electronic Palliative Consideration Rundown (ePCS).

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Arranging and conveyance of tend to patients with palliative and end of life care needs ... 1. Put pt on Palliative Care Register. Clinical, Pt decision, Surprise ...
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electronic Palliative Care Summary (ePCS) SCIMP November 2009 Dr Peter Kiehlmann GP, Aberdeen & National Clinical Lead Palliative Care eHealth peter.kiehlmann@scotland.gsi.gov.uk http://www.scotland.gov.uk/Topics/Health/NHS-Scotland/LivingandDyingWell http://www.ecs.scot.nhs.uk/epcs.html

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Outline Journeys Context What is ePCS? Why is it required? Timescale Benefits

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The labyrinth of trees

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3 Steps in Gold Standards Framework 3. Arrangement 2. Evaluate + impart 1. Distinguish

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GSFS - Key Tasks - 7 Cs Cancer Register & Team Meetings, Pt data, Treatment cards, PHR Key Person, Checklist Assessment, body outline, SPC and so on Faxed Form Learning about conditions on patients seen Practical, enthusiastic, mourning, National Carer\'s Strategy C7 Care in kicking the bucket stage C1 Communication C2 Co-ordinator C3 Control of Symptoms C4 Continuity Out of Hours C5 Continued Learning C6 Carer Support

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Reactive patient trip: in a months ago of life GP and DN specially appointed game plans & no ACP set up - was PPoC talked about or expected? - what is pt/carer comprehension of finding/guess? Issues of tension & side effect control OOH Crisis call - no ACPor drugs accessible in the home Admitted to and bites the dust in healing center Was Carer bolstered before/after cherished one\'s passing? Did OOH, PHCT or Hospital think about consideration given? Was utilization of healing facility bed proper?

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GSFS Proactive pt venture: in a months ago of life On Pall Care Register - surveyed at PHCT meeting (C1) DS1500 and information given to pt + carer (home pack) (C1, C6) Regular bolster, visits telephone calls - proactive (C1, C2) Assessment of side effects, association with SPC - altered consideration to pt and carer needs (C3) Carer evaluated incl psychosocial needs (C3, C6) Preferred Place of Care (PPoC) noted & composed (C1, C2) OOH structure sent – care arrangement & drugs in home (C4) End of Life pathway/LCP/least convention utilized (C7) Pt kicks the bucket in their favored spot - mourning bolster Staff reflect-SEA, review holes enhance care, learn (C5, C6)

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Outline Journeys Context What is ePCS? Why is it required? Timescale Benefits

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Illness directions GP will have 20 pts kick the bucket each year A Cancer Organ disappointment Dementia and decay Sudden passing B C

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finding of a dynamic or life-restricting ailment basic occasions or noteworthy weakening amid the sickness direction showing the requirement for an adjustment in consideration and administration critical changes in patient or carer capacity to \'adapt " demonstrating the requirement for extra backing the " shock question " (clinicians would not be amazed if the patient were to bite the dust inside the following 12 months) onset of the end of life stage –\' diagnosing biting the dust\' Palliative Care for whom?

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Place of death Scotland 1981-2006

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So by 2030… if current patterns proceed with home passings will lessen by 42.3% Less than one in 10 (9.6%) will bite the dust at home increment in institutional passings of 20.3%.

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Choice-favored/genuine spot of death Higginson I (2003) Priorities for End of Life Care in England Wales and Scotland National Council Place: Home Hospital Hospice Care Home Preference 56% 11% 24% 4% Cancer 25% 47% 17% 12% All causes 20% 56% 4% 20%

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Symptoms Carer Breakdown They don\'t know they would They be able to don\'t know they are biting the dust Home circumstance Patient and family wishes Lack of administrations Admitted by out of hours specialist What stops individuals kicking the bucket at home? Susan Munroe, Marie Curie Cancer Care and Scott Murray, University of Edinburgh, & Scottish Partnership for Palliative Care 2005

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Living and Dying Well

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Living and Dying Well Assessment and Review of palliative and end of life care needs Planning and conveyance of look after patients with palliative and end of life care needs Communication and Coordination Education, preparing and workforce advancement Implementation and future improvements

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Board Delivery Plans Triggers and Assessment instruments Palliative Care Registers Service Information Directories Community Nursing Care Homes Education champions Anticipatory Rx & Equipment DNA CPR Policy E-Health inc. ePCS 1 st 6month survey empowering Activities from Living and Dying Well

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Outline Journeys Context What is ePCS? Why is it required? Timescale Benefits

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ECS New GP Contract GP not mindful all day, every day Risks to protected, powerful care Patient information from GP PCs - > ECS store twice day by day Medication & Allergies 97% of GP Practices >5 million patients Explicit Consent to view \'Read just\' accessible to… NHS24, A&E, AMAU, SAS

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ePCS - What is it? An electronic Palliative Care Summary An expansion to Emergency Care Summary (ECS) & Gold Standards Framework Scotland (GSFS) For use both In Hours & OOH ePCS replaces current faxed interchanges Allows GPs & Nurses to record in one spot Diagnosis, Rx, Pt Understanding & Wishes, Anticipatory Care Plans, audit dates, records for gatherings

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NHS 24 OOH clinician ePCS show A&E ePCS overhaul Ambulance ECS Store 1. Amid discussion 2. Because of medicine 3. Group meeting or other contact Practice Admin. Staff Audit trail TBD… ePCS Overview GP/DN conference

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ePCS Dataset Consent - Palliative consideration information exchange Carer points of interest and key experts Diagnosis – as concurred by patient by pt & GP Current Rx –Rpt, 30/7 Acute, Allergies; Patient wishes Preferred Place of Care [PPoC] ) DNA CPR choice ) Anticipatory Patient\'s & Carer\'s comprehension of ) Care analysis/visualization ) Plan Just in Case – Rx & gear ) Advice for OOH care ) GP Mobile no., demise anticipated? Cert. and so forth )

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EMIS - Summary

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ePCS no conclusion included yet

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Diagnosis concurred with pt & included

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Patient/Carer Wishes

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New ECS construct screenshots Access to PCS Information

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Base ePCS –view in Adastra

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Mobile ePCS - Adastra

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Using ePCS by and by – a proceeding with procedure Does this pt have Palliative Care Needs? Add to Pall Care Register, Once Consents to send ePCS - >OOH, concur Medical History, set survey date Once agreed any new information goes naturally Not anticipated that would finish in one go! Complete pt wishes and Understanding, DNA CPR, record "In the event of some unforeseen issue" Rx and Equipment as fitting Regular audit at PHCT Keep overhauling!

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Outline Journeys Context What is ePCS? Why is it required? Timescale Benefits

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Palliative Care DES (1 of 26!) 1. Put pt on Palliative Care Register Clinical, Pt decision, Surprise Question From Prognostic Indicator Guidance 2. Make Anticipatory Care Arrangement – as ePCS 3. Send OOH structure/ePCS inside 2w 4. At the point when kicking the bucket use LCP/privately concurred pathway Aim-empower expectant consideration, for all findings

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When will it be accessible? Pilots finished Aug 09 EMIS, Vision – Grampian, Gpass – A&A, Lothian Issues tended to included worthiness & usability, enhancing the meeting & correspondence, expectant consideration arranging, NHS Lothian Rollout Sep 09 Vision more easy to understand late 09 Evaluation, national rollout late 09 Link with Board Leads for timings GP,Palliative Care, eHealth,OOH

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ePCS – Benefits Natural movement from GSFS & ECS Fits into everyday work of GPs & DNs Aims to distinguish patients "upstream" ie last 6-12 months, not simply a days ago/weeks Encourages Anticipatory Care Planning Prompts to remind to get some information about "troublesome" issues "In the event that something goes wrong", DNA CPR, PPoC Shares basic data. on defenseless patients at critical times. OOH & Secondary Care say it changes care Patients & carers consoled Safer, better experience

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NHS 24 OOH clinician ePCS show A&E ePCS redesign Ambulance ECS Store 1. Amid meeting 2. Because of medicine 3. Group meeting or other contact Practice Admin. Staff Audit trail TBD… ePCS Overview GP/DN interview

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