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Anticipator y Care Planning in the Acute Hospital: A Structured Approach

Anticipator y Care Planning in the Acute Hospital: A Structured Approach. What are we trying to achieve?. Patients in the last year of life will receive care aligned to their needs and wishes Early & reliable identification of patients where anticipatory planning is appropriate

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Anticipator y Care Planning in the Acute Hospital: A Structured Approach

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  1. Anticipatory Care Planning in the Acute Hospital: A Structured Approach

  2. What are we trying to achieve? Patients in the last year of life will receive care aligned to their needs and wishes • Early & reliable identification of patients where anticipatory planning is appropriate • Involvement of patients and families: Goals of Care • Clear plan for management • Reliable response to deterioration / change

  3. Information Reconciliation • During Hospital Stay • Structured Ward Round • Key information fields in clinical case-notes • Deteriorating Patient Package On Admission to Hospital KIS/ ePCS, GP letter, previous admissions, clinical case-notes Discharge From Hospital Immediate Discharge Letter Key information fields included in the immediate discharge letter & emailed to GP Practice mailbox Access, Review & Share Deterioration Out of Hours services- informed care at home Admission to hospital- key information included in GP letter Primary Care Key information used to create or update KIS/ ePCS.

  4. Deterioration at the End of Life 53% of all deaths (n=958) ‘expected death’ • End of life care plan commenced: median 32 hrs prior to death 28% of all deaths = ‘rapid decline’ Both groups: indicators of ‘limited reversibility’, uncertainty of recovery, risk of deterioration = need for active upstream planning

  5. What changes are we testing first? NHS Lothian Deteriorating Patient Programme • Structured Ward Round: tested vehicle for improvement in acute care • Templates: documentation fields to prompt & record • Key fields: Identification (SPICT) Escalation and treatment plan DNACPR status Communication with patient and family Goals of care Two pilot areas: Acute Medicine & Medicine of the Elderly wards Local ownership & leadership: Scottish Patient Safety Fellows

  6. The picture so far…. Area 1: Electronic templates- refining key fields- PDSA 1 Area 2: Paper template- refining key fields- PDSA 3

  7. Early lessons…. • Target group: acute medicine 54- 74% of patients medicine of the elderly 80 - 100% • Complexities of care: time to complete ward rounds/ per patient communication ‘dams’ terminology • Declining functional ability = key indicator- AHP involvement • Patient experiences and expectations • Power of ‘ fresh’ local data • Limitations of case-note review alone for improvement …

  8. Key Questions….. • ‘Conversation Ready’: staff ? patients and families ? • Glossary of terms • Immediate discharge letters • Measurement and reporting: Clinical Quality Indicator for End of Life care: 5 deaths per month within Morbidity & Mortality reviews

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