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Improving End of Life Care in Care Homes Primary Care Acute & Community Hospitals Domiciliary care Chris Banks GSF Nurse Consultant. When is end of life?. When is End of Life?. End of Life is defined as:
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Improving End of Life Care in Care Homes Primary Care Acute & Community Hospitals Domiciliary care Chris Banks GSF Nurse Consultant
When is End of Life? End of Life is defined as: ‘all patients with a chronic, progressive and generally fatal illness, or an advanced irreversible disease’ National Council for Palliative Care (2006)
Step 1 Step 2 Step 4 Step 5 Step 6 Step 3 Discussions as the end of life approaches Assessment, care planning and review Delivery of high quality services in different settings Care in the last days of life Care after death Coordination of care • Recognition that end of life care does not stop at the point of death. • Timely verification and certification of death or referral to coroner • Care and support of carer and family, including emotional and practical bereavement support • Agreed care plan and regular review of needs and preferences • Assessing needs of carers • Identification of the dying phase • Review of needs and preferences for place of death • Support for both patient and carer • Recognition of wishes regarding resuscitation and organ donation • Open, honest Communicat- ion • Identifying triggers for discussion • High quality care provision in all settings • Acute hospitals, community, care homes, hospices, community hospitals, prisons, secure hospitals and hostels • Ambulance services • Strategic coordination • Coordination of individual patient care • Rapid response services End of Life Care Strategy (2008) Spiritual care services Support for carers and families Information for patients, carers and families
End of Life Care in Numbers • 1% of the population dies each year in UK • Approx 80% care homes residents in final year of life • Approx 30% hospital patients are in final year of life • 56% die in hospital & 35% at home • 40-50% of those who died in hospital could have died at home National Audit office (2008) • Over 60% people do not die where they choose • £3,200- cost of every hospital admission- average 3 / final year
What is Gold Standards Framework? • Framework to deliver the ‘gold standard’ of care we would wish for ourselves • Framework to enable non specialist staff to deliver best standards of quality care • Framework to enable people to live and die well • Framework to enable people to die in the place of their choice • Framework to improve collaboration between services
Cross boundary care using GSF • Primary care – GP’s • Care Homes • Domiciliary care • Acute & community hospitals • Hospice • Prisons
Underlying themes to optimise care • Pre-planning of care Identify - surprise question, ACP, planning meetings, GP collaboration, OOH handover form, LCP protocol • Communication Listening, talking, recording & reflection • Team Working Within care home, with GPs and with others • Clinical care Assessment and management • Decrease hospitalisation Admission avoidance, decrease length of stay, rapid discharge
Agreement on protocols • Advance care planning discussions • Discussions with relatives etc • Use of care pathway for the dying (e.g. LCP) • DNACPR forms • Decreasing hospitalisation policies • When is it appropriate to call GPs • Out of hours providers • Verification of expected death
Goals of GSF • Consistent high quality care • Meeting individuals preferences • Pre-planning & anticipation of needs • Improved staff confidence & teamwork • More home based care, less hospital based care
Decreased hospital admissions and deaths with GSFCH Training programme as measured by ADA phases 4-6
Key Messages • End of Life Care is important and affects us all • Too few people die at home/in their place of choice • Hospital deaths are expensive and often avoidable • Everyone has a part to play • GSF helps improve quality of generalist care, co-ordination and reduce hospitalisation • GSF is used in the community and can help improve cross boundary integrated care
More information National GSF Centre firstname.lastname@example.org www.goldstandardsframework.org.uk 01743 367066