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Developments in End of
Life Care
John SheridanEnd of Life Care Clinical Educator
Tools available in the trust• AMBER care bundle
• Last Days of Life Care Plan
• Rapid Discharge Pathway
• Advance Care Planning
• DNACPR
• Advance Decisions to Refuse Treatment
Pre-pathway Step 1 Step 2 Step 3 Step 4 Step 5 Step 6
Identification of people in the last year of life
Discussions as the end of life approaches
Assessment, care planning and review
Co-ordination of care
Delivery of high quality of services in different settings
Care in the last days of life
Care after death
LCP
Rapid Discharge
AMBER Care Bundle
Advance Care Planning, including Preferred Priorities for Care
Electronic Palliative Care Co-ordination Systems
Key developments
End of Life Care Education
End of Life Care Education
Community Clinical Educator and Part
Time Acute Clinical Educator
Community Clinical Educator and Part
Time Acute Clinical Educator
Full Time Acute Clinical
Educator in End of Life Care
Full Time Acute Clinical
Educator in End of Life Care
End of Life added to trust
Stat-Mand Training
End of Life added to trust
Stat-Mand Training
CommunicationCommunication
Collaborative educational
working
Collaborative educational
workingRole Champions
Development Programme
Role Champions Development Programme
Development of best
practice tools
Development of best
practice tools
Multi-professional End of Life Education
Days
Multi-professional End of Life Education
Days
Location based
training
Location based
training
Transfer of Care ethos – not discharge
Transfer of Care ethos – not discharge
AMBER care bundle
For patients whose recovery is uncertain
• Care Plan recognised by all professionals in all settings:
community, hospital, hospice, ambulance
• Patient Held CarePlan
• End of Life Care Educational Days
• St. Catherine’s Hospice courses in communication skills.
• Guidance in relation to Advance Care Planning
• Role Champions development
• Network development – always someone to ask!
Opportunities
Can we make a difference• Change perceptions of ‘discharge’ into
‘transfer of care’
• Alerting as to admissions for susceptible patients
• Provide all MDT members, even extended members, with essential information
• Explicit information sharing – GP End of Life Register, Advance Care Plan, Preferences.
Importantly …….Unlike other aspects of care delivery and
treatment …….. We get only one opportunity to provide end of life care.
Getting it right first time is not an option
….. It is ESSENTIAL.
Contact for helpYork Acute• John Sheridan, End of Life Care Clinical
Educator, Ext 1106• Debbie Bayes, End of Life Care Clinical
Educator, Ext 1480• Specialist Palliative Care Team York Ext
5835• Out of Hours: St Leonard’s Hospice
01904 708553
Contact for help
Scarborough• Christine Wilson, End of Life Care
Clinical Educator, 01723 342446 • Specialist Palliative Care Team 01723
342446 • Out of Hours: “Pall Call”, St Catherine’s
Hospice, Scarborough: 01723 354506
Contact for help
Community• Becky Shaw, Community End of Life
Care Clinical Educator (07809) 519754• Specialist Palliative Care Team
Community York & Selby (01904) 724476
• Specialist Palliative Care Team Community Scarborough (01723) 356043