Electronic Palliative Care Summary (ePCS) SCIMP November 2009 Dr Peter Kiehlmann GP, Aberdeen &...
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![Page 1: Electronic Palliative Care Summary (ePCS) SCIMP November 2009 Dr Peter Kiehlmann GP, Aberdeen & National Clinical Lead Palliative Care eHealth peter.kiehlmann@scotland.gsi.gov.uk.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649de35503460f94ad9ccb/html5/thumbnails/1.jpg)
electronic Palliative Care Summary (ePCS)
SCIMP November 2009
Dr Peter KiehlmannGP, Aberdeen & National Clinical Lead
Palliative Care eHealth
http://www.scotland.gov.uk/Topics/Health/NHS-Scotland/LivingandDyingWellhttp://www.ecs.scot.nhs.uk/epcs.html
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TimescaleTimescaleBenefitsBenefits
What is ePCS?What is ePCS? Why is it needed?Why is it needed?
Outline
ContextContext
JourneysJourneys
![Page 3: Electronic Palliative Care Summary (ePCS) SCIMP November 2009 Dr Peter Kiehlmann GP, Aberdeen & National Clinical Lead Palliative Care eHealth peter.kiehlmann@scotland.gsi.gov.uk.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649de35503460f94ad9ccb/html5/thumbnails/3.jpg)
![Page 4: Electronic Palliative Care Summary (ePCS) SCIMP November 2009 Dr Peter Kiehlmann GP, Aberdeen & National Clinical Lead Palliative Care eHealth peter.kiehlmann@scotland.gsi.gov.uk.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649de35503460f94ad9ccb/html5/thumbnails/4.jpg)
The maze of trees
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3 Steps in Gold Standards Framework
1. Identify
2. Assess
3. Plan
+ com
munic
ate
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GSFS - Key Tasks - 7 Cs
C1 Communication
C2 Co-ordinator
C3 Control of Symptoms
C4 Continuity Out of Hours
C5 Continued Learning
C6 Carer Support
Cancer Register & Team Meetings, Pt info, Treatment cards, PHR
Key Person, Checklist
Assessment, body chart, SPC etc
Faxed Form
Learning about conditions on patients seen
Practical, emotional, bereavement, National Carer’s Strategy
C7 Care in dying phase
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Reactive patient journey: in last months of life
• GP and DN ad hoc arrangements & no ACP in place - was PPoC discussed or anticipated? - what is pt/carer understanding of diagnosis /prognosis?• Problems of anxiety & symptom control • OOH Crisis call - no ACPor drugs available in the home• Admitted to and dies in hospital • Was Carer supported before/after loved one’s death?• Did OOH, PHCT or Hospital reflect on care given?• Was use of hospital bed appropriate?
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GSFS Proactive pt journey: in last months of life
• On Pall Care Register - reviewed at PHCT meeting (C1)
• DS1500 and info given to pt + carer (home pack) (C1, C6)
• Regular support, visits phone calls - proactive (C1, C2) • Assessment of symptoms, partnership with SPC -
customised care to pt and carer needs (C3)
• Carer assessed incl psychosocial needs (C3, C6)
• Preferred Place of Care (PPoC) noted & organised (C1, C2)
• OOH form sent – care plan & drugs in home (C4)
• End of Life pathway/LCP/minimum protocol used (C7)
• Pt dies in their preferred place - bereavement support • Staff reflect-SEA, audit gaps improve care, learn (C5, C6)
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TimescaleTimescaleBenefitsBenefits
What is ePCS?What is ePCS? Why is it needed?Why is it needed?
Outline
ContextContext
JourneysJourneys
![Page 10: Electronic Palliative Care Summary (ePCS) SCIMP November 2009 Dr Peter Kiehlmann GP, Aberdeen & National Clinical Lead Palliative Care eHealth peter.kiehlmann@scotland.gsi.gov.uk.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649de35503460f94ad9ccb/html5/thumbnails/10.jpg)
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Illness trajectories GP will have 20 pts die every year
Cancer
Dementiaand
decline
A
B
C
Organ
failure
Sudden death
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Palliative Care for whom?
diagnosis of a progressive or life-limiting illness
critical events or significant deterioration during the disease trajectory indicating the need for a change in care and management
significant changes in patient or carer ability to ‘cope’ indicating the need for additional support
the ‘surprise question’ (clinicians would not be surprised if the patient were to die within the next 12 months)
onset of the end of life phase –‘diagnosing dying’
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Place of death Scotland 1981-2006
Place of death. Scotland 1981 to 2006 Source GRO Scotland
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
Home
NursingHomesetc.
Hospital
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So by 2030…if current trends continue
home deaths will reduce by 42.3%
Less than one in 10 (9.6%) will die at home
increase in institutional deaths of 20.3%.
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Choice-preferred/actual place of death Higginson I (2003) Priorities for End of Life Care in England Wales and Scotland National Council
Place: Home Hospital Hospice Care Home
Preference 56% 11% 24% 4%
Cancer 25% 47% 17% 12%
All causes 20% 56% 4% 20%
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What stops people dying at home?
Susan Munroe, Marie Curie Cancer Care and Scott Murray, University of Edinburgh, & Scottish Partnership for Palliative Care 2005
Symptoms Carer Breakdown They don’t know
they can They don’t know
they are dying
Home situation Patient and family
wishes Lack of services Admitted by out of
hours doctor
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Living and Dying Well
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Living and Dying Well
•Assessment and Review of palliative and end of life care needs
•Planning and delivery of care for patients with palliative and end of life care needs
•Communication and Coordination
•Education, training and workforce development
•Implementation and future developments
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Activities from Living and Dying Well
Board Delivery Plans Triggers and Assessment tools Palliative Care Registers Service Information Directories Community Nursing Care Homes Education champions Anticipatory Rx & Equipment DNA CPR Policy E-Health inc. ePCS 1st 6month review encouraging
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TimescaleTimescaleBenefitsBenefits
What is ePCS?What is ePCS? Why is it needed?Why is it needed?
Outline
ContextContext
JourneysJourneys
![Page 22: Electronic Palliative Care Summary (ePCS) SCIMP November 2009 Dr Peter Kiehlmann GP, Aberdeen & National Clinical Lead Palliative Care eHealth peter.kiehlmann@scotland.gsi.gov.uk.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649de35503460f94ad9ccb/html5/thumbnails/22.jpg)
ECS
New GP Contract GP not responsible 24/7 Risks to safe, effective care Patient info from GP computers -> ECS store twice daily Medication & Allergies 97% of GP Practices >5 million patients Explicit Consent to view ‘Read only’ available to… NHS24, A&E, AMAU, SAS
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ePCS - What is it?
An electronic Palliative Care Summary An extension to Emergency Care Summary (ECS) & Gold Standards Framework Scotland (GSFS) For use both In Hours & OOH ePCS replaces current faxed communications Allows GPs & Nurses to record in one place
Diagnosis, Rx, Pt Understanding & Wishes, Anticipatory Care Plans, review dates, lists for meetings
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ePCS Overview
OOH clinician ePCS display
ePCS update 1. During
consultation
2. Due to prescription
3. Team meeting or other contact
Audit
trail
ECSStore
NHS 24
A&E
Ambulance
TBD…
Practice Admin. Staff
PracticeServer
GP /DN
consultation
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ePCS Dataset Consent - Palliative care data transfer Carer details and key professionals Diagnosis – as agreed by patient by pt & GP Current Rx –Rpt, 30/7 Acute, Allergies; Patient wishes
Preferred Place of Care [PPoC] )DNA CPR decision ) Anticipatory
Patient’s & Carer’s understanding of ) Care diagnosis/prognosis ) Plan
Just in Case – Rx & equipment ) Advice for OOH care )
GP Mobile no., death expected? Cert. etc )
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EMIS - Summary
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ePCS no diagnosis added yet
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Diagnosis agreed with pt & added
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Patient/Carer Wishes
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New ECS build screenshots
Access to PCS Information
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Base ePCS –view in Adastra
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Mobile ePCS - Adastra
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Using ePCS in practice –a continuing process
Does this pt have Palliative Care Needs?Does this pt have Palliative Care Needs? Add to Pall Care Register, Add to Pall Care Register, Once Consents to send ePCS ->OOH,Once Consents to send ePCS ->OOH,
agree Medical History, set review dateagree Medical History, set review date Once consented any new info goes automaticallyOnce consented any new info goes automatically Not expected to complete in one go!Not expected to complete in one go! Complete pt wishes and Understanding, DNA CPR, record Complete pt wishes and Understanding, DNA CPR, record
“Just in case” Rx and Equipment as appropriate“Just in case” Rx and Equipment as appropriate Regular review at PHCTRegular review at PHCT Keep updating!Keep updating!
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TimescaleTimescaleBenefitsBenefits
What is ePCS?What is ePCS? Why is it needed?Why is it needed?
Outline
ContextContext
JourneysJourneys
![Page 36: Electronic Palliative Care Summary (ePCS) SCIMP November 2009 Dr Peter Kiehlmann GP, Aberdeen & National Clinical Lead Palliative Care eHealth peter.kiehlmann@scotland.gsi.gov.uk.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649de35503460f94ad9ccb/html5/thumbnails/36.jpg)
Palliative Care DES (1 of 26!)
1. Put pt on Palliative Care Register Clinical, Pt choice, Surprise Question From Prognostic Indicator Guidance
2. Make Anticipatory Care Plan – as ePCS
3. Send OOH form/ePCS within 2w
4. When dying use LCP /locally agreed pathway
Aim- encourage anticipatory care, for all diagnoses
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When will it be available?
Pilots completed Aug 09 EMIS, Vision – Grampian, Gpass – A&A, Lothian
Issues addressed included acceptability & ease of use, improving the consultation & communication, anticipatory care planning,
NHS Lothian Rollout Sep 09 Vision more user-friendly late 09 Evaluation, national rollout late 09 Link with Board Leads for timings
GP,Palliative Care, eHealth,OOH
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ePCS – Benefits
Natural progression from GSFS & ECS Fits into day to day work of GPs & DNs Aims to identify patients “upstream” ie last 6-12 months, not just last days/weeks Encourages Anticipatory Care Planning Prompts to remind to ask about “difficult” issues
“Just in Case”, DNA CPR, PPoC Shares critical info. on vulnerable patients at important times. OOH & Secondary Care say it transforms care Patients & carers reassured Safer, better experience
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ePCS Overview
OOH clinician ePCS display
ePCS update 1. During
consultation
2. Due to prescription
3. Team meeting or other contact
Audit
trail
ECSStore
NHS 24
A&E
Ambulance
TBD…
Practice Admin. Staff
PracticeServer
GP /DN
consultation