a9fb9e98-ab05-40d2-8ac4-2ae3e078a24dFuture Planning - Palliative Care (v13.5) (Ardens-QMasters)2015-12-22T15:39:37.244669+00:00EMISWEBWALVIN, Mary (Mrs)Introduction & Patient ConsentfalsefalseTemplate information (Future Care Planning)falsea507b4fd-a444-44f5-8a89-4153bc2eac97falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
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\viewkind4\uc1\pard\f0\fs18 This template is produced by Ardens-Q Ltd. in association with the Future Care Planning Project and Dr. Steve Plenderleith.\par
\par
This template is intended for use by clinicians as a data entry aid but is not intended as a replacement for clinical judgement in the care of individual patients.\par
\par
For queries, or to report broken links, please email :\b \cf1 ardens.emis@nhs.net\par
\par
\b0 Original \'a9\cf0 Future Planning Project - available at www.futureplanning.org.uk \par
This version \cf1\'a9 Ardens-Q Ltd \par
\pard\qr\cf0 \par
}
falsefalsePatient Consent to Share Enhanced Information to the Summary Care Recordfalsea3e48f05-2263-4846-9e17-20bd3dff6c56falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
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\viewkind4\uc1\pard\cf1\b\f0\fs18 PLEASE ENSURE THIS SECTION IS COMPLETED TO ALLOW SHARING WITH THE SUMMARY CARE RECORD: \b0\par
}
1e6aa775-e127-48f1-ac08-505c35929535falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red0\green0\blue0;}
\viewkind4\uc1\pard\b\f0\fs18 The "\cf1 Consent to Share\cf0 " box below will enable all information from this template to show in the patient's national Summary Care Record (SCR).\b0 \par
\pard\qc\par
\pard\par
}
e8658346-a55d-42d5-99d1-90152cced268falsefalseSCT_READV2SCT_READV2falsefalsecf476abe-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;}}
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\viewkind4\uc1\pard\cf1\f0\fs18 \cf0\par
}
81d74c37-1e5b-461d-8582-8e6969baf1b7falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
\viewkind4\uc1\pard\f0\fs18\par
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
\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
}
falsefalseIntroductionfalsec44c2557-9dbb-4fc3-b6d9-f51b10c62c7efalsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
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\viewkind4\uc1\pard\cf1\b\f0\fs18 The Future Care Planning Project is supported as part of an NHS and hospice partnership:\cf0\b0\par
}
ebeec7d7-7580-4112-9e45-bedaa4c57118falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}{\f1\fnil\fcharset2 Symbol;}}
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\viewkind4\uc1\pard\f0\fs18\par
The main purpose of this template set is to provide \cf1\b\i a summary \cf0\b0\i0 of important information about the patient to teams providing their care during Emergency & Acute Care episodes.\par
\par
\b Freetext entered anywhere in this template 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.\par
\cf0\par
By accessing the Summary Care Record (or CHIE in Hampshire from October 2018) with an NHS smartcard, the following staff will be able to access this summary information to guide their clinical responses:\par
\par
\pard{\pntext\f1\'B7\tab}{\*\pn\pnlvlblt\pnf1\pnindent0{\pntxtb\'B7}}\fi-150\li450 Ambulance Triage (111/999) and paramedic crews\par
{\pntext\f1\'B7\tab}GP Out of Hours Services\par
{\pntext\f1\'B7\tab}MAU, ED and other hospital staff\par
\pard\par
}
falsefalseFuture Care Planning Project Informationfalse49cb0397-85dd-43d1-af1c-b794418f9413falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red0\green0\blue0;}
\viewkind4\uc1\pard\cf1\f0\fs18 For project information and additional resources, please visit the following link:\cf0\par
}
59f9aaa4-650f-4f86-9064-3ed685a99dc0falsefalseFuture Planning Websitehttps://www.futureplanning.org.uk/21b3b022-f64d-4d37-9213-b098e2645eb5falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
\viewkind4\uc1\pard\f0\fs18 \par
}
falsefalseTemplate Versionfalse3fee5a67-1d6b-460f-9498-22eb654443a0falsefalseSCT_READV2truetrueFuture Care Planning (v13.5) by Ardens-Q Ltd.4067502c-d6b2-48b5-97ef-d6b659c38fbbfalsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
\viewkind4\uc1\pard\f0\fs18 This is version 13.5 (Plenderleith v3.2) of the Future Care Planning template, last updated March 2020\par
}
Treatment Escalation Planning falsefalseVital Informationfalse8b404266-ca49-472b-b3d0-8e4c4f782ea0falsefalsefalsetrue2599c836-a793-41b0-81d9-b62b23595024truefalseSCT_READV2falsetruefalsefalseCardioPulmonary Resusitation Decisionsfalsea4dee2dc-5baa-4b8b-a6bd-a4a26310dff1falsefalseSCT_READV2false60d55ea1-0036-44a6-be15-2d2fdc65c741falsefalseSCT_READV2SCT_READV2falsefalsefd1b0dbb-d803-4273-9f06-3614a655c574falsefalseSCT_READV2SCT_READV2SCT_READV2SCT_READV2SCT_READV2SCT_READV2truefalsed6ac5736-9d94-4995-bd1a-b102845068d7falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
\viewkind4\uc1\pard\f0\fs18 \par
}
falsefalseTreatment Escalation Planning (TEP)false56cc4e5b-0039-4fc8-872f-5282dbfbe08efalsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red0\green0\blue0;}
\viewkind4\uc1\pard\cf1\f0\fs18 Please use the following fields to enter information which may be useful in case there is a need for escalation of treatment:\cf0\par
}
6cca5a06-1960-4afe-99b9-272e805f177ffalsefalsetruetrueAdd name & number:d9823ff8-de69-4765-9920-ebdd6b9a997ffalsefalsefalsetrueLocation of POA:49025183-4251-481d-8c8b-49fa7ed7e9edfalsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
\viewkind4\uc1\pard\f0\fs18 \par
}
893e1db7-357f-4431-b5cb-b55d8e1ce298falsefalsefalsetruefeb04c85-8c1f-4e40-a3d1-74ef374cc3aafalsefalsefalsetrue9a8babb7-0fae-4153-b788-dbe6ce2b4803falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
\viewkind4\uc1\pard\i\f0\fs18 Contact information entered elsewhere is EMIS will not be visiible to acute services on the Summary Care Record. Please enter names & contact details of relatives, friends or neighbours who can be contacted in an emergency plus any further instructions e.g. night time only.\par
\i0\par
}
cf31addf-03fa-48ec-ba58-4890f87f97abfalsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red186\green20\blue25;}
\viewkind4\uc1\pard\ul\b\f0\fs20 Treatment Escalation Levels:\par
\par
\cf1\ulnone\b0 This section is the most important for patient clinical care.\cf0\ul\b\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;}}
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\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
}
Other TEP ConsiderationsfalsefalseRespiratory Considerationsfalse88cf60af-dff8-4393-b02f-0071f7c96b55falsefalsefalsetruee5141681-7e65-484b-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;}}
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\viewkind4\uc1\pard\cf1\f0\fs18 .\cf0\par
}
9b0e4226-c990-4ce6-bc34-8803359caeebfalsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
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\viewkind4\uc1\pard\cf1\f0\fs18 .\cf0\par
}
falsefalseDiabetesfalse531584df-3873-478d-9b9a-a6a4018774fefalsefalsefalsetruefalsefalseGeneralfalseb238945b-59f2-4d40-9f14-25ff7915c81ffalsefalsefalsetrueaf0e9ec5-016a-4174-a72f-6ab78970c8fbfalsefalsefalsetrueMy WishesfalsefalseConsiderations of Care Before Deathfalse3ab55dc4-653a-4bee-bb1c-193fd7bb34e8falsefalsefalsetrue2c1eabea-5326-44ce-a5df-8d535d003adbfalsefalsefalsetrue0f72c4ae-40fc-43b2-a1c7-ea82eb907948falsefalsefalsetrueccd0bb2b-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-f15613f9164bfalsefalsefalsetrue370638d7-07cd-4686-88cd-20299de15259falsefalsefalsetrueFPT - Referral to coroner required. Reason/s:01e2bb1e-92b1-4412-8e9b-9d1f2dfe1313falsefalsefalsetrueFPT - Wishes to be tissue donorAS3c1d912c-e3d3-4eb8-9f99-bc6a85c1f742falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
\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
\par
}
falsefalseSupport Availablefalse9db449de-1bd9-4ba9-a09b-13f4f5db255dfalsefalsetruetrueda8288c7-b8cb-4721-9fe6-744ce3787105falsefalsetruetruefalsefalseMy Wishes Leaflet - Patient informationfalse0e26ea97-c322-413c-9fa7-d15d3808faf5falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
\viewkind4\uc1\pard\f0\fs18 Please tick this box if entering information that a patient, or other person with permission to do so, has submitted to the practice using the 'Future Planning: My wishes' form:\par
}
ce15b0cf-cdee-4c33-806c-386606a638dcfalsefalsefalsefalseFrailtyfalsefalseFrailty Assessmentfalsee00f7196-3073-49e8-84a9-43bfa217d332falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red0\green0\blue0;}
\viewkind4\uc1\pard\cf1\f0\fs18 Please use the following field to complete information on the patient's named accountable GP:\cf0\par
}
aecbc099-92a2-444b-9480-8dbec2cebeeffalsefalseSCT_READV2falsetrue4b43f0f2-fb71-47ab-8cfb-7171e20d6b47falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red0\green0\blue0;\red24\green31\blue36;}
\viewkind4\uc1\pard\cf1\f0\fs18 You may wish to record a frailty score for your patient. This is not a diagnostic tool, but will help estimate their level of frailty. This information, \b\i together with\cf2 clinical assessment and judgment\b0\i0 , should be used to confirm a diagnosis.\cf1 To calculate the eFI score, please use the EMIS Web calculator in the section below.\par
\par
The next section entitled 'Frailty diagnosis' will allow you to record other information, including the actual diagnosis of frailty, if appropriate.\cf0\par
}
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{\colortbl ;\red255\green255\blue255;}
\viewkind4\uc1\pard\cf1\f0\fs18 \cf0\par
}
falsefalseFrailty diagnosisfalsec2693906-5c02-4de4-904c-895299074f01falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red0\green0\blue0;}
\viewkind4\uc1\pard\cf1\f0\fs18 You may also wish to record the Rockwood score below (also known as Canadian Study of Health and Aging clinical frailty scale):\cf0\par
}
1aa31de0-1daf-4ddb-9ce9-1b3b1f5ea7dcfalsefalse{\rtf1\fbidis\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fswiss\fprq2\fcharset0 Tahoma;}{\f1\fnil\fcharset0 Tahoma;}}
\viewkind4\uc1\pard\ltrpar\nowidctlpar\i\f0\fs18 Please be aware we have no control over, and accept no responsibility for, links to external websites. Please check your results carefully before using them to form a clinical opinion.\i0\par
\pard\ltrpar\f1\par
}
a9aa126d-c4d4-4187-bb32-0e58118d12e4falsefalseRockwood Scale - click to viewhttp://www.futureplanning.org.uk/rockwood.htmlc653d840-7a96-4f12-97ab-2b33c4fe034ffalsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
\viewkind4\uc1\pard\f0\fs18 Please enter the score below in order to add to the medical record:\par
}
fd9901cd-6b24-45b2-a233-4dad9575988efalsefalsefalsefalse2fb15c10-6d2f-4301-9f47-d5043063410afalsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
\viewkind4\uc1\pard\b\f0\fs18\par
Other relevant information and assessment:\par
\b0\par
}
244c613d-8785-441c-a721-627f7ddbdcb3falsefalseSCT_READV2falsetruedcc8565d-b70d-4277-900d-d784bdea79a5falsefalsefalsetrue860fa677-50d6-4a46-8f32-866d22851ff7falsefalsefalsefalse24556ce9-ea8b-4429-b74c-1e54527d3684falsefalseSCT_READV2SCT_READV2SCT_READV2SCT_READV2SCT_READV2SCT_READV2SCT_READV2SCT_READV2SCT_READV2SCT_READV2truetrue3016070f-a42e-4663-9fd0-9155b341e7e5falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red0\green0\blue0;}
\viewkind4\uc1\pard\cf1\f0\fs18 Please use the following field to make a clinical diagnosis of frailty (if appropriate) based on your assessment of the patient:\cf0\par
}
a1a49e31-014a-41d0-aa06-2a79f5c128abfalsefalsefalsefalse9fe7cc64-2b4f-4bae-b9c9-ab6f21a9042cfalsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
\viewkind4\uc1\pard\f0\fs18 \par
}
falsefalseFrailty Review - Annual, change of stage or other significant eventfalse1cd75a48-31ca-4d08-9c21-80974ce92c7dtruefalseSCT_READV2falsetruePrognosis & GSF MeetingfalsefalseFuture Care Planning Project Informationfalse49cb0397-85dd-43d1-af1c-b794418f9413falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red0\green0\blue0;}
\viewkind4\uc1\pard\cf1\f0\fs18 For project information and additional resources, please visit the following link:\cf0\par
}
59f9aaa4-650f-4f86-9064-3ed685a99dc0falsefalseGSF Resourceshttps://www.futureplanning.org.uk/gsf-resources.html21b3b022-f64d-4d37-9213-b098e2645eb5falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
\viewkind4\uc1\pard\f0\fs18 \par
}
falsefalsePrognosis and Staged Planningfalseaf96fd2c-a65e-4667-acd9-8e2999a07920falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red186\green20\blue25;\red10\green74\blue255;}
\viewkind4\uc1\pard\cf1\b\f0\fs18 THE FOLLOWING IS THE MOST IMPORTANT CODE FOR THE PRACTICE\par
\cf0\b0 Use the following field to add the patient to the practice GSF/EoL/Frailty Register. \i (If you haven't a clue, make them \cf2\b Blue\cf0\b0 )\par
\i0\par
}
ec19a329-4c36-4527-85e0-5c1d80ee5e99falsefalseSCT_READV2SCT_READV2SCT_READV2SCT_READV2falsefalsef6dca774-79ed-4279-b836-3a163a77e681falsefalseSCT_READV2SCT_READV2SCT_READV2SCT_READV2SCT_READV2SCT_READV2falsetrue720bfc11-a6b1-445b-a552-b4c026cc1416falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
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\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-aea97652ed65falsefalsefalsetrueDiscussion, or leaflet provided, about writing a Last Will & Testament (particularly if co-habiting)ac8cb35f-b2a7-4c0e-a602-503e55d6bd18falsefalsefalsetrueInformation around finance provided (eg CAB, Macmillan)fb4423b9-4a59-47ef-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-a001-3d43ca5f8433truefalsefalsefalse47fa0f00-60b3-458f-bd2e-f61b9e15205ffalsefalsefalsetrueHospice/SPC 24hr advice and rapid response service - info providedd149f407-07de-4223-aff7-5f9a6c9b5298falsefalsefalsefalsebb133502-9221-4e40-aa09-9a95e7d273acfalsefalsefalsefalse7a4aa3d3-7712-4516-be36-dec54fce7dd9falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red0\green0\blue0;}
\viewkind4\uc1\pard\cf1\f0\fs18 Please record medication, dosing & indications for use within the Treatment Escalation Plan\par
\cf0\par
}
falsefalseGSF Stage - Yellow Weekly Change or Potential Sudden Eventfalsefdce61d4-aa46-4e84-8449-16a8b20a61cctruefalsefalsefalse426d2f35-f0db-4aee-8c7c-93ae38e7ea8afalsefalsefalsefalse274e7f80-82e4-45da-85d4-f143648dcabatruefalsefalsetrueGP, Senior Doctor or MDT confirm imminent expected deathAS63b88013-4d9d-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;}}
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\viewkind4\uc1\pard\cf1\f0\fs18 .\cf0\par
}
3bc95fa7-fe77-4672-85e0-eb4f61f5a290falsefalsefalsetrueFPT - Hospital bed, mattress and continence equipment considered and/or in place95f4a8aa-d17a-4d29-9757-6b0a8d98b631falsefalsefalsetrueAnticipatory medications - FP10 and PRN chart issued93460247-2999-4213-b0f4-8337d44655bffalsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
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\viewkind4\uc1\pard\cf1\f0\fs18 .\cf0\par
}
falsefalseGSF Stage - Red Daily Deterioration/Dyingfalse9cc1f251-e181-4845-a9e9-cda9753ee559falsefalsefalsetrueFPT - Package of care sufficient to support 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;}}
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}
781c73ca-d145-423f-b4fd-f0dced4c4dacfalsefalsefalsetrueCommunity palliative care syringe driver (CSCI) administration order completed - if safe doses can be estimateddab51f55-992c-4aa4-9b78-c5f1aa854b10falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}{\f1\fnil\fcharset2 Symbol;}}
\viewkind4\uc1\pard\i\f0\fs18 Doses should be chosen after considering the following:\par
\par
\pard{\pntext\f1\'B7\tab}{\*\pn\pnlvlblt\pnf1\pnindent0{\pntxtb\'B7}}\fi-150\li450 previous oral medications, if any, e.g. opiods, benzodiazepines, buscopan, anti-psychotics (for whatever use)\par
{\pntext\f1\'B7\tab}patient response to SC PRN medications\par
{\pntext\f1\'B7\tab}renal function, particularly if eGFR is <30\par
{\pntext\f1\'B7\tab}intended purpose of medication. Aim to control symptoms. \par
\pard\par
Sedation for its own sake should be used rarely and only after SPC advice.\par
\par
\b\i0 Remember - Syringe Driver (CSCI) medications 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
}
End of Life/GSF RegisterfalsefalseEnd of Life/GSF Registerfalsef0f94387-0506-43ae-b1a8-47c11bc55dcafalsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red0\green0\blue0;}
\viewkind4\uc1\pard\cf1\f0\fs18 Please use the following fields to complete end of life care information:\par
\cf0\par
}
6f4f6915-f6b2-43fa-b008-ed601700611ffalsefalsefalsetrue7b1fb8b9-c50c-434f-a024-3a7201979ad5falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
\viewkind4\uc1\pard\f0\fs18 \par
}
9891e278-c203-47f4-8737-7001ac73b1f1truefalsefalsetrue1e2d7f79-e165-447a-8ef8-07ba4ddb494bfalsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
\viewkind4\uc1\pard\f0\fs18 \par
}
f691d11e-2102-4c69-a291-1fd7fa7f5a14falsefalsefalsetrueEnd of life diagnosis is: AS112ba047-2a27-46d4-b0bb-898acee0d4ecfalsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red0\green0\blue0;}
\viewkind4\uc1\pard\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
}
*Birmingham & Solihull CCGfalsefalse*Birmingham & Solihull CCG Universal Offer - EoLfalsef99a208c-7f5a-4e2e-aad7-48ae21820e75falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red186\green20\blue25;}
\viewkind4\uc1\pard\cf1\f0\fs18 >> Please use the following to record EoL care planning:\cf0\par
}
717758dc-ac33-43f7-8895-7501b03826b8falsefalseSCT_READV2falsetrue6e565a5e-2b8f-4437-bd14-d01e4454248ffalsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
\viewkind4\uc1\pard\f0\fs18 \par
}
349a423f-8bfa-4af8-ba2b-44d7a9013572falsefalseSCT_READV2SCT_READV2falsetruec89ecfdb-7396-4b27-acdf-1be147c79bc7falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
\viewkind4\uc1\pard\f0\fs18 or...\par
}
a60e91ab-f9f9-44d4-b97e-686d3b0bbf0cfalsefalseSCT_READV2SCT_READV2falsetrue9839ccd4-893d-42a9-8372-c236fbce57f3eFI60b70d83-3c55-47d1-a4fa-6d09a43b53c1260b70d83-3c55-47d1-a4fa-6d09a43b53c1falsefalseeFIfalse2828a298-6fba-4192-97f1-6d977106834cfalsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Arial;}{\f1\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red48\green96\blue213;}
\viewkind4\uc1\pard\cf1\fs20 The electronic Frailty Index is derived from a range of 36 deficits.\par
Higher scores indicate increasing frailty. \par
The score is calculated from existing local (not shared) electronic health care record data.\par
Click \b calculate \b0 to record the score:\par
\par
\cf0\f1\fs18\par
}
a9016124-3784-4272-9418-0bb7532146ecfalsefalse74cdffee-5ef7-449f-bc62-91ac37af456fefiefifalse2038e801-d34c-4ded-89fe-c0e6498056f4falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Arial;}{\f1\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red48\green96\blue213;}
\viewkind4\uc1\pard\cf1\fs20\par
\b eFI ranges\b0 \b Notes\b0\par
\par
Mild frailty - eFI score \b >0.12 \b0 and \b\u8804?0.24\b0 At risk of decompensation if concurrent illness\par
\par
Moderate frailty - eFI score \b >0.24 \b0 and \b\u8804?0.36\b0 Higher scores indicate increasing frailty and vulnerability\par
Severe frailty - eFI score \b >0.36\b0 that may require early support and intervention \par
\cf0\f1\fs18\par
\par
\par
}
53635cb8-c100-45bb-9e9a-591d4324b877falsefalseFurther information is available from the "Improvement Academy" websiteFurther informatonhttps://improvementacademy.org/our-programmes/healthy-ageing.htmld21b0671-dee3-44a9-8845-8a488641741cfalsefalseNHS England - Toolkit for supporting older peoplehttps://www.england.nhs.uk/wp-content/uploads/2017/03/toolkit-general-practice-frailty-1.pdf8cfd1a8d-7652-4704-b69e-7deffbd79d60falsefalseBristish Geriatric Society - Fit for Frailty https://www.bgs.org.uk/resources/resource-series/fit-for-frailtyffccb462-436e-4d9b-bbfa-936a2fa5bbc2falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}{\f1\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red0\green0\blue0;}
\viewkind4\uc1\pard\cf1\f0\fs20 The eFI score is reproduced by permission of University of Leeds.\par
This product was developed by University of Leeds in collaboration with The Phoenix Partnership (TPP) using the ResearchOne database.\f1\fs18\par
\cf0\par
}
9839ccd4-893d-42a9-8372-c236fbce57f3AQ - PCG 15/1/2110 (Birmingham) (v13-3)2019-04-29T18:19:50.5758+01:00ActiveCriterionORG
Diary
LatestCodeValueSetfcb7d51a-3967-4ebe-b874-1b97813259bdSCT_READV21488463018Primary Care GrouptrueDatePointEqual15/01/2110