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26 Present absentees: treatment escalation planning
  1. Paulette Kumi,
  2. Myrna Scott and
  3. Deborah Dawson
  1. St. George’s Hospital, UK


Introduction Escalation planning and resuscitation decision-making is essential for effective patient management. Treatment escalation plan (TEP) provides an effective way of formalising timely decision–making regarding care and communicating ceilings of care. It is more holistic – clarifying a wider remit of treatment options than DNACPR offers (Lipar, T., 2013). This is especially important in cardiothoracic intensive care (CTICU) where CPR has an even lower success rate due to the particular patient population and co-morbidities usually present (Barclay, S. et al., 2011).

Method A retrospective notes review was undertaken of patients admitted to St. George’s CTICU from April – June 2019. The aims were to assess;

  • Adequacy of End of Life Care (EoLC): recognition of dying, care planning, and provision of formalised anticipatory measures.

  • whether Supportive and Palliative Care Indicators Tool (SPICT) and ‘frailty’ could have identified patients at risk of deteriorating health.

Result Of 107 patients sampled, less than 5% had TEP pre-admission. However, more than 80% required TEP on admission to ICU – with over 90% lacking capacity. SPICT identified 100% of patient requiring TEP while ‘frailty’ showed a lower percentage.

Discussion The above indicates that clinicians are missing the window where patients themselves can be involved in TEP discussions. The high percentage requiring TEP may also be indicative of the need for in-depth discussions around intensive palliative care, as awareness is raised about TEP.

Conclusion This study looks at the adequacy of EoLC and highlights the relevance of TEP form completion – especially at the ward level, where patients are more likely to have capacity. It also highlights the usefulness of SPICT and even stand-alone frailty in assessment of patient.

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