route to success - assess and diagnose
DESCRIPTION
This 'how to' guide builds upon the overarching framework set out in The route to success in end of life care - achieving quality in acute hospitals, published in 2010. The route to success highlighted best practice models developed by acute hospital Trusts, providing a comprehensive framework to enable hospitals to deliver high quality care to people at the end of life. This 'how to' guide aims to help clinicians, managers and directors implement The route to success more effectively, drawing on valuable learning from the NHS Institute for Innovation and Improvement's Productive Ward: Releasing time to care™ series. This guide contains individual sections that can be worked on in any given order, dependent upon the individual hospital and its current end of life care provisions. These can be downloaded below: Introduction Section 1: prepare Section 2: assess and diagnose Section 3: plan Section 4: treat Section 5: evaluate Section 6: sustain Section 7: further resources Cover It places emphasis on existing 'enabling' tools and models, which support and follow a person-centred pathway. These are Advance Care Planning, Electronic Palliative Care Co-ordination Systems (EPaCCS), AMBER Care Bundle, Rapid Discharge Home to Die Pathway, and the Liverpool Care Pathway. Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013TRANSCRIPT
Assess and diagnose
Section 2 The route to success
Section 2
Assess and diagnose
There are numerous sources of information available to help you benchmark your current position, for example:
Your Trust’s existing key performance indicators relating to QIPP, PROMs and CQUINs for end of life care
The benchmark developed from the collated Strategic Health Authority returns indicating what is collected by Trusts currently against PROMs, CQUINs and QIPP could provide a useful marker
Use your multidisciplinary team to enable identification and overview of complaints related to end of life care
Review of clinical coding
Data from the National End of Life Care Intelligence Network’s End of Life Care Profiles will inform how you are doing to enable you to prioritise and develop your Trust’s end of life care quality improvement dashboard1
Disease specific reports from the National End of Life Care Intelligence Network2
The end of life care quality assessment tool (ELCQuA)3
The NICE end of life care for adults quality standard4
National Council for Palliative Care reports on the palliative care workforce.5
QIPP – Quality, Innovation,
Productivity and Prevention
programme
PROMs – Patient Reported Outcome
Measures
CQUINs – Commissioning for
Quality and Innovation framework
Jargon
1 www.endoflifecare-intelligence.org.uk/profiles.aspx2 www.endoflifecare-intelligence.org.uk/resources/publications/default.aspx3 www.elcqua.nhs.uk4 www.nice.org.uk/guidance/qualitystandards/endoflifecare/home.jsp5 www.ncpc.org.uk/site/policyandcampaigns/Workforce
2
Think about what good looks
like from Section 1 of this guide
and consider Figures 1 and 2
on the following pages. Use these
to help identify what is already
happening in your Trust.
TOP TIP
3
The route to success ‘how to’ guide
Section 2
Figure 1: Key drivers for excellence in end of life care
Key drivers highlight the process for moving toward excellence:
Excellence in end of life care
Primary drivers Quality in acute hospitals
Outcome MeasuresCare that is compassionate, equitable, reliable, improves the care experience, makes best use of resources.
Full compliance with national quality markers.
Reduction of harm.
Person centred/ family care
Leadership
Effective teamwork
Safe, effective reliable systems
Measurement
4
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The route to success ‘how to’ guide
Secondary drivers
1. Leadership explicit with organisation’s Trust Board agenda2. Senior management objectives3. Clinical champions for end of life care4. Competent trained staff – partnership between hospital palliative care teams/long term conditions5. Culture of compassionate care by staff caring for individuals approaching end of life
1. Implement end of life care good practice models – productive series, advancing quality, clinical audit2. Use of agreed prognostic indicator guidance3. AMBER Care Bundle in use across Trust4. Advance care planning, Preferred Priorities for Care, Do Not Attempt Cardio-Pulmonary Resuscitation,
Liverpool Care Pathway5. Electronic palliative care co-ordination system (EPaCCS), rapid discharge home to die pathway6. Symptom management
1. Agreed standards for effective communication with individual and family2. Effective identification and development of management plans3. Discharge liaison/Community/GPs/Ambulance/OOH/Social care4. Adopt common end of life care Pathway language – e.g. The route to success for acute hospitals
1. Engage individuals and families as active partners in care2. Open transparent communication that is respectful of preferred priorites for care and preferred place of death3. Involve families in the physical care of their relatives4. Involve families in improvement teams5. Facilitate user feedback within service improvement6. Care after death
1. Safe and effective care with regular review of Serious Untoward Incidents, complaints etc2. PROMS3. National bereavement survey (VOICES)4. The route to success dashboard – each trust to develop own utilising ‘how to’ guide metrics for
wards and boards
Step 1 Step 2 Step 3
Section 2
Discussions as the end of life approaches
Assessment, care planning and review
Co-ordination of care
l Open, honest communicationl Identifying triggers for
discussionl Advance care planning.
l Conduct a holistic asessmentl Agreed care plan and regular
review of needs and preferencesl Assessing needs of carersl Advance care planning.
l Strategic co-ordination working with primary and community health services, ambulance/transport services and social care
l Co-ordination of individual carel Discharge planningl Rapid discharge home to diel Fast track continuing health
care.
High quality end of life care making best use of resources
Senior clinical descision-making close to the patient and an appropriately trained and supported workforce
Strong governance including board oversight and senior management engagement
6
The six steps of the end of life care pathway are not discreet or incremental but interact and overlap along the person-centred pathway. Most hospitals will be providing some of this care, for some people, some of the time. Where are your gaps and what can you do to fill them?
© National End of Life Care Programme (2010) adapted from the End of Life Care Strategy (Department of Health, 2008)
Figure 2: The end of life care pathway for acute hospitals
Related references: Improving outcomes guidance in supportive and palliative care. NICE 2004Treatment and care towards the end of life: good practice in descision making. GMC 2010
Step 4 Step 5 Step 6
Delivery of high quality care in an acute hospital
Care in the last days of life Care after death
l Dignified environmentl Access to specialist palliative
care advice around the clockl Specialist hospital palliative care
teaml Access to spiritual carel Access to tailored information.
l Identification of the dying phasel Review of needs and preferences
for place of deathl Support for both the individual
and carerl Recognition of wishes regarding
resuscitation and organ donation.
l Recognition that end of life care does not stop at the point of death
l Timely verification and certification of death or referral to coroner
l Care and support of carer and family, including emotional and practical bereavement support.
High quality end of life care making best use of resources
Senior clinical descision-making close to the patient and an appropriately trained and supported workforce
Strong governance including board oversight and senior management engagement
7
The route to success ‘how to’ guide
www.endoflifecareforadults.nhs.uk
Published by the National End of Life Care Programme
ISBN: 978 1 908874 04 7Programme Ref: PB0005 A 02 12Publication date: Feb 2012Review date: Feb 2014
© National End of Life Care Programme (2012)All rights reserved. For full Terms of Use please visit www.endoflifecareforadults.nhs.uk/terms-of-use
or email [email protected]. In particular please note that you must not use this product or
material for the purposes of financial or commercial gain, including, without limitation, sale of the
products or materials to any person.
Supported by the NHS Institute for Innovation and Improvement