Liverpool Care Pathway - "Let Your Fingers Do The Walking..."?

"The truth will come to light; murder cannot be hid long; a man's son may, but at the length truth will out."

Downsizing care expectations and grooming for EoLC...

More on those yellow folders -

Ipswich and East Suffolk CCG - GP Claim Form

Practises are asked to identify patients likely to die within 12 months and initiate fireside chats about EoLC. This goes on the patient notes, which is held in a Yellow Folder. If possible, an EoE DNACPR form is completed and faxed to the Ambulance Service on 01234 215399 and the patient is added to the practise Palliative Care Register.

Why yellow folders? Like the CARE LESs, the one percent, and Carmel Wiseman's "Mission Impossible" slide used in the Six Steps to Success promotion, someone's sick idea of a joke, perhaps? Yellow Pages, we got your number and your number's up...?

This is Ipswich and East Suffolk Clinical Commissioning Group –

This includes a DNACPR Form, replete with GSF-style flowchart, to be completed by the Healthcare Professional following discussion/grooming.

Decisions about CPR are sensitive and complex and should be undertaken by experienced members of the healthcare team and documented carefully.

Grooming is a delicate matter not to be undertaken by the amateur.

An Advance Care Planning Discussion, 'Thinking Ahead', is next on the list, to be signed by the candidate -

Ideally an Advance Care Plan should be discussed to inform future care at an early stage. Due to the sensitivity of some of these issues, some may not wish to answer them all, or may quite rightly wish to review and reconsider their decisions later. This is a ‘dynamic’ planning document to be adapted and reviewed as needed and is in addition to Advanced Directives, Do Not Resuscitate plan, or other legal document.

This is a 'dynamic' document; as grooming progresses the care expectations may be progressively downsized.

Next, there is a 'Patient Passport'.

Patient Passport...?

Is it me or does that sound, somehow, sinister?

Wow...

The GSF is going for gold.

It's a NHS GSF Patient Passport –

The Doctor/GP caring for this patient agrees to complete a certificate unless there are reportable circumstances.
Doctor/GP’s Name (Please print): 

______________________________________
Doctor/GP’s Signature:
______________________________________

It's reassuring to know the doc's ready to sign the certificate. Just make sure you've covered all your bases, though...


Lastly, there is Directory of Key Contacts –




"Timely, coordinated and consistent..."

What's this, SMART objectives...?

This is more from Ipswich and East Suffolk Clinical Commissioning Group –

Specific intentions for 2013/14 include:

• development of the means of identifying patients who have palliative and end of life care needs, supported by a relevant prognostic tool, in a timely manner particularly in hospitals and care homes. This will include:

            - providing multi-professional education and training 

            - the use of End of Life tools 

            - the use of the yellow folders;

A 'relevant prognostic tool'... The GSF is already a front runner.

The things you may wish for include -

I do not wish for an attempt for my heart and lungs to be restarted if they stopped functioning. (Cardiopulmonary Resuscitation)
• I do not wish to be artificially fed or hydrated.
• I do not wish to receive antibiotics for a particular infection (please state)
• I do not wish to receive Non-invasive Ventilation (NIV) if my breathing becomes more difficult
- Planning for your Future Care

"I do not wish to be artificially fed or hydrated."

Well...

That solves a lot of problematic issues!

More of the same here from West Suffolk CCG –

Specific intentions for 2013/14 include:

• the delivery of timely, coordinated and consistent palliative and end of life care, including signposting to bereavement services
• development of the means of identifying patients who have palliative and end of life care needs, supported by a relevant prognostic tool, in a timely manner particularly in hospitals and care homes. This will include: providing multi-professional education and training, the use of End of Life tools and the use of the yellow folders.
• DNACPR information will be communicated when patients are discharged, where applicable
• development of a robust and dynamic system that enables information sharing across all agencies involved. There will be continued piloting and extension of the use of the Electronic Palliative Care Coordinating System/ EoL register
• exploring the extension of Advanced Care Planning to patients resident in their own homes, to include educational content as raised by the current practitioner

The word is spreading...