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Gold Standards Framework

Gold Standards Framework. Dr Mohammed Javid. Aims. Deaths Why, where, how End Of Life Care EoLC, ACP, PPC, PPD, GSF, LCP Gold Standards Framework 3 steps 5 goals 7 Key tasks. Deaths. 500, 000 per year in the UK 1% of the population dies each year Cause of death - 25% cancer

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Gold Standards Framework

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  1. Gold Standards Framework Dr Mohammed Javid

  2. Aims • Deaths • Why, where, how • End Of Life Care • EoLC, ACP, PPC, PPD, GSF, LCP • Gold Standards Framework • 3 steps • 5 goals • 7 Key tasks

  3. Deaths • 500, 000 per year in the UK • 1% of the population dies each year • Cause of death - 25% cancer - 20% heart disease - 15% respiratory disease - 10% strokes and related disorders - 30% other

  4. Place of Death • Where do people want to die ? • 55% Home • 25 % Hospice • 10 % Hospital • 5 % Care Home • Where do people die ? • 55 % Hospital • 20% Care Home • 20% Home • 5% Hospice

  5. End Of Life Care One year Last days ACP Advanced care Plan PPC Preferred priorities of care PPD Preferred place of death GSF Gold standards Framework LCP Liverpool Care Pathway EoLC End of Life Care LCP ACP / PPC supportive and palliative care deterioration death/bereavement

  6. Gold Standards Framework

  7. GSF Step 1: Identify Organ failure Cancer Sudden death Dementia and decline

  8. Assess • Symptom assessment • Personal needs • Preferred priorities of care • Place of care • Place of death • Advanced Care planning • Statement of wishes and preferences • Advance decisions • Power of attorney • Patient focussed • Needs based • Voluntary

  9. Plan • Communication • Out of hours handover • Drugs in home • What drugs • DN prescribing • Pharmacy • Syringes, diluents • OOH bypass number • Crisis prevention

  10. 5 Goals Patients are enabled to have a ‘good death’ 1) Symptoms controlled 2) Preferred place of care 3) Safe + secure with fewer crises 4) Carers feel supported, involved, empowered, and satisfied. 5) Staff confidence, teamwork, satisfaction, co-working with specialists and communication better.

  11. 7 C C1 Communication Register, PHCT Meetings, care plan Advanced care planning (ACP) eg PPC C2 Co-ordination Identified co-ordinator for GSF, keyworker for patient C3 Control of Symptoms Assessment tools, C4 Continuity Out of Hours Handover form + OOH protocol C5 Continued Learning Learning about conditions on patients seen, SEA / reflective practice C6 Carer Support Practical, emotional, bereavement, National Carer’s Strategy C7 Care in dying phase-Protocol LCP / ICP

  12. What should we do ? Level 1 – register, PHCT meeting, co-ordinator C1,2 Level 2 – Assessment tools, OOHs handover, education, audit and reflective practice C3,4,5 Level 3 – Carer/family support, bereavement plan and protocol for final days C6,7 Level 4 – Sustain and build on developments, practice protocol, extend

  13. Mr W death • GP and DN ad hoc arrangements - no PPoD discussed or anticipated • Problems with symptom control - high anxiety • Crisis call OOHs - no plan or drugs available in the home • Admitted to hospital • Dies in hospital • Carer given minimal support in grief • No reflection by PHCT team on care given • ? Inappropriate use of hospital bed?

  14. Mr W with GSF • On GSF Register - discussed 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 noted and organised (C1, C2) • Handover form issued – care plan and drugs issued for home (C4) • End of Life pathway/LCP/minimum protocol used (C7) • Pt dies in preferred place - bereavement support Staff reflect-SEA, audit gaps improve care, learn (C5, C6)

  15. Take Home message • Identify patients in last year of life • Prognostic indicators • Assess needs • GSF tools • Plan for deterioration and death

  16. Any Questions • http://www.endoflifecareforadults.nhs.uk/ • http://www.goldstandardsframework.nhs.uk

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