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O-20 Playing Jenga with our paramedic colleagues to improve end of life decision making – @frailtyjourney
  1. Jo Brady1,
  2. Clifford Lisk2,
  3. Shama Mani2,
  4. Debbie Bertfield2,
  5. Towhid Iman3,
  6. Joanne Nevitt4,
  7. Jayashree Pathak5 and
  8. Catherina Nolan6
  1. 1North London Hospice, London, UK
  2. 2Royal Free NHS Foundation Trust, London, UK
  3. 3NHS England and St George’s NHS Foundation Trust, UK
  4. 4London Ambulance Service NHS Trust, London, UK
  5. 5Health Education UK
  6. 6King’s College NHS Foundation Trust, London, UK


Background Paramedics services are under immense strain, decisions to convey or not are critical. We have an ageing frail population with 1 in 3 adults admitted to hospital in their last year of life. Active treatment is often the default option. Teams find it difficult to pause and recognise dying. People can be admitted repeatedly, although this may not be what they want if asked. Can we empower our front line paramedics to recognise advanced frailty and have brave honest conversations?

Aims Bring together expertise from the community and hospitals, with paramedics at the interface.

Deliver interactive multidisciplinary webinars.

Address gaps in knowledge by improving understanding of the Clinical Frailty Scale (CFS) to support decision making and end of life care.

Methods We used our established ‘Frailty Journey Education programme’ and tailored it for paramedics. We threaded scoring the CFS at crisis points exploring decisions to convey or not and outlined a framework and resources to support decision making. We evaluated with real time polls for confidence scores using CFS. We recorded feedback via QR codes between sessions then used PDSA methodology to make adjustments such as incorporating an ED perspective.

Results The polls from the webinars delivered so far demonstrated increase confidence in use of the CFS.

Feedback reported increased confidence in communication and managing EoL decisions not to convey and use of urgent care records. This will result in more people receiving care in the community and reduce conveyances.

Conclusions We conclude high impact interactive education can be delivered to increase staff confidence that impacts patient care. This has system wide benefits from reduced conveyances and admissions.

This programme has been successful due to the collaboration between, hospital trusts (ED and Geriatricians), Ambulance services, Hospice teams and Primary care. Our take home message is working together and sharing expertise across the whole patient journey is key to excellent end of life care.

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