The Treatment The Treatment Escalation Plan (TEP)Escalation Plan (TEP)

and and Resuscitation Decision RecordResuscitation Decision Record

FOR DEVON FOR DEVON

Across all health sectors Across all health sectors into the homeinto the home

NHSNHS TEP implementation groupTEP implementation group

July 2014July 2014

Looking to a broader planLooking to a broader plan

►““All people approaching the end of life All people approaching the end of life need to have their needs assessed, need to have their needs assessed, their wishes and preferences their wishes and preferences discussed and an agreed set of actions discussed and an agreed set of actions reflecting the choices they make about reflecting the choices they make about their care recorded in a care plan” their care recorded in a care plan” The The NHS End of Life Care Strategy (2010)NHS End of Life Care Strategy (2010)

Looking to a broader planLooking to a broader plan

Many people are still needlessly sent to hospital to die simply because care home staff do not know what else to do.

► The Second Annual Report of the End of Life Care Strategy, Department of Health. London, August 2010.

Senior clinicians should make treatment decisions close to the

patient, intervening early and managing uncertain prognosis.

► National End of Life Care Programme. Improving end of life care. The route to success in end of life care – achieving quality in acute hospitals. Department of Health. London, 2010

The NHS Devon TEPThe NHS Devon TEPWhy is the form itself useful?Why is the form itself useful?

►Improvement upon DNR process►An overall plan►Adoption of one form across ALL OF

DEVON’S health community ensures continuity of care approach

Aims

►All appropriate patients are included in TEP process

►TEP process completed with engagement of patient/family

►Complete as much of form as possible (although not mandatory)

TEP – How to do itTEP – How to do it

►Document the plan in the TEPDocument the plan in the TEP►Keep a Keep a copycopy of the original TEP in the clinical of the original TEP in the clinical

notesnotes►Let the original TEP stay with the patientLet the original TEP stay with the patient

On their fridge at homeOn their fridge at home With their care home managerWith their care home manager

► If the TEP is changed ensure the patient has If the TEP is changed ensure the patient has the new original and an updated copy is kept the new original and an updated copy is kept for the clinical notesfor the clinical notes

►Cancel preceding TEPsCancel preceding TEPs

This is not really about This is not really about forms......forms......

It’s about a It’s about a conversation.conversation.

Key pointsKey points

►Conversations about TEPs are not Conversations about TEPs are not compulsorycompulsory

►Timing needs to be rightTiming needs to be right►Part of a process of Advance Care Part of a process of Advance Care

PlanningPlanning

Doing the TEP in the acute hospital;

Discussions with the patient/family

►Things you might say I don’t think Intensive Care has anything

to offer you that will get you better Readmitting you to the hospital again

may not be the best thing for you. Can we talk about ways of looking after you at home?

Sending the form home with the Sending the form home with the patientpatient

►This This mustmust be discussed with patents be discussed with patents before dischargebefore discharge

►Should we do that?Should we do that?►There may be times when it is There may be times when it is

burdensome for the patient to have burdensome for the patient to have that conversation, if so, form should that conversation, if so, form should not be sent home.not be sent home.

What if it’s not right to send a What if it’s not right to send a TEP form home?TEP form home?

►Communicate with the GP. Communicate with the GP. ►Let them know what decisions were Let them know what decisions were

made about the patient while they made about the patient while they were in Hospital.were in Hospital.

►They can continue the process of They can continue the process of planning at home.planning at home.

Sending the form home with the Sending the form home with the patient: some words to try.....patient: some words to try.....

►We are working closely with Out –Of-We are working closely with Out –Of-Hospital doctors, ambulance teams Hospital doctors, ambulance teams and community nurses and matrons.and community nurses and matrons.

► If an emergency happened and a 999 If an emergency happened and a 999 ambulance was called, they would be ambulance was called, they would be duty bound to start CPR if you haven’t duty bound to start CPR if you haven’t said somewhere that you didn’t want said somewhere that you didn’t want it.....they follow protocols and it.....they follow protocols and guidelines.guidelines.

► I’m not convinced that that would be I’m not convinced that that would be right for you, given your illness.right for you, given your illness.

Sending the form home with the Sending the form home with the patient: some ways.....patient: some ways.....

►There is a form which we can put in There is a form which we can put in your house/send home with you that your house/send home with you that can let ambulance crews know what can let ambulance crews know what treatment plan we’ve decided treatment plan we’ve decided together.together.

What other tools do we have What other tools do we have available?available?

►Preferred Priorities of Care documentPreferred Priorities of Care document►Advance Decisions to Refuse Advance Decisions to Refuse

Treatment documentTreatment document

Other TEP resources

►See www.devontep.co.uk educational movies downloadable teaching material Guidelines and information Patient information

Comments regarding TEP can be sent to Comments regarding TEP can be sent to tep-sw@nhs.net

Key MessagesKey Messages

► The Treatment Escalation Plan (TEP) and Resuscitation Decision The Treatment Escalation Plan (TEP) and Resuscitation Decision Record is a clinical decision making tool and common sense Record is a clinical decision making tool and common sense should be applied to who should have one.should be applied to who should have one.

► Only complete appropriate boxes.Only complete appropriate boxes.

  ► The TEP should be completed in collaboration with the patient The TEP should be completed in collaboration with the patient

and family where possible and should be reviewed over time.and family where possible and should be reviewed over time.

► The TEP is only good if everyone knows it exists – update the The TEP is only good if everyone knows it exists – update the Electronic End of Life Register (Adastra).Electronic End of Life Register (Adastra).

► The TEP travels with the patient wherever they go.The TEP travels with the patient wherever they go.