electronic Palliative Care Summary (ePCS)
Grampian ECC 16th September 2010
Dr Gillian BrewisGP, Inverurie & Palliative Care Lead
Aberdeenshire Central CHPDr Peter Kiehlmann
GP, Aberdeen & National Clinical Lead Palliative Care eHealth
http://www.scotland.gov.uk/LivingandDyingWellhttp://www.ecs.scot.nhs.uk/epcs.html
The maze of trees
“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
The aim of the work is to leave families with what can only be described as a “good
enough” memory of the life, dying and death of their child or in some cases children...
Questions?
What is ePCS? Who can use it? How does it help
Patients & carers Staff
In-hours Out of hours?
Rollout Future Developments
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
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
ePCS Overview
OOH clinician ePCS display
ePCS update 1. During
consultation
2. Due to prescription
3. Team meeting or other contact
Audit
trail
ECSStore
NHS 24
A&E
Ambulance
TBD…
Practice Admin. Staff
PracticeServer
GP /DN
consultation
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
Patient’s & Carer’s understanding of ) Care diagnosis/prognosis ) Plan
Just in Case – Rx & equipment ) Advice for OOH care )
GP Mobile no., death expected? Cert. etc )
Use in Secondary Care
As routine some admitting units Take consent from patient Print off ECS – Current Drugs and Allergies from
GP Attach to Hospital Notes as 1st part of record
If ePCS present, seen in same way as ECS Medical History – summarised, relevant Preferred Place of Care DNACPR Status
EMIS - Summary
screenshots
Showing std EMIS screenEMIS Screen ePCS recordNHS24 call handler screenAdastra – used in GMED – centre & car
SAME DATA seen in all places available in any acute admitting Unit
ePCS no diagnosis added yet
Diagnosis agreed with pt & added
Patient/Carer Wishes
New ECS build screenshots
Access to PCS Information
Base ePCS –view in Adastra
Mobile ePCS - Adastra
Increasing use ePCS Apr-Aug 2010
Board % use ePCS Aug 2010
Current ePCS use Aug 2010
Board Practices % using Live Total Remaining ePCS
Lothian 74 126 52 59%Grampian 24 83 59 29%Dumfries & Galloway 10 35 25 29% Western Isles 2 12 10 17%Gtr Glasgow & Clyde 42 272 230 15%Forth Valley 8 58 50 14% Ayrshire & Arran 5 59 54 8%Orkney 1 14 13 7% Lanarkshire 5 98 93 5% Borders 0 24 24 0%Fife 0 57 57 0%Highland 0 102 102 0%Shetland 0 10 10 0%Tayside 0 69 69 0%
Grand Total 171 1019 848 17%
Using ePCS in practice –a continuing process
Does this pt have Palliative Care Needs?Does this pt have Palliative Care Needs? Add to Pall Care Register, Add to Pall Care Register, Once Consents to send ePCS ->OOH,Once Consents to send ePCS ->OOH,
agree Medical History, set review dateagree Medical History, set review date Once consented any new info goes automaticallyOnce consented any new info goes automatically Not expected to complete in one go!Not expected to complete in one go! Complete pt wishes and Understanding, DNA CPR, record Complete pt wishes and Understanding, DNA CPR, record
“Just in case” Rx and Equipment as appropriate“Just in case” Rx and Equipment as appropriate Regular review at PHCTRegular review at PHCT Keep updating!Keep updating!
Profile of People who die
UK1900 /
Age at death
46 Top 3 causes
1. Infectious diseases
2. Accident
3. Childbirth
Disability before death Not much
UK 2000
Age at death
78 Top 3 causes
1. Cancer
2. Organ failure
3. Frailty/ dementia
Disability before death Months - many years
Death
High
LowMany years
Function
Death
High
LowMonths or years
Function
Organ failure
6
Acute2
Dementia, frailty and decline
7
Death
High
LowWeeks, months, years
Function
5
Cancer
GP has 20deaths perlist of 2000patients peryear
How to deliver End of Life care for all?
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
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
Questions?
How best to roll out in your Board? Lothian Pall Care/Oncology Discharge letters Benefits to Sec Care EPS /ePCS
Meetings planned with key stakeholders Primary Care / Palliative Care / OOH / eHealth/ LTCs
Awareness Raising/Training Websites – LDW and ECS
PIL, PIG, 1st Steps Clinical Systems Training material
Nov 2nd pm Workshop – all Board leads for ePCS Living and Dying Well delivery 2010
Assessment Tools Anticipatory Care Plans Palliative Care DES ongoing Communication Training National Resuscitation Policy – DNA CPR “Public awareness Death, Dying & Bereavement”
ePCS Overview
OOH clinician ePCS display
ePCS update 1. During
consultation
2. Due to prescription
3. Team meeting or other contact
Audit
trail
ECSStore
NHS 24
A&E
Ambulance
TBD…
Practice Admin. Staff
PracticeServer
GP /DN
consultation
