Transcript End of Life Care - St George`s Hospital

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STAFF BRIEFING
An overview of essential processes and policies
This document contains:
1) An overview of the key points within essential process and policy
2) Useful contacts for each area
3) Signposts to additional policy information on the intranet
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Question 3 : Are they caring?
Equality and diversity
Interpreting services
Complaints
Communication effectively with patients
End of life care and DNACPR
Friends and Family
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Equality and Diversity
What is equality and diversity?
• Equality and diversity is a term used to define and champion equality, diversity and
human rights as defining values of society. It promotes equality of opportunity for all,
giving every individual the chance to achieve their potential, free from prejudice and
discrimination.
• Direct discrimination is when one person receives less favourable treatment than
another person because of a protected characteristic.
What training is provided by the trust?
• E&D is part of the new starter induction programme
• It is also part of the MAST programme, covering:
• Equality Act - protected characteristics, EDS and public sector duty
• Differences between equality and diversity
• Prejudice, stereotyping, unconscious bias
• Institutational discrimination
• Benefits of E&D to the organisation, staff, patients/visitors
• Local policy and procedures, including bullying and harassment
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Equality and Diversity
What are the statutory requirements?
• The Equality Act 2010 came into force in May 2012
• All NHS organisations are required to make sure health and social care services are
fair and meet the needs of everyone, whatever their background or circumstances.
• The Equality Act 2010 offers protection to nine characteristics. These are:
• age
• race
• sex
• gender reassignment status
• disability
• religion or belief
• sexual orientation
• marriage and civil partnership status
• pregnancy and maternity
• The law also protects people who are at risk of discrimination by association or
perception. For example, a carer who looks after a disabled person.
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Equality and Diversity
How do I demonstrate equality and diversity in care?
For example…
• Does the patient understand?
• Interpreting services available for inpatient or outpatient consultations (either
face to face or by telephone)
• Is the interpreting services poster clearly displayed?
• Are patients’ needs catered for?
• Catering for nutritional needs - special menu available where necessary
• Red trays for those that need help and red tumblers and jugs for those who
would need help with fluids
• Multi-faith chaplains available
• Respecting specific wishes as part of care plan (e.g. Jehovah’s witnesses)
How do I find out more?
• Trust lead for equality and diversity – Wilfred Carneiro Ext 4175
• Within divisions, the Governance Manager will be able to offer guidance
• Trust intranet contains key policies, e.g. HR policy – Equality and Diversity in
Employment
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Interpreting and signing guidance
• Whenever possible we should not rely solely on, or expect family members or
staff to interpret or sign for patients. (In an emergency this may be necessary).
There are different types of support available, some that need to be booked in
advance and some that are available 24/7.
• If you have any queries, please contact PALS or visit their intranet site. Out of
hours please contact the site management team.
The support that is available is:
•Face to face interpreting (foreign language)
•Telephone interpreting (foreign language)
•British sign language
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Interpreting and signing guidance
Face to face interpreting services
• Is not available out of hours and must be booked in advance. A minimum of three
days notice is required.
• Face to face interpreting services are provided by Central and North West London
NHS Foundation Trust Interpreting Service. To book, fill in the booking form
available on the PALS intranet site
• Email the booking form to [email protected] or fax to 020 3317 2940
Telephone interpreting service
• Is available 24 hours a day and can be used in an emergency
• Is provided by Language Line telephone interpreting service
• Staff should locate their department ID on the PALS intranet page and call
0845 310 9900. Full instructions are provided on the intranet.
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Interpreting and signing guidance
British Sign Language (BSL)
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Please note that the British Sign Language service should be booked in advance.
However there is an emergency service available from the Royal Association for
Deaf People (RAD) which can be accessed by calling 07974325563.
There are a number of providers you can access. However the RAD is our
preferred supplier.
The booking form and further information is available on the PALS intranet site.
Please note all BSL interpreting services will need to be paid for direct from your
departmental budget.
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Complaints
• We must always try to resolve someone’s concerns at the time. Referring them to
PALS or to make a complaint straight away is not always helpful.
• If you don’t feel confident to resolve an issue find a senior colleague
• If someone does want to speak to a more senior person try to contact that person for
them rather than just giving them a number, and document concerns
• If you respond to complaints please offer a local resolution meeting, not all replies
have to be via letters
• Say sorry if someone is upset (even if not your “fault”), it is not an admission of guilt
and usually is all that someone wants to hear
• Don’t take it personally or get defensive, someone may be just upset but not with
you
• If you know someone is cross or upset don’t avoid them, it will make things worse
• If you are concerned something may be a serious incident ensure it is reported on
Datix and tell your manager and document it
• If there are serious concerns about care/neglect/abuse contact the Matron/Senior
Nurse or Midwife and the Safeguarding Lead David Flood on bleep 8031
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Communicating effectively with patients
• Always seek permission and explain what you are doing
• Don’t assume that the patient understands – encourage them to ask any questions
• Provide leaflets or written information if it would be helpful
• Involve the person at every opportunity – explain what the plan of care is and ensure
that they are in agreement
• Keep patients, relatives and carers updated as appropriate, even if nothing new, let
them know.
• Don’t talk over or about patients in their earshot, even if they are unconscious or
confused
• Remember intentional/comfort rounds if appropriate. Tell the patient when you will
be coming back so they are reassured and don’t have to rely on their call bell or
telephone if at home
• Document conversations with the patient and any preferences or plans they have
• Remember to ask the patient to complete the FFT and RaTE surveys for feedback
• If patients need an interpreter or signer contact PALS on ext 2453 or if outside 020
8725 2453 and for an IMCA the Safeguarding Lead Nurse David Flood on bleep 8031
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Palliative and end of life care
Palliative care
Palliative care is the active holistic care of patients with advanced progressive illness. It affirms
life and regards dying as a normal process.
• Involves management of pain and other symptoms
• Provides psychological support for patients and families to help cope during the patients
illness and their own bereavement.
• Provides social support
• Provides spiritual support
• Neither hastens nor postpones death
“The goal of palliative care is achievement of the best quality of life for patients and their
families” (NICE)
End of Life Care
End of Life Care is a term interchangeable with Palliative Care and can refer to care given at any
time between the last year and last days of life. An ‘End of Life Care Plan’ specifically refers to
care in the last hours to days of life.
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Palliative and end of life care
The Palliative Care Team at St. George’s is a multidisciplinary team of Doctors, Clinical Nurse
Specialists and a Counsellor.
•The team provides:
• Advice and support for any in-patients with life limiting illness
• Symptom control
• End of life care (last hours/days)
• Rapid discharge home project (fast track service)
• Regular teaching for Trust staff and undergraduate students
•The team is available for face to face visiting 7 days a week 9am to 5pm
• Outside of these hours telephone advice is available from the on call Registrar at Trinity Hospice
via 0207 787 1000
•Referrals should be made by bleeping the referral bleep 6508. Urgent referrals seen within 24hrs.
•The Palliative Care Team Intranet Homepage contains links to:
• McKinley Syringe Pump Policy
• Care in the last days of life guidance
• Education links
• Rapid discharge guidance
• Team contact details
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Care in the last hours and days of life
• All patients who are identified by the Senior Clinician in charge of their care as
being in the last hours or days of life should be referred to the palliative care
team and have an individual end of life care plan.
• The Principles of ‘Care for Dying Patients’ and ‘Daily End of Life Care Guide’ are
available via the palliative care homepage on the intranet. The following
principles are detailed.
• Communicate
• Document
• Review interventions and medications
• Maintain excellent basic care
• Assess symptoms regularly
• Identify support needs of family
• Identify spiritual needs
• Care after death
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Do Not Attempt Cardio Pulmonary
Resuscitation ( DNACPR)
• Cardiopulmonary resuscitation (CPR) is a treatment that could be
attempted on any individual in whom cardiac or respiratory function ceases.
• It is essential to identify patients for whom cardio-pulmonary arrest
represents the terminal event in their illness and for whom CPR will not work
and / or is inappropriate.
• It is also essential to identify those patients who would not want CPR. If a
patient with capacity refuses CPR or has a valid and applicable advance
decision refusing CPR, this should be respected
DNACPR decisions apply only to CPR and not to any other aspects of
treatment
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DNACPR Process
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The responsibility for DNACPR decision-making rests with the most senior clinician, It is
recommended that these decisions should not be made in isolation, but where
appropriate, should involve the patient (or those close to the patient if s/he lacks
capacity) and others involved in the clinical care of the patient.
When planning the care of the patient, a decision should be made with regards to
whether the patient would benefit from CPR should they suffer a cardiac arrest. Ideally,
this should be done on admission and be reviewed if there is a significant change in the
patient’s medical condition. ( the decision making framework is available in the Trust’s
DNACPR policy, page 6)
If the decision is to not attempt resuscitation, this should be documented clearly using
the trust’s DNACPR form which is then filed at the front of the patient’s medical notes.
Teamwork and good communication are of paramount importance. It is fundamental
that any DNACPR decision is communicated to all members of the multidisciplinary
team involved in the patient’s care
DNACPR decisions must be reviewed regularly and especially where there is a change in
the patient’s condition or in the patient’s expressed wishes.
At St George’s, DNACPR compliance is audited and reported on annually as part of the
Trust’s risk management strategy
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Friends and Family Test (FFT)
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Encourage patients to complete the Friends and Family Test
Ask on discharge from care
The survey asks patients - How likely are you to recommend us?
Average 1,200 surveys a month
Tablets, kiosks and paper (RaTE system)
A&E, wards and now Maternity
Minimum number of surveys required 15%
The score can range from -100 to +100
We report every month and on public website
Interpreting results
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What is you area’s score and % of surveys?
What reasons do patients give?
What actions are being taken?
Are you displaying the results?
Also ask 9 or 10 other questions about experience