The following library of example Treatment Escalation Plans, ordered by condition, situation and symptom, are offered as encouragement to get you started. They will primarily be used by clinical staff, writing plans into the patients record, because writing a clinical plan is a clinical skill.
However, we make two requests:
However, we make two requests:
- Copy away, but please remember to personalise each plan, ensuring it is right for the person to whom the plan refers. How do you do that? Simple. Talk to the patient or, if they persistently lack capacity, then speak to their representative (attorney, NoK, friend, etc).
- Remember that the aim of each plan is to provide a patient, family, friend, clinician a brief guide of how a particular situation might be managed. It is not a "legal" judgement. The patient or family can change their mind in the moment. And many people do, because many of these acute situations are scary. Having a plan hopes to make an event a bit less scary.
Do's and Dont's
DO - Involve patients and, with their permission, others close to them in Treatment Escalation and other Future Planning conversations.
DON'T - Forget that a printed Future Care Plan will be provided to the patient to keep in their home. If, you make a plan and write it in the clinical record without first discussing and agreeing it with the patient, then at some point it may come back to bite you.
DON'T - Forget that a printed Future Care Plan will be provided to the patient to keep in their home. If, you make a plan and write it in the clinical record without first discussing and agreeing it with the patient, then at some point it may come back to bite you.
DO - Remember that facing an uncertain future is scary, particularly when this relates to a medical condition. Taking opportunities to talk to people about "what to expect" from their medical condition and "how to manage" when things go pear shaped will reduce anxiety 99% of the time.
DON'T - Forget that we all have bad days. If a patient isn't ready to discuss their fears, then fair enough. But maybe:
DON'T - Forget that we all have bad days. If a patient isn't ready to discuss their fears, then fair enough. But maybe:
- explore when might be a good time. And who they may want present to support them.
- offer another time, place or clinician with whom they might wish to talk. Consider other sources of information. Would a leaflet or website allow them to consider some plans in their own time.
- if it remains too much for a patient, then offer to discuss plans with their next of kin, family or carers.
DO - Structure each Treatment Escalation Plan as below:
Problem: TEP Level: Management Plan & Wishes:
DON'T - Waffle. Keep the plan specific to the problem. Ideally, no more than a few lines. If there are drugs to be used give details, name, dose and where the patient plans to keep them. If oxygen, how much. If equipment, where is it and where is the manual. Mention names and contact numbers, teams and hospitals.
ALSO DON'T - Give different TEP Levels for a single Problem. Agree at the time of writing a plan, one of - Intensive, Hospital, Home or Comfort. A plan for someone going into hospital is different to a plan for staying at home.
Problem: TEP Level: Management Plan & Wishes:
DON'T - Waffle. Keep the plan specific to the problem. Ideally, no more than a few lines. If there are drugs to be used give details, name, dose and where the patient plans to keep them. If oxygen, how much. If equipment, where is it and where is the manual. Mention names and contact numbers, teams and hospitals.
ALSO DON'T - Give different TEP Levels for a single Problem. Agree at the time of writing a plan, one of - Intensive, Hospital, Home or Comfort. A plan for someone going into hospital is different to a plan for staying at home.
DO - Remember we all change our minds. TEPs need re-visiting. Paper Future Care Plans will occasionally need re-printing.
DON'T - Forget that a conversation is a journey. Ideally, without an end!
DON'T - Forget that a conversation is a journey. Ideally, without an end!
Links to example Treatment Escalation Plans
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Situations
Falls Head Injury Frailty +/- Multi-morbidity Failure of care (Carer crisis, equipment, accommodation) |
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Conditions
Heart, Lung, Liver, Kidney or Brain failure Solid organ cancer Haematological cancer MND, Parkinsons Disease Associated conditions, |
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Symptoms
Delirium/Confusion Breathlessness Bowel Obstruction, Dysphagia, Nausea and vomiting Haemorrhage Pain |