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Showing results for tags 'End of life care'.
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News Article
‘Do not resuscitate’ orders caused potentially avoidable deaths, regulator finds
Patient Safety Learning posted a news article in News
Do-not-resuscitate orders were wrongly allocated to some care home residents during the COVID-19 pandemic, causing potentially avoidable deaths, the first phase of a review by England’s Care Quality Commission (CQC) has found. The regulator warned that some of the “inappropriate” do not attempt cardiopulmonary resuscitation (DNACPR) notices applied in the spring may still be in place and called on all care providers to check with the person concerned that they consent. The review was prompted by concerns about the blanket application of the orders in care homes in the early part of the pandemic, amid then prevalent fears that NHS hospitals would be overwhelmed. The CQC received 40 submissions from the public, mostly about DNACPR orders that had been put in place without consulting with the person or their family. These included reports of all the residents of one care home being given a DNACPR notice, and of the notices routinely being applied to anyone infected with Covid. Some people reported that they did not even know a DNACPR order had been placed on their relative until they were quite unwell. “There is evidence of unacceptable and inappropriate DNACPRs being made at the start of the pandemic,” the interim report found, adding that the practice may have caused “potentially avoidable death”. Read full story Source: The Guardian, 3 December 2020 -
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Content ArticleC-Diff Dentures in the healthcare setting Discharge instructions Drug allergies End of life care Falls at home Getting the right diagnosis Handwashing Hospital ratings Influenza (the flu) Latex allergies Medical records Medication safety at home Medication safety: Hospital and doctor's office Metric-based patient weights MRI safety MRSA Neonatal abstinence syndrome (NAS) Norovirus (stomach flu) Obstructive sleep apneoa Pneumonia Pressure injuries (bed sores) Sepsis What is an MRI? Wrong-site surgery
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Content ArticleDrawing together insights from an extensive expert roundtable in November 2019, prisoner consultation and wider research, the analysis covers primary care and chronic disease management, care of older prisoners, dementia care, social care provision, compassionate release, palliative care, culture, workforce and training. These findings lead to 15 recommendations grouped into the following themes: Improve join-up and information sharing across services and departments. Implement improvements to primary and secondary care. Take steps to improve provision and care for specific vulnerable groups. Improve end of life care across the prison estate. Enhance the profile of prison healthcare as a career. Improve learning and investigations. Ann Norman, the RCN’s Professional Lead for Criminal Justice, said: "We are seeing a growing number of natural deaths in custody and this has now reached an unacceptably high level. These deaths may be prevented if there is adequate care, particularly for those prisoners with long-term chronic conditions. The Government must act now to make sure that prisoners’ health is properly managed, as it would be in the community.” Juliet Lyon, Chair of the Independent Advisory Panel on Deaths in Custody, said: “Many so-called natural deaths in prison can and should be avoided. Our report draws together information from health and justice experts, investigators and people in prison to examine how such deaths could be prevented and how end of life care can be managed with dignity and compassion. During Covid-19, the struggle to identify prisoners who, for clinical reasons, would have been shielded in the community and the failure to effect safe temporary release for all but a few, has thrown the challenges presented by the poor health of the prison population into sharp relief.”
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News ArticleAn urgent investigation into blanket orders not to resuscitate care home residents has been launched amid fears some elderly people may still be affected by the “unacceptable” practice. After COVID-19 cases rose slightly in care homes in England in the last week, with 116 residences handling at least one infection, the Care Quality Commission (CQC) said it was developing the scope of its investigation “at pace” and it would cover care homes, primary care and hospitals. In March and April, there were reports that some GPs had applied “do not attempt resuscitation” (DNAR) notices to groups of care home residents that meant people would not be taken to hospital for potentially life-saving care. This was being done without their consent or with little information to allow them to make informed decisions, the CQC said. Cases emerged in care homes in Wales and East Sussex. Care homes said the blanket use of the orders did not appear to be as prevalent ahead of a possible second wave of infections and families were reporting fewer concerns, although that could be because visiting restrictions meant they had less access to the homes and were getting less information. There are also concerns that steps may not have been taken to review DNAR forms added to care home residents’ medical files, and so they could remain in place, without proper consent. The CQC review will examine the use of “do not attempt cardiopulmonary resuscitation” (DNACPR) notices, which only restrict chest compressions and shocks to the heart. Dr Rachel Clarke, a palliative care expert in Oxford, has described the CPR process as “muscular, aggressive, traumatic” and said it often resulted in broken ribs and intubation. The review will also investigate the use of broader do not resuscitate and other anticipatory care orders. “We heard from our members about some pretty horrific examples of [blanket notices] early in the pandemic, but it does not appear to be happening now,” said Vic Rayner, the executive director of the National Care Forum, which represents independent care homes. “DNAR notices should not be applied across settings and must be only used as part of individual care plans.” It will also investigate the use of broader do not resuscitate and other anticipatory care orders. Read full story Source: The Guardian, 12 October 2020
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An Introduction to End of Life Care
Claire Cox posted an article in Learning disabilities
Contents: The importance of good quality end of life care What is the difference between end of life care and palliative care? Useful words that can help you understand end of life care Talking about death and dying Talking about death to the dying person Respecting human rights and a right to know Human rights and end of life care Supporting people at the end of their life. -
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Advanced Care Planning (Macintyre)
Claire Cox posted an article in Learning disabilities
Why is Advance Care Planning Important? What is Advance Care Planning? Who can undertake Advance Care Planning and when should it occur? When should Advance Care Planning take place? Identify ways of promoting positive communication around ACP Recognise barriers to communication Promoting opportunities for discussion and responding to 'cues' Time and place Communicate and Listen Documenting References. -
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Content ArticleKey recommendations Ask the patient if they would like to have the conversation and how much information they would want. All healthcare professionals reviewing patients with chronic conditions, patients with more than one serious medical problem or terminal illness, should initiate shared decision making including advance care planning in line with patient preferences. Conversations about the future can and should be initiated at any point. The conversation is a process not a tick-box, and does not have to reach a conclusion at one sitting. Be aware of the language you use with patients and those they have identified as being important to them, and try to involve all the relevant people in agreement with the patient.
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Helping break unwelcome news (Health Education England)
Claire Cox posted an article in Coronavirus (COVID-19)
This web page includes: Films The framework Community Breaking bad news Ceilings of treatment Resources Evidence-based advice for difficult conversations, by Professor Ruth Parry, Loughborough University Poster and sketch note Telephone call checklist -
Content ArticleThis guidance is produced during the COVID-19 outbreak in order to support the care in the community of patients and those important to them, at the end of their lives or who are unwell as the result of COVID-19 or other life-limiting illnesses. This document will be updated and adapted as further contributions are received and in line with changing national guidance. The most current version of the guidance document will be available on the public-facing pages of the RCGP COVID-19 Resource Hub and Association for Palliative Medicine website. Please check that you are referring to the most current version.
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Content ArticleImagine... You are 80 years old. You live independently and have a full social life with friends of similar ages. You have no close family; your friends are your family. You are very much part of the community and enjoy life. Every winter you get a ‘bad chest’. You visit the GP when this happens and get antibiotics. This is your only health issue. Being locked down hasn’t been an issue for you. Life is different, but the village you live in has a great support network, you can get shopping delivered, you are connected via the internet to your activity groups – even tai chi on zoom! You receive a phone call from your GP. They state "...with your chest, it's unlikely that you will survive this virus. So, I need to ask you... do you want to be placed on a ventilator and do you want to be resuscitated?" They expect an answer while they are on the phone to you. You have less than 5 minutes to respond. "Errrrrr, yes… I have lots to live for, please do everything you can" is your reply. You put the phone down and cry. You are scared. What now? This is a real case that was told to me this morning. ‘Difficult conversations’ are needed. They have always been needed. Whether that be in primary care or secondary care, these conversations are important. It is important to find out what patients and families wishes are, important to offer informed choice of what treatments will be of benefit and important to manage expectations from both, patient, families and clinicians. Much has been written on how to have these conversations, when to have these conversations and by whom – this advice has been written in a non-pandemic time where people have the time, have up to date, clear information that patients and families can discuss the issues. Some GPs are using the RESPeCT document, its been slow to adopt and spread, but if completed makes the world of difference. Having an open conversation about dying may feel taboo, but you only get to die once (usually)… you may as well do it well. Where I work clinically, all patients who are suspected COVID-19, have a treatment escalation form completed as they are admitted. This informs other clinicians what treatment that patient can receive during their admission. If a patient doesn’t have a treatment escalation discussion, patients may experience unnecessary pain, suffering or futile treatment that they didn’t want, but were unable to say. The treatment escalation form and process we are using has transformed and streamlined our care. We are now able to give the right care to the right patient at the right time. Patients and families are fully informed and are grateful for having the conversation. But what happens during the pandemic in primary care? GPs are unable to wait for their patients to turn up to the surgery to have these conversations. Many of their patients are the most vulnerable, in care homes, the homeless and often difficult to reach. Is a telephone call, out of the blue the best way of having this conversation? GPs have hundred, if not thousands of patients on their case load, how are they to have meaningful conversations during this pandemic with the most vulnerable? This blog is not to highlight the bad practice. It is not a time for naming and shaming. We are learning together. Are you doing things differently? Do you have a solution? Are you a patient and have an idea on how we can do this better?
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Content ArticleMEs are a key element of the death certification reforms, which, once in place, will deliver a more comprehensive system of assurances for all non-coronial deaths, regardless of whether the deceased is buried or cremated. MEs will be employed in the NHS system, ensuring lines of accountability are separate from NHS Acute Trusts but allowing for access to information in the sensitive and urgent timescales to register a death. This case study outlines the approach of South Tees Hospitals NHS Foundation Trust as one of the early adopter sites. To date, the following learning points have been identified and explored: End of Life Care, ceilings of care and avoidable admissions Some investigations have highlighted cases where the End of Life Care pathway could have either been established or fully implemented, where this would have been of benefit to patients and their families. Some patients may not have been cared for in the right location, and some admissions could have been avoided if the End of Life Care pathway had been suitably established and followed. Early detection and response to physiological deterioration, and effective communication Response stretched by implementation of National Early Warning Score (NEWS) but still learning around effective communication of escalation. The use of standardised communication tools is essential. Record keeping and organisation of medical records Some learning was identified in relation to the accuracy and completeness of medical records. It was evident that not all records are reflective of the clinical picture. Discussion with specialty teams is vital to support the investigation An independent review by the ME should be further supported by speciality ‘experts’, and if possible, peer review from other trusts can be sought to allow for full independent review. Seeking speciality opinion from those not directly involved with the case within STHFT has also been shown to be effective. Pathways for links to wider clinical governance processes have been strengthened.
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News Article
Coronavirus: GP surgery apology over 'do not resuscitate' form
Patient Safety Learning posted a news article in News
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 -
News Article
UK healthcare regulator brands resuscitation strategy unacceptable
Patient Safety Learning posted a news article in News
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 -
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Coronavirus: Doctors urge conversations about dying
Patient Safety Learning posted a news article in News
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 -
Content ArticleThis case study outlines: Aims, objectives and scope Method and approach Measurement plan Learning points Plans to spread the learning and adoption
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Content ArticleDarzi Alumni, Claire Cox , who was hosted by the Kent Sussex and Surrey Academic Health Science Network, summarises the barriers and assumptions held with in the system of learning from deaths and serious incidents. 1 deaths and serious incidents.pdf
