Background Older people with frailty living in care homes (CHs) are vulnerable to sudden deterioration and death. Unnecessary and unwanted conveyance to hospital could be avoided by robust treatment escalation plans (TEP). However, plans are only useful if accessed at times of crisis when CH staff feel challenged to avoid risk.
Aim To introduce a system to improve communication of TEPs between GP, Hospice, Hospital, CH teams avoiding repetition and dependency on electronic systems.
Methods Palliative care consultants worked with the Lead GP for CHs in one London borough to 1) integrate electronic record systems; 2) capture key data from conversations; 3) translate information to a patient specific colour coded format; and 4) ensure display and access of TEP by the CH staff in real time. This solution is being trialled over 3 months with the intention that people will receive care in the place they have requested and staff feel more supported.
Results TEP generation through EMIS shows a large deficit in the current number of recorded TEPs: 69% of CH residents had TEPs, 32% were patients on the Gold Standards Framework with death anticipated <1yr. Working as part of a pilot project to facilitate excellent end-of-life care in CHs, data showed that the majority of residents/patients and their families are realistic about long-term future when given opportunity to engage in discussions about TEPs. Patients and families were keen to avoid hospital, but importantly wanted reassurance they would receive care that would maintain comfort and dignity. Case studies during this time indicated that TEPs were less likely to be adhered to out-of-hours with poor access to agreed TEPs in CH setting.
Conclusion We believe a simple TEP chart generated by the GP, with information shared by the hospice, can be accessed by the CH team to help advocate for CH residents to receive the care and treatment they want.
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