Ensuring that dying patients and their families receive good End of Life Care

Transcription

1 Ensuring that dying patients and their families receive good End of Life Care Andrea Hanson Macmillan/STH AMBER/End of Life Care Pathway Facilitator April 2015

2 Aim of this session To identify and discuss the timeline of national events relating to end of life care from November 2011 to the present time Identify the key findings of More Care: Less pathway report 2013 Identify and discuss the role of the Leadership Alliance for the care of dying people Working in groups identify guidelines essential for addressing the five priority areas for achieving high quality care tailored to patients needs and wishes and delivered with compassion and competence

3 End of Life Care Strategy 2008 The route to success was a resource for transforming end of life care in the acute sector. This centred on 5 key enablers to achieve better end of life care; one being the Liverpool Care Pathway (LCP)

4 LCP background Developed in Based on the hospice model of care of the dying Developed to reproduce the same quality of end of life care in all care settings STH/St Luke s Hospice version of the LCP is The End of Life Care Pathway for last hours/days of life it follows the same principles as the LCP

5 A change in attitudes.. Liverpool Care Pathway to be Scrapped LCP denies patients hydration and food Mother put on pathway to death Family unaware father was dying 130,000 elderly people put to death by the NHS

6 What is your understanding of the concerns raised in the media about the Liverpool Care Pathway?

7 Key Findings in the review of the LCP More care: less pathway July 2013 When applied correctly, the Liverpool Care Pathway does help patients have a dignified and pain free death and the panel support the principles of it

8 Key Findings continued; Absence of Independent prospective testing of integrated end of life care pathways for end of life Lack of clear definitions of terminology relating to end of life Difficulty in diagnosing death Misunderstanding of how to document in the LCP

9 Key findings (2) LCP used as a tick box exercise Evidence of falsifying records Evidence of good and bad decision making Confusion over consent issues LCP in itself is not a single medical treatment requiring consent, some aspects are not medical treatments whereas others such as medicine changes are

10 Key Findings (3) Many cases where the LCP is used as a tick box exercise Too many serious cases of unacceptable care where the LCP has been incorrectly implemented Patients left without adequate nutrition, hydration and were in-appropriately sedated

11 Key Findings (4) Lack of/or poor communication with patients/relatives Little evidence/research on the use of drugs to manage symptoms & distress The professional guidance for clinicians on attempting resuscitation is not clear The general belief that being on the LCP deliberately hastens death

12 Neuberger (2013) It is the way that the LCP has been misused and misunderstood that has led to such great problems, along with it being too generic in its approach for the needs of some people It is too late to reverse this and turn the clock back to get it used properly by everyone Recommend phasing out the LCP and replacing it with a more personalised care plan and a clinically sensitive approach

13 Leadership Alliance for the care of dying people (March 20 th 2014) Alliance members are committed to ensuring that everyone who is in the last hours/days of life and those important to them, receive high quality care tailored to their needs and wishes and delivered with compassion and competence

14 Key points No National care pathway/ care bundle Avoid tick box exercises Good communication Work in partnership with patient and those important to them to formulate a personal palliative care plan which is regularly reviewed Clear documentation

15 References Dept. of Health (2008) End of Life Care Strategy NHS England July (2013) Guidance for doctors and nurses caring for people in the last days of life. July More Care Less Pathway: an independent review of the Liverpool Care Pathway

16 References continued NHS England (Jan 2014) Joint statement by the leadership Alliance for the care of Dying People NHS England (March 2014) Update from the Leadership Alliance for the care of Dying People