partnership for Palliative Care 2005

living and dying well18
Living and Dying Well
  • Assessment and Review of palliative and end of life care needs
  • Planning and delivery of care for patients with palliative and end of life care needs
  • Communication and Coordination
  • Education, training and workforce development
  • Implementation and future developments
activities from living and dying well
Board Delivery Plans

Triggers and Assessment tools

Palliative Care Registers

Service Information Directories

Community Nursing

Care Homes

Education champions

Anticipatory Rx & Equipment

DNA CPR Policy

E-Health inc. ePCS

1st 6month review encouraging

Activities from Living and Dying Well
outline21
Outline

Journeys

Context

What is ePCS?

Why is it needed?

Timescale

Benefits

slide22
ECS
  • New GP Contract
  • GP not responsible 24/7
  • Risks to safe, effective care
  • Patient info from GP computers

-> ECS store twice daily

  • Medication & Allergies
  • 97% of GP Practices
  • >5 million patients

Explicit Consent to view

  • ‘Read only’ available to…
  • NHS24, A&E, AMAU, SAS
epcs what is it
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

slide24

NHS 24

OOH clinician

ePCS display

A&E

ePCS update

Ambulance

ECSStore

1. During consultation

2. Due to prescription

3. Team meeting or other contact

Practice Admin. Staff

Audit

trail

TBD…

ePCS Overview

GP /DN

consultation

epcs dataset
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 )
new ecs build screenshots
New ECS build screenshots

Access to PCS Information

using epcs in practice a continuing process
Using ePCS in practice –a continuing process

Does this pt have Palliative Care Needs?

Add to Pall Care Register,

Once Consents to send ePCS ->OOH,

agree Medical History, set review date

Once consented any new info goes automatically

Not expected to complete in one go!

Complete pt wishes and Understanding, DNA CPR, record “Just in case” Rx and Equipment as appropriate

Regular review at PHCT

Keep updating!

outline35
Outline

Journeys

Context

What is ePCS?

Why is it needed?

Timescale

Benefits

palliative care des 1 of 26
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

when will it be available
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 late 09
  • Evaluation, national rollout late 09
  • Link with Board Leads for timings
    • GP,Palliative Care, eHealth,OOH
epcs benefits
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
slide40

NHS 24

OOH clinician

ePCS display

A&E

ePCS update

Ambulance

ECSStore

1. During consultation

2. Due to prescription

3. Team meeting or other contact

Practice Admin. Staff

Audit

trail

TBD…

ePCS Overview

GP /DN

consultation

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