Why add the option to record an eDNACPR decision in the Future Planning template ?
The TAB above is in development. We would be very grateful for any feedback via the comments page . The addition of an electronic Cardio-Pulmonary Decisions TAB is progressing in light of:
NHS England mandating the use of electronic Palliative Care Co-ordination Systems; which Future Planning seeks to provide for Hampshire.
Harnessing Technology, part of the MCP development infrastructure, saw fit to sponsor the Future Planning project in 2019
The Future Planning Project provided considerable feedback and support in the development of the NHS Digital EoL Interoperability Review attached below. This led to the May 2018 NHS EoL Minimum Dataset and October 2018 HL7 FHIR APIs developed by NHSDigital to encourage sharing of End of Life clinical data between systems.
March 2018 NHS Digital End of Life Interoperability Review
The ReSPECT form, developed by the Resuscitation Council, builds upon Treatment Escalation Plans (TEPs) developed in a number of CCGs over the last 10 years. The ReSPECT form is not however nationally mandated, was released in 2018 as a paper document only and does not have specific SNoMED CT codes to allow production of a truly digital version at the moment. However, it does have numerous teaching and rollout resources behind it and is a more useful document for ambulance crews and Out of Hours providers than a DNACPR form alone. NHSEngland does support the concept of Treatment Escalation Planning (TEP) by whatever means.
Version 2 of the Future Planning Template borrowed TEP ideas from the well used South Coast Frailty Care Plan with inclusion of the "Comfort, Home, Hospital, Intensive" grading that can be applied to each anticipated problem discussed with a patient & family.
Electronic DNACPR Workshop - London January 2018
With 25 attendees and lots of discussion during a busy afternoon this workshop helped clarify the minimum requirements of a DNACPR coding set. An eDNACPR form designed prior to the workshop was used as a discussion aid, has been adapted following feedback and was returned to attendees for final comments. The final version is shown above. Rollout of the DNACPR page would require a lot of additional work and agreement across Primary, Community and Acute settings, however the NHS South Central paper uDNACPR is in need of updating and change to an entirely electronic system now makes sense. Though patients and families wanting a printed paper form should continue to have this option. Successful implementation of an electronic solution in Hampshire would require;
SystmONE, EMISweb and RiO Future Planning DNACPR templates accessible to GPs and Community Trust staff, that can share data to each other in real time - the SystmONE draft version is included above. Uploading to the SCR currently only takes place from General Practice records.
Hence for the next couple of years it seems likely that Ambulance and Out Of Hours services will have to be able to access the SCR to ensure access to the most up to date patient Future Planning Information.
Acute Trust Staff, who still use paper records, to complete a DNACPR that can be printed out locally.
Individual solutions will be needed for Acute Trusts, though information feeds to CHIE are already established.