Gold Standards Framework in Community Palliative Care

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Gold Standards Framework in Community Palliative
Care

• 07/09/2005.
• Doreen Shaw.

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What we know is important.

• Choice is important- Half our patients dont die
  where they choose- control and self determination
  valued
• Home Care -Most of final year of life is at home-
  With a limited increase in community care more
  patients with cancer could be supported to die at
  home
• Hospital stays and deaths should be reduced
• Inequity- Hospital death more likely for poor,
  elderly, women, long illness etc
• Planning -If plan care and discuss preference for
  place of care, more likely to happen
• Silent majority- Non cancer pts, care homes etc
• Increasing urgency with demographic changes

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Choice- preferred and actual place of death
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Place of death Higginson I (2003) Priorities for
End of Life Care in England Wales and Scotland
National Council

• Place Home Hospital Hospice CareHome
• Preference 56 11 24 4
• Cancer 25 47 17
  12
• All causes 20 56 4 20

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Epidemiology of dying in England

• Approx 530,000 deaths pa
• Cause of death
• - 25 cancer
• - 19 heart disease
• - 14 respiratory disease
• - 11 strokes and related disorders
• - 31 other
• Office of National Statistics summer 2004
• Statistics relate to 2003

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Why do it?Ensuring the best for dying patients

• The Care of the dying is raised to the level of
  the best(NHS Cancer Plan 2000).
• Better care for the dying should become a
  touchstone for success in modernizing the NHS
• (Sir Nigel Crisp March03)
• Dying well is the norm- a bad death is no
  longer tolerated in todays NHS

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End of Life Care Programme

• Aims
• Choice, Dignity, Quality.
• To extend the boundaries of palliative care
  provision...for all patients regardless of
  diagnosis
• By enabling more patients to live and die in the
  place of their choice
• Command paper Building on the best 2003

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5 Goals of GSF

• 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.

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Key Tasks The 7 CS

• Communication.
• Co-ordination.
• Control of symptoms.
• Continuity.
• Continued learning.
• Carer support.
• Care in the dying phase.

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Communication.

• Improved liaison between professional staff
  at primary level. PHCT meetings.
• All palliative patients on a Supportive Care
  register easily identifiable by the PHCT, their
  needs being dealt with quickly and
  comprehensively. Advanced care planning (ACP)
• Improved communication with other services/
  agencies e.g., secondary care, social services,
  clergy.
• Improved communication to and from patients
  and carers.

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Co-ordination.

• Identified practice Co-ordinator, orchestrates
  team and key worker for patient.
• Network of practice co-ordinators meeting
  monthly to feedback problems.

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Control of Symptoms.

• Greater awareness of need to monitor patients
  condition, key person appointed i.e. GP/DN.
• Proactive prescribing. (ACP)
• Pepsi Cola Checklist
• Assessment tools/body charts

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Continuity.

• Use of handover forms to out of hours
  services, preventing critical events an
  unnecessary admission to hospital.
• Out of Hours Protocol.

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Continued Learning.

• Commitment to continued learning of skills and
  information.
• Significant event analysis/Critical incident
  reporting.
• Reflective practice.

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Carer Support.

• Carer register maintained.
• Initiatives to improve practical support i.e.
  respite services.
• Identification of need improved bereavement
  services.
• National Carers Strategy.

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Care in the Dying Phase.

• Many more patients dying well and in their
  place of choice.
• Protocol LCP/ ICP

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Reactive patient journeyMR B in last months of
life

• 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?

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GSF Proactive pt journey Mrs W in last months
of life

• On SC 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 inc 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)

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GSF Spread in Wirral.

• 2001. Phase 1
• Framework devised by Dr. Keri
  Thomas.
• 2002. Phase 2.
• Rolled out nationally with pilot
  practice in Wirral
• 2003. Phase 3 and 4.
• Decision made to implement in
  Wirral. Funding/facilitators
• 23 Practices.
• 2004. Phase 5 and 6.
• 37 Wirral practices.
• 2005. Phase 7and 8.
• 49 Practices (76)

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What makes it work?

• Framework is excellent tool. Step by step
  approach to change. (7 Cs) Non prescriptive.
• Works due to enthusiasm and commitment of
• Primary care teams, practice co-ordinators,
  facilitators PCT AND Cancer network to make
  changes.

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The Future.

• Make GSF the norm.
• Maintain momentum with all practices on Wirral
  taking part.
• Identification of problems/barriers at PCT and
  Cancer Network level initiating implementation of
  change.
• GSF in Care Homes.

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THANKYOU.

• Doreen Shaw.
• GSF Facilitator Wirral.
• 0151 328 0481.