Download EOLC Minutes - Croydon Health Services NHS Trust

End of Life Steering Group Meeting
Minutes of Meeting held on
10th July 2013
Crosby Wing Meeting Room, Nightingale House
Present:
Caroline Adams (CA), Chair - Palliative Care CNS
Dr Debra Swann (DS), - Palliative Care Consultant
Kate Burridge (KB) – Palliative Care CNS
Sharon DeSouza (SD) – Palliative Care CNS
Dr Lim (SL) – Consultant
Leena Knowles (LK) – Chaplaincy
Tina Lawton – Heart Failure CNS
Karen Grindrod – CRT CNS
Carol Mamora – OT
Anne James (AJ) – Practice Development Nurse
Sister Lizzie Magurie (LM) - Wandle 1
Paula Lobo – Specialist Trainee Palliative Medicine
Apologies
Francis Hanrahan, Glynis Chestnut, Victoria Wray
1.
Previous Minutes: Reviewed and agreed
2.
Terms of Reference
CA presented Draft End of Life Care Steering Group Terms of Reference.
Membership, quorum, frequency of meetings, chairs, feeder committee were all agreed.
It was agreed that a representative from pharmacy, community nursing and a service
user representative would be welcome additional members to call upon as needed by the
group.
Action: CA to send TOR to Eunice Hollist for review and ratification at Patient
Issues Committee
3.
LCP Version 12
CA presented an update on version 12 LCP use in the hospital. LCP v12 is now
implemented on all adult care wards. SL advised there was still lack of clarity about
where the LCP document was kept across the wards. The group agreed that a standard
location across wards for the LCP document would be helpful. It was agreed for the
document to be placed in the folder at the patient’s bedside attached to the drug chart.
This would not change with the introduction of Cerner Millennium as the LCP document
will not be electronically available on Cerner. AJ advised that there is a productive ward
white LCP magnet used on some wards to highlight that a patient is being cared for using
the LCP.
Action: CA to clarify with all ward managers where the LCP document is to be kept
on all wards.
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4.
EOLC CQUIN:
a). Update from 2012-2013:
DS & SDS updated the group on the progress of the end of life care CQUIN. In 20112012, the initial pilot ward for the EOLC CQUIN was Purley 3. In 2012-13 the Croydon
Respiratory Team (CRT), were introduced as a new speciality to the CQUIN
incorporating use of the Coordinate My Care Record (CMCR) for advanced care
planning. DS reported that for 2012/2013 CUH had achieved 100% of its end of life care
CQUIN.
b). CQUIN 2013-2014:
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increased uptake of advanced care planning but via CMCR,
identification of leads for the end of life care CQUIN in Croydon respiratory team,
heart failure, dementia, cancer A&E and elderly care,
Education and training of staff in the emergency care team and all front line
clinical staff about CMCR.
The overall training target is to achieve 60% of front line staff in the defined group
trained in advance care planning and what CMCR actually is.
N.B: There is no target from commissioners re number of patients details
uploaded onto CMCR, the target required is about numbers of staff trained about
CMCR.
c). Co-ordinate my care register:
DS explained some of the background of the end of life care CQUIN and advanced care
planning. DS advised that when people have expressed a wish to die at home, it is
usually a crisis that brings them back into hospital. Out of hours responders may know
little about the patient’s individual situation despite the patient having thought about
advanced care planning. CMCR provides an electronic database and with patients
permission information is readily available to London Ambulance Service, 111 services
and out of hours GP providers about the individual patients advanced cared planning.
The palliative care team at CUH have been uploading individual patient details to CMCR
for 18 months or so and more than 500 in Croydon globally are on the register. This
must now be rolled out across specialties.
5.
Any Other Business:
a). Nomination of End of Life Care Leads for EOLC CQUIN:
Nominated leads for the end of life care CQUiN were agreed:
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Tina Lawton is the lead for heart failure
Karen Gindrod is the lead for Croydon Respiratory Team
Victoria Wray is the lead for Dementia
Sharon DeSouza is the lead for Cancer
The leads must identify all front line staff to be trained about CMCR. The additional
requirement is that all staff in A&E have training about CMCR.
b). T34 McKinley CME Medical Syringe Pumps:
KB provided an update on the introduction of these new syringe pumps to CHS. 47
McKinley syringe pumps were purchased last year in response to the NPSA alert. The
pumps have been used across the whole Trust since November 2012 in the hospital and
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the community where pumps are held at District Nurse bases. In hospital pumps are
held in the equipment library and are brought the wards as needed. Site Practitioners
are able to access pumps out of hours. Ward nurses are getting to grips with using
pumps. There is on-going training from the nurse trainers with monthly updates.
Needless devices for use with the McKinley pumps will be introduced over the next few
weeks with training on how to use these, ongoing at the moment.
Action: DS&KB will support the introduction of syringe driver prescriptions on
Cerner Millennium. KB will discuss the possibility of incorporating the syringe
driver checklist on to vital pack with Dr Soper.
Lizzie Magurie advised that checklist for PCAs and epidurals are already in place on vital
pack. KB advised that when Cerner prescription drugs go live, there should remain
initially a separate monitoring form for safety.
KB advised that implementation of McKinley pumps has gone relatively smoothing. EME
print out a monthly update on any problems with the pumps or repairs needed. There
have been a few problems with porters accessing pumps out of hours. The Graseby
pumps which were previously used have been donated to the developing world.
c).Heart Failure Service:
Tina Lawton updated the group with regards to heart failure patients, she hopes that
membership of the steering group and establishing the lead for heart failure within the
end of life care CQUiN will lead to more joint working with palliative care, particularly in
terms of symptom management in end stage heart failure and incorporating the use of
diuretics. SL highlighted the role of elderly care consultants out-patient clinics and
supporting GPs to manage difficult symptoms in heart failure.
d). Training of AHPs:
CM updated the group that KB and the palliative care social worker, Martha Noah
provided training for therapies which has been very effective. Therapies continue to
need advice and support, particularly about which patients are at the end of their life and
which patients need a mix of palliative care and rehabilitation.
CM advised it would be useful of occupational therapy to receive updates about CMCR.
She also discussed continuing need for education generally for OTs about palliative care,
particularly regarding expectations of rehab.
e). Education:
CA discussed with AJ that the end of life care session on the clinical update education
programme for nurses had been lost recently because the clinical update was required to
focus on patient safety.
Action: AJ will discuss with the senior nursing team and look for opportunities to
reinstate this teaching.
f). Ward Supply of End of Life Medications:
CA, KB, SDS and DS reported the difficulty in ensuring wards have adequate stock of
injectable medications for symptom management out of hours. LK said she had
witnessed some of the problems described out of hours and at the weekend in terms of
planning for patient deterioration and access to medicines. SL agreed that she had
witnessed wards running out of end of life injectable medicines and that nurses must plan
for their medicines out of hours and at weekends.
Action: AJ to bring this to the attention of ward sisters and matrons, and explore
further.
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g). Out of Hours Cover:
DS noted we need to encourage better written and verbal communication across all
teams to highlight those patients who may be expected to deteriorate and die out of
hours with a management plan written in the notes. PL reminded us of the on-call
consultant for St Christopher’s Hospice being available for telephone advice out of hours
and over the weekend and suggested a low threshold for referral by the medical teams
for phone advice.
h). CRT Update
KG described similar concerns from the Croydon Respiratory Team to the heart failure
team in terms of extended disease trajectory and quite a long period of deterioration.
Work to do includes use of rescue packs, a more joint working and collaboration with
palliative care. DS highlighted the availability of the breathlessness clinic at St
Christopher’s Hospice.
6.
Dates of Future Meetings
 Friday 4th October 2013 – 2pm Crosby Wing Meeting Room, Ground Floor,
Nightingale House
 Friday 6th December 2013 – 2pm Crosby Wing Meeting Room
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