PR300415-Priorities of Care of Life Care/IOW... · 24 Priorities of Care 30 April 2015 Version 2 ‘Priorities of Care’ Individualised Care Plan Information for doctors For patients

1Priorities of Care 30 April 2015 Version 2

‘Priorities of Care’Individualised Care Plan

Patient’s name

NHS number

Senior clinician

Registered nurse/Key worker responsible for care

Key worker contact number

Out of hours telephone number

Priorities for care

1. The possibility that a person may die within the next few days or hours is recognised and communicated clearly, decisions made and actions taken in accordance with the person’s needs and wishes, and these are regularly reviewed and decisions revised accordingly.

2. Sensitive communication takes place between staff and the person who is dying, and those identifi ed as important to them.

3. The dying person, and those identifi ed as important to them, are involved in decisions about treatment and care to the extent that the dying person wants.

4. The needs of families and others identifi ed as important to the dying person are actively explored, respected and met as far as possible.

5. An individual plan of care, which includes food and drink, symptom control, psychological, social and spiritual support, is agreed, coordinated and delivered with compassion.

Commencing this Care Plan is a multidisciplinary decision.Put the ‘information for Drs sheet’ in the Medical/Progress notes.

2 Priorities of Care 30 April 2015 Version 2

Professionals and Agencies Involved in the Patient’s Care

Patient’s name

Date of birth NHS number

Lasting Power of Attorney

Name Telephone number

Address Health & wellbeing Property & fi nance

Psychological and Bereavement Services

Name

Date referred Telephone number

Nurse Specialist/Nursing Services involved



Faith or Religious Support

Name of Chaplain/Vicar or Priest

Contact number

Care Agency

Name

Date referred Telephone number

Consent to share information

To assist with your care we may have to refer you to other healthcare professionals and share your information with them.

Please tick box if patient consents to this Patient agreed

Name of advocate Patient advocate agreed


Patient Information

Patient’s name


Assessor sign Designation

Assessor print Date Time

Address/Addressograph Telephone

PostcodeMobile

GP name Telephone

Surgery

Diagnosis

Other relevant information

Allergies

Preferred place of care

Is there an advance care plan (ACP)? Yes No

Is there an Advance Decision To Refuse Treatment (ADTRT)? Yes No

Where is it held?

Cardiopulmonary Resuscitation Status (DNACPR) Yes No

Where is it held?

Religion/Faith

Family/Carer contact details1st contact

Family/Carer contact details2nd contact

Name Name

Relationship Relationship

Address Address

Contact number Contact number

Contact number 2 Contact number 2

Care in the community

Triage bypass card in place Yes No

Is an ACP/ADRT held on Adastra Yes No

Just in case medication in place Yes No


Record of Initial Discussion

Patient’s name


Nurse sign Designation

Nurse print Date Time

• Record conversation with patient, their understanding of their diagnosis and prognosis.

• Record mental capacity at the time of the conversation.

• Identify if a Cardiopulmonary Resuscitation Decision has been made and if the patient was involved with this decision.

• Identify those present during the conversation.

• Record conversation with those close to the patient, their understanding of the diagnosis and prognosis.

• The level to which they wish to be involved in the patient’s care.

Record all subsequent conversations on the Record of Conversations.


Baseline Nursing Assessment /Re-Assessment

Patient’s name




Communication

(Detail any barriers or needs, including sight or hearing loss)

Neural capacity assessment

Patient’s understanding of their condition/Including mental capacity

Detail fears or concerns

Family’s understanding of the patient’s condition

Detail fears or concerns

Psychological, emotional and spiritual needs

EatingIs clinically assisted nutrition required Yes No

MUST score

DrinkingIs clinically assisted hydration required Yes No

Bowel care

Urinary output

Describe urinary output Is catheter in situ? Yes No

Suprapubic or urethral Date last changed

Breathing

Mobility

(Please detail any moving or handling requirements)

Waterlow score

Skin careAre there any wounds/injury? Yes No

If Yes, detail wound care in care plan


Daily Nursing Assessment and Management of Symptoms

(Review 4 hourly if needs are rapidly changing)

Patient’s name




No Problem Summary of problems Signature

1 Pain

2 Nausea

3 Vomiting

4 Secretions

5 Dyspnoea

6 Urinary

7 Bowels

8 Skin care/Pressure areas

9 Eating

10 Drinking

11 Mouth care

12 Agitation

13Psychological, emotional, spiritual

14 Mental capacity

15 Other problem


Daily Nursing Care Plan(Plan more frequently if needs are rapidly changing)

Patient’s name




Time Planned care/Care given

Please record all care planned including personal hygiene

Time Evaluation and key issues to take forward

Signature of evaluator Print




Patient’s name





1 Pain

2 Nausea

3 Vomiting

4 Secretions

5 Dyspnoea

6 Urinary

7 Bowels


9 Eating

10 Drinking

11 Mouth care

12 Agitation


14 Mental capacity

15 Other problem



Patient’s name











Patient’s name





1 Pain

2 Nausea

3 Vomiting

4 Secretions

5 Dyspnoea

6 Urinary

7 Bowels


9 Eating

10 Drinking

11 Mouth care

12 Agitation


14 Mental capacity

15 Other problem



Patient’s name











Patient’s name





1 Pain

2 Nausea

3 Vomiting

4 Secretions

5 Dyspnoea

6 Urinary

7 Bowels


9 Eating

10 Drinking

11 Mouth care

12 Agitation


14 Mental capacity

15 Other problem



Patient’s name











Patient’s name





1 Pain

2 Nausea

3 Vomiting

4 Secretions

5 Dyspnoea

6 Urinary

7 Bowels


9 Eating

10 Drinking

11 Mouth care

12 Agitation


14 Mental capacity

15 Other problem



Patient’s name











Patient’s name





1 Pain

2 Nausea

3 Vomiting

4 Secretions

5 Dyspnoea

6 Urinary

7 Bowels


9 Eating

10 Drinking

11 Mouth care

12 Agitation


14 Mental capacity

15 Other problem



Patient’s name











Patient’s name





1 Pain

2 Nausea

3 Vomiting

4 Secretions

5 Dyspnoea

6 Urinary

7 Bowels


9 Eating

10 Drinking

11 Mouth care

12 Agitation


14 Mental capacity

15 Other problem



Patient’s name









Additional Information

Patient’s name


Date/Time Please record repositioning/mouthcare/other care here Signature/Print/Designation


Additional Information

Patient’s name


Date/Time Please record repositioning/mouthcare/other care here Signature/Print/Designation


Communication Sheet(Record all multidisciplinary decisions, conversations

with patients and relatives)

Patient’s name


Date Time Communication Signature/Print/Designation


Communication Sheet(Record all multidisciplinary decisions, conversations

with patients and relatives)

Patient’s name


Date Time Communication Signature/Print/Designation



Information for doctors

For patients who are probably dying

• It is very hard to be certain that a person is dying. Sometimes it is reasonable to be giving basic ward treatments whilst also giving symptom control drugs.

• Communicate clearly with the family about the expected prognosis and any uncertainty and document your thoughts and the contents of any discussions. An example of what might be said is, “I think your father is dying but there is a small chance he may pull through. We’ll continue to try antibiotics at the moment but we will also aim to keep your father pain free with appropriate medications so that if he continues to deteriorate, he won’t suffer.”

• It is important to ensure that the following has been clearly documented in the appropriate place:

Advanced care plan/advanced decision to refuse treatment/do not resuscitate and ceilings of treatment decisions.

• Issues to consider include:

What PRN medications may be needed to relieve suffering? Write these up before they are needed.

How important is maintaining hydration at this stage? How important are longer term medications such as anti-hypertensives? How important is it to know the vital signs?

Is there an ICD in situ? If so, it will need deactivation.

What would be the best site of care for this patient?

After death occurs, will a post-mortem or referral to the Coroner be required? If so, it may be helpful to discuss this with the family early.

The patient’s previous occupation, time of death and people present at death will be needed to fi ll out paperwork after death.

• See the Isle of Wight’s Palliative Medicine Symptom Advice Guidelines for help. Hard copies can be obtained from the Earl Mountbatten Hospice, electronic copies can be downloaded from their website and mobile and tablet apps can be downloaded from the iOS, Android and Windows app stores.

• Please don’t hesitate to call the Island’s palliative care team for advice +/- a review if you feel this might help.

(Place this sheet in the medical/progress notes when commencing the Priorities of Care, Care Plan)



Information for nurses

For patients who are probably dying

• Good nursing care will make a person’s death more peaceful and dignifi ed where the focus of care is on maintaining comfort and relieving suffering; this care will extend to family members who will be fi nding the time incredibly stressful, and time will be needed in caring for and communicating with the family too.

• It is helpful to communicate well with the medical staff about what they think the prognosis is and whether recording observations such as blood pressure are still needed.

• It is important to have recorded in the appropriate part of the case notes information related to:

Lasting power of attorney and next of kin and family members contact details.

• To minimise suffering, physical and symptom observations of most relevance are:

Pain

Nausea

Vomiting

Secretions

Dyspnoea

Urinary incontinence or retention

Bowel incontinence or constipation

Skin care and pressure areas

Oral intake and mouth care

Agitation

• Document in the medical/progress notes if any of the above are particularly concerning and, if required, speak to the treating medical team if PRN medications are not bringing relief.

• Document the contents of any discussions with family members in the medical/progress notes.

• Other issues to think about include:

Is there a role for a chaplain or input from other spiritual or religious leaders?

Is there a role for psychological or bereavement services?

• Please don’t hesitate to call the Island’s palliative care team for advice +/- a review if you feel this might help.


Care After Death

Patient’s name


For an expected death at home call 111.

Refer to policy for care after death, the management of patient’s property and the deactivation of ICDs.

Date of death

Certifi ed by

Referred to the Coroner Yes No Date

Tissue donation

Funeral arrangements

Burial Cremation

Chosen Funeral Director Telephone number

Family and carer needs

Name

Relationship

Contact details

Other needs


Signature Sheet

Patient’s name


Please give your full name, designation, full signature and initials below if you write in this care plan.This is for legal purposes.

Full name (printed) Designation Full signature Initials


Photocopy these notes and retain photocopies in the records if patient is

transferred between hospital, hospice or home.

Documents

PR300415-Priorities of Care of Life Care/IOW... · 24 Priorities of Care 30 April 2015 Version 2 ‘Priorities of Care’ Individualised Care Plan Information for doctors For patients