Anticipatory Care Planning using the electronic Palliative Care Summary

(ePCS)

August 2010

Dr Peter KiehlmannGP, Aberdeen & National Clinical Lead

Palliative Care eHealth

peter.kiehlmann@scotland.gsi.gov.uk

http://www.scotland.gov.uk/LivingandDyingWellhttp://www.ecs.scot.nhs.uk/epcs.html

Questions?

What is ePCS? Who can use it? How does it help

Patients & carers Staff

In-hours Out of hours?

Developing an Anticipatory Care Plan

The maze of trees

“How we care for the dying must surely be an indicator of how we care for all our sick and vulnerable patients. Care of the dying is urgent care – with only one opportunity to get it right, to create a potential lasting memory for relatives and carers…”

Professor Mike Richards CBE

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

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

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 Patient’s & Carer’s understanding of

diagnosis/prognosis Just in Case – Rx & equipment Advice for OOH care

GP Mobile no., death expected? Cert. etc

EMIS - Summary

ePCS no diagnosis added yet

Diagnosis agreed with pt & added

Patient/Carer Wishes

New ECS build screenshots

Access to PCS Information

Base ePCS –view in Adastra

Mobile ePCS - Adastra

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!

Profile of People who die

UK1900 /

Age at death

46 Top 3 causes

1. Infectious diseases

2. Accident

3. Childbirth

Disability before death Not much

UK 2000

Age at death

78 Top 3 causes

1. Cancer

2. Organ failure

3. Frailty/ dementia

Disability before death Months - many years

Death

High

LowMany years

Function

Death

High

LowMonths or years

Function

Organ failure

6

Acute2

Dementia, frailty and decline

7

Death

High

LowWeeks, months, years

Function

5

Cancer

GP has 20deaths perlist of 2000patients peryear

How to deliver End of Life care for all?

Palliative Care DES (1 of 20!)

1. Put pt on Palliative Care Register Clinical, Pt choice, Surprise Question From Prognostic Indicator Guidance

2. Send OOH form/ePCS within 2w 3. Make Anticipatory Care Plan – as ePCS inc. Preferred Place of Care/death 4. When dying use LCP /locally agreed pathway

Aim- encourage anticipatory care, for all diagnoses

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 started Sep 09 Evaluation by Edinburgh University

complete National rollout in progress complete

early 2011 Link with Board Leads for timings

Palliative Care, eHealth,OOH

ePCS – Summary

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