End of Life Care

Overview

Palliative care is defined by the World Health Organisation as an approach that improves the quality of life of patients (adults and children) and their families who are facing problems associated with life-limiting illness, usually progressive. It prevents and relieves suffering through the early identification, correct assessment and treatment of pain and other problems whether physical, psychosocial or spiritual.

In England, the term ‘end of life care’ refers to the last year of life.

NHS England » Palliative and end of life care

Please also see the NHS patient guide to End of life care - NHS (www.nhs.uk)

The following pages may also be useful:

• ReSPECT Plus
• End of life care - community support
• St Peters Hospice
• Weston Hospice
• SR1 Form (formerly DS1500)
• End of life care (children)

Prognostic Indicator and EOL Checklist

Prognostic Indicator

The prognostic indicator guidance has been updated and replaced with the Proactive Identification Guidance: https://www.goldstandardsframework.org.uk/proactive-identification-guidance-pig  (you need to complete a registration form to download) this aims to help clinician’s in the earlier recognition of patients who are nearing the end of life and identifying the specific needs of the patient.

EOL Checklist

See the EOLC checklist for GPs. You may also find the Carers Checklist for End of Life Support useful.

BNSSG ICB has developed a new End of Life Shared Care plan called ReSPECT Plus for recording patients wishes for when their health deteriorates including DNACPR, and an additional section related to End of Life care that replaces the previous EPaCCS template.

Anticipatory Prescribing

Anticipatory Prescribing Form

Use the Community Anticipatory Drug Chart which includes a guide on parenteral medication to use at end of life. This is available on EMIS as a protocol in the OneCare Resource publisher called ‘Launch Anticipatory Drugs Chart then launch drug adding protocol’.

The protocol displays a series of information boxes, then checks if the eGFR is less than 30 or if the patient has parkinsonism using concepts and if these are present it then offers advice. It then asks if you are using the lowest doses of the standard medication pack and if so it will give the option to create an injectable anticipatory medication chart with the prn medications prepopulated at the lowest doses, otherwise you are presented with a blank chart for you to complete with prepopulated drop down lists.

If a syringe driver is going to be needed in the next couple of days then the second section for 24 hour continuous subcutaneous infusion can also be completed.

After you have printed and saved the chart, it will then offer to add the injectable medications to EMIS and issue them on FP10s.

PLEASE NOTE: When creating the chart you can sign it electronically with your GMC or other professional number, but whether you sign it electronically or in ink on a print out, please ENSURE the front page and each individual drug on the PRN and Syringe Driver pages are SIGNED and DATED.

See follow this link for more advice about using the Anticipatory Drugs Chart including videos on its use - https://teamnet.clarity.co.uk/Library/ViewItem/dcbde8e1-ee69-4a39-b833-aaf000a69bf7.

If you need support with this, please contact one of One Care's digital consultants. 

Opioid conversion tables

Please see the St Peters Hospice website for Local Clinical Guidelines .There is a link to their Guidelines on the management of pain due to cancer in adults which includes opioid conversion tables.

Prescribing guidance.

Please see the guidance on the St Peter's Hospice Website on prescribing

BNSSG Formulary - Chapter 16 Palliative Care

BNSSG Formulary- palliative care guidelines

Palliative Care Guidelines

Patient Support

Macmillan

Macmillan produce useful booklets for patients such as End of Life and Bereavement and Your Life and your choices: Plan Ahead. These are available to order or download from Macmillian.

Marie Curie

In conjunction with Macmillan, Marie Curie has produced booklets for both people in the final stages of life and their carers.

Hospice

Bristol and South Gloucestershire - Please see St Peter's Hospice page.

North Somerset - Please see Weston Hospice page.

End stage liver and kidney disease

Advice on management and symptom control in patients with end stage liver or kidney failure can be found in the Remedy pages below:

Chronic Liver Disease

Chronic Kidney Disease

Advance Care Plans

Living Wills, Advance Statements and other documents can be completed from the comfort of people’s own homes if need be, with free, specialist support available from charities such as Compassion in Dying, without the need for a solicitor.

The Compassion in Dying website guides people through creating a Living Will and/or Advance Statement at their own pace, with further support available on 0800 999 2434.

The Hospice UK website also has resources for patients and professionals.

Chronic pain in the context of palliative and end of life care

Please see Dorothy House’s Information Hub as it contains some videos to help healthcare professionals in the assessment and management of chronic pain, in the context of palliative and end of life care: Chronic Pain - Dorothy House

Resources

Claiming Benefits at End of Life

Patients who are in the last 12 months of life can claim benefits under the Special Rules - see the SR1 Form (formerly DS1500) page for details.

Additional Services

To find additional services within BNSSG please use your MiDoS Login: Login - MiDoS Admin - 2019 (midosweb.co.uk) If you need your password resent, or be issued with one, please contact: Dosteam.southwest@nhs.net

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.