a4ad3a07-92df-4cb9-ab8c-a2b1df531011FuturePlanningTemplate v3.02015-12-22T15:39:37.244669+00:00EMISWEBWALVIN, Mary (Mrs)Introduction & Patient ConsentfalsefalseIntroductionfalse99f31796-3701-40c3-8455-8246bcc5911dfalsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red31\green73\blue125;}
\viewkind4\uc1\pard\cf1\b\f0\fs22 For project information, template updates and additional resources\cf0\b0\fs18\par
}
73faf8a7-4f08-403f-aedf-149809f12e7bfalsefalseFuture Planning Websitehttp://www.futureplanning.org.uk/c44c2557-9dbb-4fc3-b6d9-f51b10c62c7efalsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red31\green73\blue125;}
\viewkind4\uc1\pard\cf1\b\f0\fs22 Project supported as part of an NHS and hospice partnership:\cf0\b0\fs18\par
}
f7550825-1c6f-4ea8-97f8-63272aea448dfalsefalseSupported byhttp://www.futureplanning.org.uk/supported_by.htmlebeec7d7-7580-4112-9e45-bedaa4c57118falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red237\green28\blue36;}
\viewkind4\uc1\pard\f0\fs18\par
\par
The main purpose of this template set is to provide \cf1\b\fs22 a summary \cf0\b0\fs18 of important information about the patient to teams providing their care during Emergency & Acute Care episodes.\par
\par
\b\fs22 Freetext\b0\fs18 entered anywhere in this template \b will be uploaded to the Summary Care Record \b0 (with patient consent)\b \b0 to guide care provided by Urgent Care staff. \cf1 Please keep it succinct, understandable and relevant to the question asked / info. box title.\cf0\par
\par
By accessing the Summary Care Record (or CHIE in Hampshire from October 2018);\par
- Ambulance Triage (111/999) and paramedic crews,\par
- GP Out of Hours Services,\par
- MAU, ED and other hospital staff,\par
with an NHS smartcard, will be able to access this summary information to guide their clinical responses.\par
}
208b6e90-9528-4b5f-a84a-15b6b211a497falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red255\green255\blue255;}
\viewkind4\uc1\pard\cf1\f0\fs18 .\par
.\par
.\cf0\par
}
falsefalsePatient Consent to Share Enhanced Information to the Summary Care Recordfalse034438e0-284b-4bb2-b418-144023a333f7falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red255\green255\blue255;}
\viewkind4\uc1\pard\cf1\f0\fs18 .\cf0\par
}
a3e48f05-2263-4846-9e17-20bd3dff6c56falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red204\green0\blue204;}
\viewkind4\uc1\pard\qc\cf1\b\f0\fs24 THIS IS THE MOST IMPORTANT CODE IN THE WHOLE TEMPLATE, \b0 bar none.\cf0\fs18\par
}
0501ecd0-9085-402c-bde4-44cb4d741ec8falsefalsefalsefalse1e6aa775-e127-48f1-ac08-505c35929535falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red237\green28\blue36;}
\viewkind4\uc1\pard\qc\f0\fs18 The "\cf1\b\fs22 Consent to Share\cf0\b0\fs18 " tick box above will enable\b all information from this set of templates to show in the patient's national Summary Care Record \b0 (SCR). \par
In addition some other coded information from their GP record, such as diagnoses and involved teams, will also be shared to the SCR.\par
\par
\pard Verbal or written consent is acceptable. Consent may also be gained by other clincial teams, though they will need to pass this info to the practice as, currently, only GP practices can record this code in the patient record.\par
If a patient has a persisting lack of capacity for giving this consent then their legal representative (LPoA for H&W, court appointed guardian) or an appropriate clinician (ideally with MDT backing) should add the consent code in their best interests.\par
}
cf476abe-7882-4473-8fc4-5489745fff84falsefalsefalsetrueFor each person involved; name, role and contact detailse19585ee-56e6-4de7-a3f4-301e5b930c29falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red255\green255\blue255;}
\viewkind4\uc1\pard\cf1\f0\fs18 .\par
.\par
.\par
.\cf0\par
}
falsefalseFuture Planning Template Version 3 - October 2018falseEnd of Life/GSF RegisterfalsefalseEnd of Life/GSF Registerfalsebee76cbc-162c-4c35-8651-4c40796a12a7falsefalseFuture Planning Websitehttp://www.futureplanning.org.uk/8f559139-885f-4e27-bab8-7d49285698b7falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red255\green255\blue255;}
\viewkind4\uc1\pard\cf1\f0\fs18 .\cf0\par
}
6f4f6915-f6b2-43fa-b008-ed601700611ffalsefalsefalsetruef0f94387-0506-43ae-b1a8-47c11bc55dcafalsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red255\green255\blue255;}
\viewkind4\uc1\pard\cf1\f0\fs18 .\par
\cf0\par
}
9891e278-c203-47f4-8737-7001ac73b1f1truefalsefalsetrue2c808f90-e4dc-4a2b-85df-8485c6d504d1falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red255\green255\blue255;}
\viewkind4\uc1\pard\cf1\f0\fs18 .\cf0\par
\par
}
f691d11e-2102-4c69-a291-1fd7fa7f5a14falsefalsefalsetrueAS112ba047-2a27-46d4-b0bb-898acee0d4ecfalsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red0\green0\blue0;}
\viewkind4\uc1\pard\qc\cf1\f0\fs18 EoL Diagnosis is coded as "Advance Care Planning" as no specific code is available.\cf0\par
}
6231c486-8d76-4b58-b85f-1c4f187314e6falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red255\green255\blue255;}
\viewkind4\uc1\pard\cf1\f0\fs18 .\cf0\par
}
f4507ec3-e8ad-4dcb-a2f2-94ffade0b847falsefalsefalsefalse9e249dd4-7620-4f3e-91a8-67fe9df4a574falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red255\green255\blue255;}
\viewkind4\uc1\pard\cf1\f0\fs18 .\cf0\par
}
96afb74e-f08b-49a0-95e7-bb9ea0d96163falsefalsefalsefalse94f7b975-01a1-40e2-a73c-982ea6c89ac7falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
\viewkind4\uc1\pard\b\f0\fs20 Modified Karnofsky Performance Status Scale:\b0\par
\par
\pard\sl276\slmult1 100% - Normal, no complaints, no evidence of disease\par
90% - Able to carry on normal activity, minor signs or symptoms of disease\par
80% - Normal activity with effort, some signs or symptoms of disease\par
70% - Cares for self, but unable to carry on normal activity or to do active work\par
60% - Able to care for most needs, but requires occasional assistance\par
50% - Considerable assistance and frequent medical care required\par
40% - In bed more than 50% of the time\par
30% - Almost completely bedfast\par
20% - Totally bedfast and requiring extensive nursing care by professionals and/or family\par
10% - Comatose or barely arousable, unable to care for self, requires equivalent of institutional or hospital care, disease may be progressing rapidly\par
\pard\fs18\par
}
falsefalseFuture Planning Template Version 3 - October 2018falseFrailtyfalsefalseFrailty Assessmentfalse9de77ce1-9c24-4785-a67e-52b226255d61falsefalseFuture Planning Websitehttp://www.futureplanning.org.uk/e00f7196-3073-49e8-84a9-43bfa217d332falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red255\green255\blue255;}
\viewkind4\uc1\pard\cf1\f0\fs18 .\cf0\par
}
aecbc099-92a2-444b-9480-8dbec2cebeeffalsefalsefalsetrue3763789d-c4ba-4ab4-851f-51c2f6a65625falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red255\green255\blue255;}
\viewkind4\uc1\pard\cf1\f0\fs18 .\cf0\par
}
21bd6256-1877-400f-b212-0de1e8ed84c3falsefalsefalsefalse4b43f0f2-fb71-47ab-8cfb-7171e20d6b47falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red255\green255\blue255;}
\viewkind4\uc1\pard\cf1\f0\fs18 .\cf0\par
\par
}
fd9901cd-6b24-45b2-a233-4dad9575988efalsefalsefalsefalsea9aa126d-c4d4-4187-bb32-0e58118d12e4falsefalseAlso known as the ROCKWOOD SCALE - click to viewhttp://www.futureplanning.org.uk/rockwood.html29215fba-85ea-4a60-8e93-3fc4398fba75falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red255\green255\blue255;}
\viewkind4\uc1\pard\cf1\f0\fs18 .\cf0\par
\par
}
244c613d-8785-441c-a721-627f7ddbdcb3falsefalsefalsetruec216a953-8ad0-4c0f-839a-329bb85b91b9falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red255\green255\blue255;}
\viewkind4\uc1\pard\cf1\f0\fs18 .\cf0\par
}
860fa677-50d6-4a46-8f32-866d22851ff7falsefalsefalsefalsedcc8565d-b70d-4277-900d-d784bdea79a5falsefalsefalsetrue3016070f-a42e-4663-9fd0-9155b341e7e5falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red255\green255\blue255;}
\viewkind4\uc1\pard\cf1\f0\fs18 .\cf0\par
}
a1a49e31-014a-41d0-aa06-2a79f5c128abfalsefalsefalsefalse8dc26709-da07-4876-adbd-b31758a7457efalsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red255\green255\blue255;}
\viewkind4\uc1\pard\cf1\f0\fs18 .\par
.\par
.\par
\cf0\par
}
falsefalseFrailty Review - Annual, change of stage or other significant eventfalse08685e39-bb31-4222-b628-51ec7be924a8falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red255\green255\blue255;}
\viewkind4\uc1\pard\cf1\f0\fs18 .\cf0\par
\par
}
1cd75a48-31ca-4d08-9c21-80974ce92c7dtruefalsefalsetruefalsefalseFuture Planning Template Version 3 - October 2018falsePrognosis & GSF MeetingfalsefalsePrognosis and Staged Planningfalse96d1dd09-3dd2-4ad3-bfba-0ee65ac460fffalsefalseFuture Planning Websitehttp://www.futureplanning.org.uk/c04f390e-18c5-47dd-8d31-c65c3a025d6cfalsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red255\green255\blue255;}
\viewkind4\uc1\pard\cf1\f0\fs18 .\cf0\par
}
af96fd2c-a65e-4667-acd9-8e2999a07920falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red204\green0\blue204;\red10\green74\blue255;}
\viewkind4\uc1\pard\cf1\b\f0\fs24 MOST IMPORTANT CODE FOR THE PRACTICE\cf0\b0\fs18\par
- will add the patient to the practice GSF/EoL/Frailty Register. \i ( If you haven't a clue, make them \cf2\b Blue \cf0\b0 )\i0\par
}
ec19a329-4c36-4527-85e0-5c1d80ee5e99falsefalsefalsefalsef6dca774-79ed-4279-b836-3a163a77e681falsefalsetruetrue720bfc11-a6b1-445b-a552-b4c026cc1416falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red255\green255\blue255;}
\viewkind4\uc1\pard\cf1\f0\fs18 .\cf0\par
}
falsefalseGSF Stage - Blue Prognosis Likely > 12 Monthsfalseecedcaa3-8a80-4fca-89c7-ad3440ff07a3falsefalsefalsefalse513a3437-fa98-4a90-8fdc-c466c473f982falsefalsefalsefalse9b133d6c-7d43-49f8-bcc2-aea97652ed65falsefalsefalsefalseac8cb35f-b2a7-4c0e-a602-503e55d6bd18falsefalsefalsefalsefb4423b9-4a59-47ef-93ee-64e13df31063falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red255\green255\blue255;}
\viewkind4\uc1\pard\cf1\f0\fs18 .\cf0\par
}
falsefalseGSF Stage Green Monthly Deterioration or Symptom Control Issuesfalse996deb42-2b5e-427a-a001-3d43ca5f8433truefalsefalsefalsed149f407-07de-4223-aff7-5f9a6c9b5298falsefalsefalsefalse47fa0f00-60b3-458f-bd2e-f61b9e15205ffalsefalsefalsefalsef5868686-8d0b-4bd2-8905-b07e77e7623ffalsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red186\green20\blue25;}
\viewkind4\uc1\pard\cf1\f0\fs18 Not commissioned in all areas, though SPC/Hospice advice available for clinicians 24/7 all areas.\cf0\par
}
91b4a7cd-89c4-46a0-bc39-e4b7b475a237falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
\viewkind4\uc1\pard\f0\fs18 \par
}
bb133502-9221-4e40-aa09-9a95e7d273acfalsefalsefalsefalse5ba6c52d-cc6a-4977-8052-a9d32c8b3409falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red186\green20\blue25;}
\viewkind4\uc1\pard\cf1\f0\fs18 For each anticipated problem, document, how and when to use, in the Treatment Escalation Planning TAB\cf0\par
}
7a4aa3d3-7712-4516-be36-dec54fce7dd9falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red255\green255\blue255;}
\viewkind4\uc1\pard\cf1\f0\fs18 .\cf0\par
}
falsefalseGSF Stage - Yellow Weekly Change or Potential Sudden Eventfalsefdce61d4-aa46-4e84-8449-16a8b20a61cctruefalsefalsefalse426d2f35-f0db-4aee-8c7c-93ae38e7ea8afalsefalsefalsefalse3109f939-813b-481b-95c3-8b5be586a28efalsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
\viewkind4\uc1\pard\f0\fs18 \par
}
3bc95fa7-fe77-4672-85e0-eb4f61f5a290falsefalsefalsetrueFPT - Hospital bed, mattress and continence equipment considered and/or in place6c67f703-36a1-4e23-901f-68993b393648falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
\viewkind4\uc1\pard\f0\fs18 \par
}
274e7f80-82e4-45da-85d4-f143648dcabatruefalsefalsefalseAS63b88013-4d9d-401c-888b-c095e8c9ceeffalsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
\viewkind4\uc1\pard\f0\fs18 ( Allows a competent clinician to diagnose \b\{\b0 verify \b\} \b0 an expected death )\par
}
37c60680-0d4e-4200-8fc9-96a2b064ac7cfalsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red255\green255\blue255;}
\viewkind4\uc1\pard\cf1\f0\fs18 .\cf0\par
}
95f4a8aa-d17a-4d29-9757-6b0a8d98b631falsefalsefalsefalse93460247-2999-4213-b0f4-8337d44655bffalsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red255\green255\blue255;}
\viewkind4\uc1\pard\cf1\f0\fs18 .\cf0\par
}
falsefalseGSF Stage - Red Daily Deterioration/Dyingfalse9cc1f251-e181-4845-a9e9-cda9753ee559falsefalsefalsetrueFPT - POC sufficient to meet needs5c648475-8bbb-40da-8b51-94ad1dd6e1b7falsefalsefalsetrueFPT - Known to Hospice at Home / End of Life Nursing Teame321b78f-b28b-441a-b8e5-227449dedc71falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red255\green255\blue255;}
\viewkind4\uc1\pard\cf1\f0\fs18 .\cf0\par
}
781c73ca-d145-423f-b4fd-f0dced4c4dacfalsefalsefalsefalsedab51f55-992c-4aa4-9b78-c5f1aa854b10falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
\viewkind4\uc1\pard\i\f0\fs18 Doses should be chosen after considering:\par
\tab - patient response to SC PRN medications\par
\tab - previous oral medications, if any\par
\tab - renal function\par
\tab - intended purpose of medication. Aim to control symptoms. \par
\tab\tab Sedation for its own sake should be used rarely and only after SPC advice.\par
\par
\b\i0 Remember. CSCI meds will take 4-6hrs to provide effective symptom control. SC PRNs can be used in the meantime.\b0\par
}
71ef21b1-a920-46b5-b5ea-c33aec9a2848falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red255\green255\blue255;}
\viewkind4\uc1\pard\cf1\f0\fs18 .\cf0\par
}
falsefalseFuture Planning Template Version 3 - October 2018falseTreatment Escalation Planning falsefalseTreatment Escalation Planning (TEP)false1284d074-9c9a-470b-bab8-c9b17e73e0c5falsefalseFuture Planning Websitehttp://www.futureplanning.org.uk/56cc4e5b-0039-4fc8-872f-5282dbfbe08efalsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red255\green255\blue255;}
\viewkind4\uc1\pard\cf1\f0\fs18 .\cf0\par
}
8b404266-ca49-472b-b3d0-8e4c4f782ea0falsefalsefalsetrue3a97a47d-5ec4-4f5c-a018-8904d8507576falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red255\green255\blue255;}
\viewkind4\uc1\pard\cf1\f0\fs18 .\cf0\par
}
893e1db7-357f-4431-b5cb-b55d8e1ce298falsefalsefalsetrue706f6402-7adc-4853-9be4-b3fd9f057e52falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red255\green255\blue255;}
\viewkind4\uc1\pard\cf1\f0\fs18 .\cf0\par
}
feb04c85-8c1f-4e40-a3d1-74ef374cc3aafalsefalsefalsetrue8127c1e5-8c1e-44c1-aa20-08ca75b4d484falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red255\green255\blue255;}
\viewkind4\uc1\pard\cf1\f0\fs18 .\cf0\par
}
6cca5a06-1960-4afe-99b9-272e805f177ffalsefalsetruetrue7f14c349-c648-4c62-bf40-29fad9ed5bbffalsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red255\green255\blue255;}
\viewkind4\uc1\pard\cf1\f0\fs18 .\cf0\par
}
cf31addf-03fa-48ec-ba58-4890f87f97abfalsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
\viewkind4\uc1\pard\ul\b\f0\fs20 Treatment Escalation Plan (TEP) Levels:\par
\par
\ulnone Intensive: \b0 Transfer to hospital for treatment if appropriate. Critical care, intubation and ventilation should be considered\ul\b .\par
\ulnone Hospital: \b0 Transfer to hospital if appropriate, but not for critical care, intubation or ventilation\par
\b Home: \b0 Treat with normal and rescure medications at home with support from GP. Admission to hospital to be avoided unless measures fail and following discussion with Palliative Care or involved Specialist Team and GP.\par
\b Comfort: \b0 Palliative Meds via SC, oral or PR route, positioning, wound care and other measures to relieve symptoms. Admission to hosptial to be avoided.\fs18\par
}
1450a4a5-ccca-4115-b22a-485937eb515cfalsefalsefalsetrueProblem: TEP level: Management Plan:a23025c3-cfa6-4799-be21-7f30d9082667falsefalsefalsetrueProblem: TEP level: Management Plan:4f5e37c2-b6fe-49f9-85db-bc287b082af2falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red204\green0\blue204;}
\viewkind4\uc1\pard\qc\cf1\f0\fs20 Please save before entering additional Problems, Levels and Management Plans.\cf0\fs18\par
}
9ba6beab-cc63-4738-addc-9d4f67f7c3f2falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red255\green255\blue255;}
\viewkind4\uc1\pard\cf1\f0\fs18 .\par
.\cf0\par
}
6957222d-5119-494b-8521-653229f360b0truefalsefalsetruefalsefalseFuture Planning Template Version 3 - October 2018falseTEP ObservationsfalsefalseObservations to be Consideredfalse531584df-3873-478d-9b9a-a6a4018774fefalsefalsefalsetrue5785903a-03e6-4a1c-9fe0-c12ec1f9a60efalsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red255\green255\blue255;}
\viewkind4\uc1\pard\cf1\f0\fs18 .\cf0\par
}
88cf60af-dff8-4393-b02f-0071f7c96b55falsefalsefalsefalsee5141681-7e65-484b-b2cb-9c781ede6b70falsefalsefalsetrue36adb463-0d8a-4531-8744-f7bf170c64d0falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}{\f1\fnil\fcharset2 Symbol;}}
\viewkind4\uc1\pard\sb100\sa100\ul\b\f0\fs20 CO2 Retention Risk Factors (BTS guidelines 2012):\par
\ulnone\b0 Patients may be at risk of CO2 retention and therefore respiratory depression with higher oxygen concentrations if they have any of the following:\par
\pard{\pntext\f1\'B7\tab}{\*\pn\pnlvlblt\pnf1\pnindent0{\pntxtb\'B7}}\fi-150\li450\sb100\sa100 Past history of CO2 retention \par
{\pntext\f1\'B7\tab}Chronic chest disease such as COPD, muscluloskeletal disease or chronic neuromuscular conditions\par
{\pntext\f1\'B7\tab}All three of the following risk factors: longterm smoker, >50 years old, unexplained exertional dyspnoea\par
\pard\fs18\par
}
9c1ea1c2-e1ed-46d8-8e2f-96893036857dfalsefalsefalsetrued12a8000-1d34-475a-962b-1401d37809d6falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red255\green255\blue255;}
\viewkind4\uc1\pard\cf1\f0\fs18 .\cf0\par
}
af0e9ec5-016a-4174-a72f-6ab78970c8fbfalsefalsefalsetrue9b0e4226-c990-4ce6-bc34-8803359caeebfalsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red255\green255\blue255;}
\viewkind4\uc1\pard\cf1\f0\fs18 .\cf0\par
}
b238945b-59f2-4d40-9f14-25ff7915c81ffalsefalsefalsetruefalsefalseFuture Planning: My Wishes. Information submitted by patient, family or carer.false7f9b6091-f529-4ac6-a2d9-2a0d05157adbtruefalsefalsefalsefalsefalseFuture Planning Template Version 3 - October 2018falseFuture PlanningfalsefalseConsiderations of Care Before Deathfalse3e75fa22-1f61-4ceb-9411-859d0cfa73fdfalsefalseFuture Planning Websitehttp://www.futureplanning.org.uk/53a64a33-36c9-43bb-a700-47462a583666falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red255\green255\blue255;}
\viewkind4\uc1\pard\cf1\f0\fs18 .\cf0\par
}
3ab55dc4-653a-4bee-bb1c-193fd7bb34e8falsefalsefalsetrue2c1eabea-5326-44ce-a5df-8d535d003adbfalsefalsefalsetrue0310f579-6b55-466d-bfdd-16f5cb9df3cbfalsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red255\green255\blue255;}
\viewkind4\uc1\pard\cf1\f0\fs18 .\cf0\par
}
0f72c4ae-40fc-43b2-a1c7-ea82eb907948falsefalsefalsetrued95385cf-94e7-413c-898d-3ec4e16d2856falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red255\green255\blue255;}
\viewkind4\uc1\pard\cf1\f0\fs18 .\cf0\par
}
8ddfd1d7-5fd7-4566-afa4-c30578603477falsefalsefalsefalseaa826c11-9e75-4aca-81bb-8930c80bd9a7falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red237\green28\blue36;}
\viewkind4\uc1\pard\cf1\b\f0\fs18 This record does NOT replace the need for a uDNACPR or ReSPECT form. For the moment.\cf0\b0\par
}
c8eba2f1-83d1-46b8-8b2d-1e93a915c4d6falsefalsetruefalseccd0bb2b-d439-413d-b8c7-3c6731133f93falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red255\green255\blue255;}
\viewkind4\uc1\pard\cf1\f0\fs18 .\cf0\par
}
falsefalseConsiderations for Care After Deathfalsec09bdf33-d8a7-4908-a0e9-f15613f9164bfalsefalsefalsetrue23a8a4de-c75d-48a4-9541-144ccd57dd65falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red255\green255\blue255;}
\viewkind4\uc1\pard\cf1\f0\fs18 .\cf0\par
}
370638d7-07cd-4686-88cd-20299de15259falsefalsefalsetrueFPT - Referral to coroner required37a1e4d7-9962-4d6c-b0ac-272f1a9b9ee8falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red255\green255\blue255;}
\viewkind4\uc1\pard\cf1\f0\fs18 .\cf0\par
}
01e2bb1e-92b1-4412-8e9b-9d1f2dfe1313falsefalsefalsetrueFPT - Wishes to be tissue donorAS3c1d912c-e3d3-4eb8-9f99-bc6a85c1f742falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}{\f1\froman\fcharset0 Times New Roman;}}
{\colortbl ;\red255\green255\blue255;}
\viewkind4\uc1\pard\sb100\sa100\f0\fs18 e.g. Patient and family wishes, what to donate & who to contact upon death. This may include details of research requests for rare conditions.\par
\cf1 .\cf0\f1\fs24\par
\pard\f0\fs18\par
}
falsefalseSupport Availablefalse9db449de-1bd9-4ba9-a09b-13f4f5db255dfalsefalsetruetruef70b0045-fa93-4ef9-844d-e562b8893df9falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red255\green255\blue255;}
\viewkind4\uc1\pard\cf1\f0\fs18 .\cf0\par
}
da8288c7-b8cb-4721-9fe6-744ce3787105falsefalsetruetruefalsefalseFuture Planning Template Version 3 - October 2018falseCPR DecisionsfalsefalseCardioPulmonary Resuscitation Decisionsfalsee1053721-96ca-425b-867e-7059dfc8af99falsefalseFuture Planning Websitehttp://www.futureplanning.org.uk/cc237097-2fe0-4f1b-9c3c-d234ac7a5015falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Comic Sans MS;}{\f1\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red186\green20\blue25;}
\viewkind4\uc1\pard\cf1\f0\fs30 PAGE IN DEVELOPMENT\par
\cf0\b\f1\fs18 Will be released as Future Planning version 3.2 as soon as possible.\b0\par
}
427b7f7e-3c21-49e8-9315-80f24d195f41falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
\viewkind4\uc1\pard\f0\fs22 A Hampshire and Isle of Wight STP supported work group is being established, which aims to use the Future Planning template to replace the lilac uDNACPR form. This will allow digital recording of CPR decisions, automatic transfer of this info to both the Summary Care Record and CHIE and, for the next year or so, printing of adapted ReSPECT forms populated with CPR and other information from the Future Planning template.\par
\par
Communication via the LMC and CCG newsletters will take place when the new TAB and linked resources are ready for publication.\fs18\par
\par
\par
}
Anticipatory PxfalsefalseAnticipatory Prescribing LINK PAGEfalse5e5199a7-2567-41e0-8f1c-c35d98426251falsefalseFuture Planning Websitehttp://www.futureplanning.org.uk/dc7eaa82-0dd1-472a-afcf-bd6a5d622a34falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Comic Sans MS;}{\f1\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red186\green20\blue25;}
\viewkind4\uc1\pard\cf1\f0\fs30 PAGE IN DEVELOPMENT\cf0\f1\fs18\par
\b Will be released as Future Planning version 3.1 as soon as possible.\b0\par
}
a02fdb69-9632-412a-81d9-9b3783db84f0falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
\viewkind4\uc1\pard\f0\fs22 Please do not wait for Version 3.1 before starting to use the Future Planning template. We are aware some practices have been doing just that while waiting for Version 3. There will always be a new Version sometime in the future!\par
\par
In response to the Report of the Gosport War Memorial Independant Panel Jan 2018, Hampshire & Isle of Wight Palliative Care Physicians, working with pharmacy and GP colleagues, are aiming to develop a standard simple Anticipatory Prescribing template. This page will link to the new template and will also aid with consistent printing or NHSmailing of the Community Syringe Driver and PRN Administration Orders used by both Solent and Southern Health community teams.\par
\par
Communication directly to practice managers/IT managers will take place when this new TAB and linked resources are ready for publication.\fs18\par
}