Gold Standards Framework
Dr Mohammed Javid
Aims
• Deaths
– Why, where, how
• End Of Life Care
– EoLC, ACP, PPC, PPD, GSF, LCP
• Gold Standards Framework
– 3 steps
– 5 goals
– 7 Key tasks
Deaths
• 500, 000 per year in the UK
• 1% of the population dies each year
• Cause of death
- 25% cancer
- 20% heart disease
- 15% respiratory disease
- 10% strokes and related disorders
- 30% other
Place of Death
• Where do people want to die ?
–
–
–
–
55% Home
25 % Hospice
10 % Hospital
5 % Care Home
• Where do people die ?
–
–
–
–
55 % Hospital
20% Care Home
20% Home
5% Hospice
End Of Life Care
One year
ACP / PPC
supportive and
palliative care
ACP Advanced care Plan
PPC Preferred priorities of care
PPD Preferred place of death
GSF Gold standards Framework
LCP Liverpool Care Pathway
EoLC End of Life Care
Last days
LCP
deterioration
death/bereavement
Gold Standards Framework
Identify
Which patients may be in the last year of life + their stage?
Use of register+ planning meeting (PIG, NB Coding ) .
Assess
Current and Future Clinical needs and Personal needs
(assessment tools, Advance care planning )
Plan
Planning care in line with needs -cross boundary
Plan care in final days (eg LCP) + action plans
GSF Step 1: Identify
Organ
failure
Sudden
death
Assess
• Symptom assessment
• Personal needs
• Preferred priorities of care
– Place of care
– Place of death
– Advanced Care planning
• Statement of wishes and preferences
• Advance decisions
• Power of attorney
• Patient focussed
– Needs based
– Voluntary
Plan
• Communication
• Out of hours handover
• Drugs in home
– What drugs
– DN prescribing
– Pharmacy
– Syringes, diluents
• OOH bypass number
• Crisis prevention
5 Goals
Patients are enabled to have a ‘good death’
1) Symptoms controlled
2) Preferred place of care
3) Safe + secure with fewer crises
4) Carers feel supported, involved, empowered, and satisfied.
5) Staff confidence, teamwork,
satisfaction, co-working
with specialists and communication better.
7C
C1
Communication
C2
Co-ordination
Register, PHCT Meetings, care plan
Advanced care planning (ACP) eg PPC
Identified co-ordinator for GSF, keyworker for patient
C3
Control of Symptoms
C4
Continuity Out of Hours
C5
Continued Learning
C6
Carer Support
C7
Care in dying phase-
Assessment tools,
Handover form + OOH protocol
Learning about conditions on patients seen, SEA / reflective practice
Practical, emotional, bereavement, National Carer’s Strategy
Protocol LCP / ICP
What should we do ?
Level 1 –
Level 2 –
Level 3 –
register, PHCT meeting, co-ordinator
C1,2
Assessment tools, OOHs handover,
education, audit and reflective practice
C3,4,5
Carer/family support, bereavement plan and
protocol for final days
C6,7
Level 4 –
Sustain and build on developments,
practice protocol, extend
Indicator
Poi
n
t
s
Payment
stage
s
Palliative Care (PC1)
The practice has a complete register available of all
patients in need of palliative care/support.
3
—
Palliative Care (PC2)
3
—
5
—
6
40–90%
The practice has regular (at least 3 monthly) multidisciplinary
case review meetings where all patients on the palliative care
register are discussed.
Cancer (Cancer 1)
The practice can produce a register of all cancer patients
defined as a 'register of patients with a diagnosis of
cancer excluding non-melanotic skin cancers from 1
April 2003'.
Cancer (Cancer 3)
The percentage of patients with cancer, diagnosed within
the last 18 months, who have a patient review
recorded as occurring within 6 months of the practice
receiving confirmation of the diagnosis.
Records and information (Records 13)
2
—
3
—
4
—
6
—
There is a system to alert the out-of hours service or duty doctor
to patients dying at home.
Practice management (Management 9)
The practice has a protocol for the identification of carers and a
mechanism for the referral of carers for social services
assessment.
Education and training (Education 7)
The practice has undertaken a minimum of 12 significant event
reviews in the past 3 years which could include:
New cancer diagnoses
Deaths where terminal care has taken place at home
Education and training (Education 10)
The practice has undertaken a minimum of 3 significant event
reviews within the last year.
Mr W death
• GP and DN ad hoc arrangements - no PPoD
discussed or anticipated
• Problems with symptom control - high anxiety
• Crisis call OOHs - no plan or drugs available in the
home
• Admitted to hospital
• Dies in hospital
• Carer given minimal support in grief
• No reflection by PHCT team on care given
• ? Inappropriate use of hospital bed?
Mr W with GSF
• On GSF Register - discussed at PHCT meeting (C1)
• DS1500 and info given to pt + carer (home pack) (C1,
C6)
• Regular support, visits phone calls - proactive (C1, C2)
• Assessment of symptoms, partnership with SPC customised care to pt and carer needs (C3)
• Carer assessed incl psychosocial needs (C3, C6)
• Preferred place of care noted and organised (C1, C2)
• Handover form issued – care plan and drugs issued for
home (C4)
• End of Life pathway/LCP/minimum protocol used (C7)
• Pt dies in preferred place - bereavement support Staff
reflect-SEA, audit gaps improve care, learn (C5, C6)
Take Home message
• Identify patients in last year of life
– Prognostic indicators
• Assess needs
– GSF tools
• Plan for deterioration and death
Any Questions
• http://www.endoflifecareforadults.nhs.uk/
• http://www.goldstandardsframework.nhs.uk