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Difficult discussions at the end of life SCIMP Nov 2010

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Difficult discussions at the end of life SCIMP Nov 2010 Using the electronic Palliative Care Summary (ePCS) & Key Information Summary (KIS) as Anticipatory Care Plans – PowerPoint PPT presentation

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Title: Difficult discussions at the end of life SCIMP Nov 2010


1
Difficult discussions at the end of life SCIMP
Nov 2010
  • Using the electronic Palliative Care Summary
    (ePCS)
  • Key Information Summary (KIS)
  • as Anticipatory Care Plans
  • Dr Peter Kiehlmann
  • GP, Aberdeen National Clinical Lead Palliative
    Care eHealth
  • Dr Libby Morris
  • GP, Edinburgh National Clinical Lead Primary
    Care eHealth

2
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
  • Future developments Key Information Summary
    (KIS)

3

4
The maze of trees
5
  • 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
6
Living and Dying Well
  • to ensure a comprehensive approach to
    palliative care based on clinical need and not
    diagnosis, age, post code, creed or ethnicity
  • Outputs from many expert groups
  • GMC Guidance on End of Life Treatment and care
  • How to help Clinical staff to have confidence to
    deliver quality Pall End of Life Care

7
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

8
ECS
  • Patient info from GP computers -gt ECS store twice
    daily
  • Medication Allergies
  • 97 of GP Practices
  • gt5 million patients
  • Explicit Consent to view
  • Read only available to
  • NHS24, AE, AMAU, SAS

9
Emergency Care Summary benefits
  • Covers 99 of population
  • Used by 4500 NHS staff
  • 50,000 accesses per week
  • (3.5million to date)
  • EU-commissioned independent evaluation
  • Benefits found included
  • patient safety, time saving, faster treatment
    decisions
  • financial value assigned to costs and benefits,
    over time.

10
Usage progress of ECS
  • Pilot 2004, full rollout 2006
  • Over 5.3 million patient records
  • 1900 patient opt-outs (0.03)
  • 5.5 million clinical accesses to ECS since launch
  • Average 195,000 accesses per month
  • 2.17 million ECS accesses were made from Jan
    Dec 2009, an increase of 37 from 2008

11
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12
Ongoing ECS Projects
  • Go live with Scottish Ambulance Service
  • In Cab paramedic use
  • Integration with Clinical Portal
  • North and West Portals in testing
  • Integration with National PMS
  • InterSystems developing user interface
  • Integration with FairWarning
  • Audit reporting linked to use of other eHealth
    systems

13
ePCS Overview
GP /DN consultation
14
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
  • Patients Carers understanding of ) Care
    diagnosis/prognosis
    ) Plan
  • Just in Case Rx equipment )
  • Advice for OOH care
    )
  • GP Mobile no., death expected? Cert. etc )

15
EMIS - Summary
16
ePCS no diagnosis added yet
17
Diagnosis agreed with pt added
18
Patient/Carer Wishes
19
New ECS build screenshots
Access to PCS Information
20
Base ePCS view in Adastra
21
Mobile ePCS - Adastra
22
Using ePCS in practice a continuing process
  • Does this pt have Palliative Care Needs?
  • Add to Pall Care Register,
  • Once Consents to send ePCS -gtOOH,
  • agree Medical History, set review date
  • Once consented any new info goes automatically
  • Not expected to complete in one go!
  • Complete pt wishes and Understanding, DNA CPR,
    record Just in case Rx and Equipment as
    appropriate
  • Regular review at PHCT
  • Keep updating!

23
Profile of People who die
  • UK1900 /
  • Age at death
  • 46
  • Top 3 causes
  • Infectious diseases
  • Accident
  • Childbirth
  • Disability before death
  • Not much
  • UK 2000
  • Age at death
  • 78
  • Top 3 causes
  • Cancer
  • Organ failure
  • Frailty/ dementia
  • Disability before death
  • Months - many years

24
How to deliver End of Life care for all?
GP has 20 deaths per list of 2000 patients
per year
25
Palliative Care DES (1 of 26!)
  • 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

26
Current ePCS Use Aug 2010
  • Health Board Practices of Total
  • Lothian 74 54
  • Greater Glasgow Clyde 42 15
  • Grampian 24 29
  • Dumfries and Galloway 10 28
  • Forth Valley 8
  • Ayrshire Arran 5
  • Lanarkshire 5
  • Western Isles 2
  • Orkney 1
  • 171 16
  • Total summaries 1281

27
N3 Links to Hospices
  • N3 Link required to access ePCS
  • Orders placed by each Health Board through
    national N3 contract
  • Lothian link to Marie Curie underway
  • Completion by end of 2010
  • Other links in planning
  • Will also enable access to other NHS systems (SCI
    Gateway, PMS, SCI Store)

28
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

29
Key Information Summary
  • Proposal / Early development stage
  • Aims to replace paper based faxing of Special
    Notes from GP Practices
  • More generic version of ePCS
  • Support for
  • electronic Anticipatory Care Plans (eACP)
  • Long Term Conditions
  • Mental Health
  • Use existing infrastructure and process

30
Principles of KIS
  • Patient consent required to send information
  • Explicit Consent to view record
  • Review date consent only mandatory fields
  • Flexible
  • Only send information required
  • Focused on Patient Wishes and Safety
  • KIS sent automatically to ECS
  • Further consultation with patients and clinicians
    to be carried out

31
4 Sections on KIS
  • Section 1 Special Note
  • Free text field for information (usually to OOH)
  • Review date and consent
  • Patient and Carer details
  • Section 2 Current Situation
  • Main Diagnosis and Current Issues
  • ACP / Self Management Plan agreement
  • BP and Oxygen

32
4 Sections on KIS
  • Section 3 Care and Support details
  • Homecare support
  • Incapacity / Guardianship
  • Power of Attorney
  • Section 4 Information and Action for OOH / AE
  • DNACPR
  • Current and Preferred Place of Care

33
KIS Next Steps
  • Further consultation planned
  • Development of specifications and plan
  • Discussions with GP Suppliers
  • Discussions with End Users
  • Accelerate to support eACP timescales
  • Learn from ePCS rollout.
  • Maintain patient focus

34
Summary
  • ePCS rollout well underway with increasing use
    and clinical benefit
  • Further projects underway on ECS to build upon
    existing infrastructure and process
  • Key Information Summary (KIS) expected to make
    significant difference to patient safety and care

35
Thank you
  • Dr Peter Kiehlmann
  • GP, Aberdeen National Clinical Lead Palliative
    Care eHealth
  • Dr Libby Morris
  • GP, Edinburgh National Clinical Lead Primary
    Care eHealth
  • peter.kiehlmann_at_scotland.gsi.gov.uk
  • Libby.morris_at_scotland.gsi.gov.uk
  • http//www.scotland.gov.uk/epcs
  • http//www.ecs.scot.nhs.uk/epcs.html

36
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37
ePCS Overview
GP /DN consultation
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