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 persistently lacking capacity, their representative.
- Remember that the aim of each plan is to provide family, friends, clinicians 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 because many of these acute situations are 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 will 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 will 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 couple of paragraphs. 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 plan. Agree one at the time of writing a plan - Intensive, Hospital, Home or Comfort. A plan for someone going into hospital is different to a plan for staying at home. If both options are needed, then write two plans.
Problem: TEP Level: Management Plan & Wishes:
DON'T - Waffle. Keep the plan specific to the problem. Ideally, no more than a couple of paragraphs. 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 plan. Agree one at the time of writing a plan - Intensive, Hospital, Home or Comfort. A plan for someone going into hospital is different to a plan for staying at home. If both options are needed, then write two plans.
DO - Remember we all change our minds. TEPs need re-visiting. Future Care Plans will 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 Failure of care (Carer crisis, equipment, accommodation) Safeguarding Laceration or other injury |
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Conditions
Heart, Lung, Liver, or Kidney 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 |