PP20  Paramedic identification and referral of patients in the last year of life: a stakeholder interview study

2020 ◽  
Vol 37 (10) ◽  
pp. e10.1-e10
Author(s):  
Kim Kirby ◽  
Sarah Black ◽  
Laura Goodwin ◽  
Lucy Pocock ◽  
Alyesha Proctor ◽  
...  
Keyword(s):  
End Of Life ◽  
Hospital Admissions ◽  
Positive Impact ◽  
Research Question ◽  
List Type ◽  
Care Planning ◽  
Advanced Care Planning ◽  
Telephone Interviews ◽  
Referral Tool ◽  
Or Team

BackgroundPatients are approaching End of Life when they are likely to die within the next 12 months. Quality in End of Life Care is variable and identifying patients in the End of Life phase is challenging, particularly in those people with diagnoses other than cancer. Many patients accessing the ambulance service are in the last year of their lives and the role of ambulance services in recognising patients approaching the end of their lives is often overlooked. Patients who are End of Life should be offered advanced care planning.Research QuestionWhat are stakeholders’ views on a paramedic screening and referral intervention aimed at improving care planning in patients in the last year of life?MethodsA qualitative study using semi-structured telephone interviews conducted with 17 stakeholders to investigate stakeholders’ views on:the utility of a paramedic screening and referral toolthe likely impact of a paramedic screening and referral toolPreliminary ResultsAll staff groups:Increasing advanced care planning would be advantageous for patientsPatients with non-malignant conditions are not readily recognised as End of Life.Paramedics should use the Gold Standards Framework Proactive Identification Guidance to identify patients in the last year of life.The proposed intervention has the potential to reduce unnecessary hospital admissions and unnecessary resuscitation.Specific staff groups:GPs: Concerns about additional workload.GPs: The intervention is useful for patients who may ‘fall under the radar’.GPs and ED doctors: Concerns about the need for paramedics to have sensitive communication skills.Paramedics and GPs: A dedicated End of Life lead or team would be advantageous.ConclusionsThe introduction of an end of life screening and referral tool into paramedic practice is a welcome intervention and will have a positive impact on patients at the end of life. GPs expressed concern about capacity to manage referrals.

scholarly journals 53 Does the Community Geriatrician’s Role in Advanced Care Planning Help Community Dwellers Achieve Their Preferred Place of Care?

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i14-i17
Author(s):  
K Honney ◽  
H Judd ◽  
A Mitchell ◽  
H Nash ◽  
J Ford ◽  
...  
Keyword(s):  
End Of Life ◽  
Statistical Significance ◽  
Care Home ◽  
Education Programme ◽  
Care Planning ◽  
Advanced Care Planning ◽  
Chi Square ◽  
Before And After ◽  
Chi Square Test ◽  
Community Dwellers

Abstract Introduction Advanced Care Planning (ACP) is well established for patients with terminal cancer diagnoses but is poorly utilised when caring for elderly patients with other terminal illnesses. We aimed to assess the effectiveness of ACP in our older, community dwellers following a period of increased awareness. Methods A closed loop audit was undertaken, assessing deaths from a dementia care home within rural Norfolk, before and after implementation of an education and focus programme (cycle 1=Jan 2017-Jan 2018, cycle 2: Feb 2018-Jan-2019). Deceased patients were identified from care home records and data from electronic hospital and general practice records were analysed. Results were compared according to existing guidance outlined in the Palliative Gold Standards Framework (GSF) and Department of Health End of Life Care Strategy 2009. Compliance between cycles was compared using the chi-square test with p=.05 indicative of statistical significance. Results 59 patients were included (median age=84, male=31). Results of the audit for each criterion are shown in table 1. More patients achieved their preferred place of care (PPOC) following the implementation of the education programme, with access to end of life medications significantly improving. Conclusions Increasing awareness and understanding of ACP in the community has been shown to improve compliance with GSF standards, particularly access to end of life medications. Further efforts are still required to improve care and a third cycle is scheduled for January 2020, following further training.

scholarly journals Health Care Professionals’ Views Associated with the Barriers and Facilitators of Advance Care Planning (ACP) for Community Dwelling Older Adults with Palliative and End-of-Life Care Needs Towards Achieving a ‘Good’ Death: Findings from a Qualitative, Exploratory Pilot Study

2018 ◽  
Author(s):  
Gary Bellamy ◽  
Jennifer Stock ◽  
Patricia Schofield
Keyword(s):  
Older Adults ◽  
Health Care ◽  
End Of Life ◽  
Health Care Professionals ◽  
End Of Life Care ◽  
Care Planning ◽  
Life Care ◽  
Face To Face ◽  
Telephone Interviews ◽  
Advance Care

This paper reports the findings from a pilot study designed to explore the barriers, facilitators and similarities with the delivery and implementation of two distinct models of Advance Care Planning (ACP) documentation for older adults in their last year of life used by health care professionals in their clinical practice. PACe (Proactive Anticipatory Care Plan): a GP led model and PEACE (Proactive Elderly Persons’ Advisory CarE): a nurse led model with community geriatrician oversight were used by participants in their clinical practice. Telephone interviews were conducted with general practitioners (GPs) to explore their views of using the PACe tool. Hospital admission avoidance matrons took part in face to face interviews and care staff employed in private residential care homes took part in individual telephone interviews to explore their views of using the PEACE tool. GPs and admission avoidance matrons were employed by Clinical Commissioning Groups (CCGs) and all study participants were recruited from the South East of England where data collection took place in 2015. Nine telephone interviews and two face-to-face interviews (one joint and one individual) were conducted with twelve participants. The data was analysed thematically. Participants highlighted the similarity of both tools in providing focus to ACP discussions to inform individual end-of-life care preferences. The importance of relationships was a pivotal theme-established, trusting inter-professional relationships to enable multidisciplinary teamwork and a prior relationship with the older person (or their proxy in the case of cognitive impairment) to enable conversations of this nature. Using both tools enabled participants to think critically and reflect on their own practice was another theme identified. Notwithstanding participants’ views to improve the layout of both tools, using a paper-based approach to deliver streamlined ACP and end-of-life care was a theme to emerge as a barrier which focused on the problems with access to paper-based documentation, accuracy and care co-ordination in the context of multidisciplinary team working. The value of technology in overcoming this barrier and underpin ACP as a means to help simplify service provision, promote integrated professional practice and provide seamless care was put forward as the solution.

scholarly journals Acceptability of Paper-Based Advance Care Planning (ACP) to Inform End-of-Life Care Provision for Community Dwelling Older Adults: A Qualitative Interview Study

Geriatrics ◽  
2018 ◽  
Vol 3 (4) ◽  
pp. 88 ◽  
Author(s):  
Gary Bellamy ◽  
Jennifer Stock ◽  
Patricia Schofield
Keyword(s):  
Older Adults ◽  
End Of Life ◽  
Advance Care Planning ◽  
End Of Life Care ◽  
Community Dwelling ◽  
Care Planning ◽  
Care Provision ◽  
Life Care ◽  
Telephone Interviews ◽  
Advance Care

This paper reports the findings from a study to investigate health care professionals’ views regarding the use and acceptability of two similar paper-based advance care planning (ACP) documents designed for older adults in their last year of life to inform end-of-life care provision. Participants’ views of using PEACE (Proactive Elderly Persons Advisory Care), a nurse led model with community geriatrician oversight, and PACe (proactive anticipatory care plan), a general practitioner (GP) led model implemented by two clinical commissioning groups (CCGs) as part of a wider pilot to determine their ability to improve end-of-life care provision, were explored. Hospital admission avoidance matrons took part in face to face interviews and care staff employed in private residential care homes took part in individual telephone interviews to explore their views of using the PEACE tool. Telephone interviews were conducted with GPs to explore their views of PACe. GPs and admission avoidance matrons were employed by CCGs and all study participants were recruited from the South East of England, where data collection took place in 2015. The data were analysed thematically. Findings from the study demonstrate how both tools provide a focus to ACP discussions to inform individual end-of-life care preferences. The importance of relationships was a pivotal theme established, trusting inter-professional relationships to enable multidisciplinary teamwork and a prior relationship with the older person (or their proxy in the case of cognitive impairment) to enable such conversations in the first place. Both tools enabled participants to think critically and reflect on their own practice. Notwithstanding participants’ views to improve their layout, using a paper-based approach to deliver streamlined ACP and end-of-life care was a theme to emerge as a potential barrier, and highlighted problems with accessing paper-based documentation, accuracy and care co-ordination in the context of multidisciplinary team working. The value of technology in overcoming this barrier and underpinning ACP as a means to help simplify service provision, promote integrated professional practice and provide seamless care, was put forward as a way forward.

Improving code status documentation as a marker of advanced care planning at an outpatient academic cancer center: A pilot project.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 38-38 ◽  
Author(s):  
Anjana Ranganathan ◽  
James J. Sauerbaum ◽  
Katie Green ◽  
Heather Sheaffer ◽  
Mary Coniglio ◽  
...  
Keyword(s):  
Pilot Study ◽  
End Of Life ◽  
End Of Life Care ◽  
Pilot Project ◽  
Cancer Center ◽  
Care Planning ◽  
Advanced Care Planning ◽  
Life Care ◽  
Code Status ◽  
Group A

38 Background: Advanced care planning can significantly impact the quality of end of life care. Readily accessible documentation of goals of care for patients (pts) known to have a high morbidity and mortality provides a concrete means for practitioners to discuss and guide advanced care planning. We previously reported a surprisingly small proportion of established pts in our oncology clinic with a documented code status (CS), and undertook a pilot project aimed at improving this rate. Methods: Query of the outpatient electronic medical record (EMR) at the Abramson Cancer Center for established pts revealed an average of 2% with a documented CS. Our pilot study focused on 8 providers in thoracic and gastrointestinal oncology. We established provider agreement on the importance of CS documentation, and analyzed the mechanisms in place for documentation. We educated providers on the method of documentation, raised visibility and importance of advanced directives, implemented a system of normalizing conversations for all new pts, reported weekly to providers on upcoming established pts without documentation and provided monthly report cards, indicating provider rates within the pilot group. Results: Prior to intervention, a median of 499-established pts per month were seen by our pilot group. A median of 50 pts (10%) had a documented CS with documentation rates by provider ranging from 0 – 91%. 5 of 8 providers had no established pts with a documented CS. After intervention, a median of 494-established pts per month were seen by the same group. A median of 197 pts (40%) (p < 0.05) had a documented CS with provider rates ranging from 26 – 94%. All providers had documented a CS on at least some of their established pts; improvements ranged from an increase of 0 to 26%, to an increase of 1 to 43%. Conclusions: Previously, at our institution, only a small minority of established patients with an oncologic diagnosis had documentation of CS in the readily available EMR. Our pilot study resulted in a statistically significant increase in the documentation rates for all providers over a 2-month period. We have yet to analyze the clinical significance of this, with attention to quality and cost of end of life care.

Prescribing in end-of-life care

2019 ◽  
Vol 1 (6) ◽  
pp. 284-288
Author(s):  
Amanda Armstrong
Keyword(s):  
End Of Life ◽  
Health Professionals ◽  
End Of Life Care ◽  
Care Planning ◽  
Advanced Care Planning ◽  
Life Care ◽  
Limiting Condition

End-of-life care aims to support a person in the last stages of a life-limiting condition to live as well as possible until they die. Prescribing at the end-of-life presents many challenges. Advanced care planning can be carried out so that health professionals are aware and supportive of the patient's and their family's wishes. This article discusses the care and management of patients as they receive care at the end of their life as well as any anticipatory medication that may be needed.

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