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Found 107 results
  1. Content Article
    Advance Care Planning (ACP) is becoming increasingly important in ensuring that people receive good care and ultimately experience a “good death”. ACP can lead to less aggressive or invasive medical care, better quality of life near death, decreased rates of hospital admission, and people being more likely to receive care that is aligned with their wishes and dignity. It can be a difficult subject to discuss and can be confusing for health and social care professionals, staff and families, due to a lack of knowledge about ACP and a lack of awareness regarding the legal position.
  2. Content Article
    The current COVID-19 pandemic has necessitated the redeployment of NHS staff to acute-facing specialties, meaning that care of dying people is being provided by those who may not have much experience in this area. This report published by Future Healthcare Journal, details how a plan, do, study, act (PDSA) approach was taken to implementing improved, standardised multidisciplinary documentation of individualised care and review for people who are in the last hours or days of life, both before and during the COVID-19 pandemic. The documentation and training produced is subject to ongoing review via the specialist palliative care team's continuously updated hospital deaths dashboard, which evaluates the care of patients who have died in the trust. It is hoped that sharing the experiences and outcomes of this process will help other trusts to develop their own pathways and improve the care of dying people through this difficult time and beyond.
  3. Content Article
    The COVID-19 pandemic is challenging health care systems worldwide; none more so than critical and intensive care settings. Significant attention has been placed on the capacity of intensive care units (ICUs) to respond to a COVID-19 surge, particularly in relation to beds, ventilators, staffing and personal protective equipment. This position statement has been produced by the Australian College of Critical Care Nurses and the Australian College of Infection Prevention and Control (ACIPC) to guide critical care nurses in facilitating next-of-kin presence for patients dying from COVID-19 in the ICU.
  4. Content Article
    All hospitals have access to specialist palliative care teams, whether as in-house hospital palliative care teams or in-reach teams from local palliative care services. These teams will be able to provide advice and support, but it will not be possible for them to provide direct care to everybody who needs it, especially as the pandemic progresses. This NHS guidance is aimed at all professionals looking after patients with coronavirus, and their families, in the hospital setting.
  5. Content Article
    Health Education England has published a set of materials and films which aim to support staff through difficult conversations arising from the COVID-19 outbreak.
  6. News Article
    The government is under pressure to go further on measures to relax rules on powerful painkillers such as morphine to prevent patients suffering “unnecessary pain and distress in the last days of their lives”. On Tuesday the health secretary, Matt Hancock, announced staff in care homes and hospices would be allowed to “re-use” controlled drugs such as morphine and midazolam, with medication prescribed for one patient used for another where there is an immediate need. But the Home Office today confirmed to The Independent that it had no plans to extend the rules to the care of patients in their own homes – a restriction experts and charities have warned could leave people suffering at the end of their lives. The government announced the changes following concerns over the supply of drugs. The Royal College of GPs (RCGP) welcomed the changes announced by Mr Hancock, calling them “a significant step forward”, but added: “This only applies to patients living in care home and hospice settings, so there is still work to be done to ensure patients living in their own homes have appropriate access to necessary medication in a timely way.” Last week the RCGP wrote to home secretary Priti Patel warning that people were suffering unnecessarily due to problems accessing drugs. Read full story Source: The Independent, 30 April 2020
  7. Content Article
    This is a guide to end of life care symptom control when a person is dying from COVID19 for General Practice Teams, prepared by the Royal College of General Practitioners (RCGP) and the Association for Palliative Medicine.
  8. Content Article
    This poster has been developed by Dr Antonia Field-Smith and Dr Louise Robinson from the Palliative Care Team at West Middlesex Hospital. It provides a guide for communicating with relatives with compassion during the Covid-19 pandemic.
  9. News Article
    Elderly care home residents have been categorised “en masse” as not requiring resuscitation, in a strategy branded unacceptable by the healthcare regulator. People in care homes in Hove, East Sussex and south Wales are among those who have had “do not attempt resuscitation” (DNAR) notices applied to their care plans during the coronavirus outbreak without proper consultation with them or their families, MPs and medical unions fear. Care homes in Leeds have reported that district nurses have been asking them to “revisit do not resuscitate conversations with people who said they didn’t want them” and a care worker in Wales told the Guardian that after a visit from a GP, all 20 of their residents had DNAR notices attached to their plans. DNAR notices are a common part of care plans and many people wish to have them in place because, in the event of cardiac arrest, attempts to resuscitate can cause serious trauma, including broken bones. But the Care Quality Commission and other medical bodies are so concerned about the blanket application of the notices that it has issued a warning to stop. “It is unacceptable for advance care plans, with or without DNAR form completion, to be applied to groups of people of any description,” the notice states. “These decisions must continue to be made on an individual basis according to need.” Read full story Source: The Guardian, 1 April 2020
  10. Content Article
    This link provides a framework for end of life care and breaking bad news during the Covid-19 pandemic. It has been created by e-LfH, a Health Education England Programme in partnership with the NHS and Professional Bodies. Resources include: Discussion of Unwelcome News during Covid-19 Pandemic: a framework for health and social care professionals  Covid-19: Evidence-based advice for difficult conversations Scottish Quality and Safety Partnership Poster - unwelcome news Real Talk Framework Telephone Prompt List Real Talk Framework Sketch Note Video 1 - The framework Video 2 - Community (Advance Care Planning: how I have the conversation) Video 3 - Breaking bad news Video 4 - Ceilings of Treatment. Nb: The below link will take you to a landing page. To access the end of life resources listed above, you will need to go to the 'End of Life Care' folder and then to 'Documents and Videos'. 
  11. Content Article
    This page provides a list of useful resources for healthcare staff who are working in intensive care units and critical care roles during the COVID-19 pandemic.
  12. Content Article
    Difficult conversations are always needed in healthcare and are important in order to offer informed choice of what treatments will be of benefit to the patient and are important to manage the expectations of patients, families and clinicians. But what is currently happening during the coronavirus pandemic in primary care? What should be best practice? Claire, a clinical outreach nurse, explores this in her latest blog.
  13. News Article
    A GP surgery has apologised after sending a letter asking patients with life-limiting illnesses to complete a "do not resuscitate" form. A letter, from Llynfi Surgery in Maesteg, asks people to sign to ensure emergency services would not be called if their condition deteriorated due to coronavirus. "We will not abandon you.. but we have to be frank and realistic," it said. Cwm Taf health board issued an apology from the surgery, the Guardian reports. The letter says in an "ideal situation" doctors would have had this conversation in person but had written to them due to fears they were carrying the virus and were asymptomatic. Read full story Source: BBC News, 1 April 2020
  14. Content Article
    The Talking about dying report seeks to offer advice and support for any doctor on holding conversations with patients much earlier after the diagnosis of a progressive or terminal condition, including frailty. The report identified that the timely, honest conversations about their future that patients want are not happening. Yet, these proactive discussions are fundamental to effective clinical management plans, part of being a medical professional and align with the aspirations of the Royal College of Physicians's Future Hospital Commission report. The Talking about dying report begins to highlight and challenge professional reluctance to engage in conversations with patients about uncertainty, treatment ceilings, resuscitation status and death. It offers some ‘mythbusters’ to get physicians thinking and we offer signposts to tools and educational resources to support physicians and other healthcare professionals.
  15. News Article
    Palliative care doctors are urging people to have a conversation about what they would want if they, or their loved ones, became seriously unwell with coronavirus. We should discuss all possible scenarios - even those we are not "comfortable to talk about", they said. Medics said the virus underlined the importance of these conversations. New guidelines are being produced for palliative care for Covid-19 patients, the BBC understands. Read full story Source: BBC News, 21 March 2020
  16. Content Article
    This is the second part of Irene Tuffrey-Wijne's (Professor of Intellectual Disability and Palliative Care at St Georges NHS Trust) blogs on end of life care for people with learning disabilities. This time focusing on why it is important. 'End of life care planning is not so much a question of where and how do you want to die? But where and how do you want to live until you die?'
  17. Content Article
    This is part 1 of a series of blogs on end of life care planning and people with learning disabilities. This is a tricky subject as there seems to be confusion on the language. What's the difference between an end of life plan and a funeral plan? Should these plans be for young and old - well and unwell? What does the CQC say? This blog, by Irene Tuffrey-Wijne, Professor of Intellectual Disability and Palliative Care at St Georges NHS Foundation Trust, should give you some of these answers.
  18. Content Article
    Asking a simple yet powerful question: ‘what matters to you?’ can give us, as healthcare professionals, vital insights into the lives of our patients, not always captured in routine assessments. If what matters to a patient is then shared with the whole multidisciplinary team (MDT) it can ensure that ongoing support and treatment is focused around the patients’ priorities, rather than what we think is important as healthcare professionals. It becomes truly patient focused. This blog was written by Ann Bryan, a physiotherapist, and Ines Brito, an occupational therapist, both part of the therapy team working at the Marie Curie hospice in Hampstead.
  19. News Article
    The Care Quality Commission (CQC) has awarded 'Outstanding' ratings to St Giles Hospice in Walsall and Whittington. The CQC, an independent regulator of health and social care services in England, has recently introduced a new regime holding hospices to the same level of scrutiny as hospitals, making this outstanding rating all the more impressive. St Giles hospice, founded in 1983, started as a charity caring for local people dying from cancer and now supports people living with incurable illnesses and their families for free. Care providers from the hospice work on-site and in patients’ own homes, and their level of care has made them one of only a handful of hospices to ever have been awarded this accolade. In the CQC report inspectors complimented the hospice for its “compassionate” range of speciality services. Inspectors added: “People were truly respected and valued as individuals. They were empowered as partners in their care, practically and emotionally, by an exceptional and distinctive service.” Read full story Source: National Health Executive, 16 January 2020
  20. Content Article
    Helping patients and their families cope during a terminal illness is fundamental to good health care and that depends on professionals and the people in their care having access to the right information at the right time to support them. The Professional Record Standards Body (PRSB) has published the crisis care standard to support better coordination of treatment in primary,acute and community care, as well as hospices, care homes, and social services. The standard will also help patients to avoid unnecessary admissions and procedures.
  21. Content Article
    A powerful account from a daughter on the care her mum and dad received in hospital.
  22. Content Article
    Critical care teams frequently have to deal with uncertainty of prognosis and outcome, simultaneously react to changing physiology with resuscitative measures, consider palliative interventions and communicate (with empathy) rapidly changing situations to patients and families during very distressing times. Shared decision-making is regarded as best practice but lack of capacity often precludes this. If more information about patients’ wishes and beliefs were available ICU teams would be better positioned to make Best Interests decisions, enabling individualised care, thereby minimising confusion and conflict due to clear communications about advance care planning.
  23. Content Article
    The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) is a process supported by the Resuscitation Council (UK) and UK Royal Colleges to create personalised anticipatory care plans for patients. Hampshire Hospitals NHS Foundation Trust has been an early adopter of this process with variability in engagement with this process across our trust. Published in Progress in Palliative Care, this paper describes a quality improvement project was performed to improvement engagement with ReSPECT as well as consistency and quality of documentation.
  24. Content Article
    In this Editorial published in BMJ Quality & Safety, Major and Aphinyanaphongs discuss the challenges in translating mortality risk to the point of care. Despite advances in medicine, prognostication remains inaccurate for many patients. Physicians tend to overestimate survival, even in advanced cancer and terminal illness groups. Over half of terminally ill patients express they do not want prolonging of life if their quality of life would decline. End-of-life interventions such as advanced care planning have shown improved adherence to patient’s wishes, improvement in satisfaction and reductions in stress, anxiety and depression, but clinicians remain reluctant to initiate end-of-life discussions with terminal patients if they are currently asymptomatic. Automated systems can complement clinician judgement to prompt earlier end-of-life discussions.
  25. Community Post
    What training have you had to have that crucial end of life conversation with a patient and their relatives? What has helped you have those conversations?
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