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Choices and decisions towards the end of life

Choices and decisions towards the end of life. Annual Conference 2014. #sppc2014. RCPE-WIFI Password : chiron1681. Scottish Palliative Care Guidelines Launch. Ready to set sail. http ://www.palliativecareguidelines.scot.nhs.uk/. Guidelines will be available in October at:.

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Choices and decisions towards the end of life

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  1. Choices and decisions towards the end of life Annual Conference 2014 #sppc2014 RCPE-WIFI Password: chiron1681

  2. Scottish Palliative Care Guidelines Launch

  3. Ready to set sail http://www.palliativecareguidelines.scot.nhs.uk/ Guidelines will be available in October at:

  4. Final sea trials http://www.testing29.scot.nhs.uk/ Guidelines can currently be viewed at:

  5. Policy background • Evidence-based clinical guidelines supports the provision of high quality palliative care by both specialists and general staff.

  6. 2 Actions: • All Health Boards to ensure that guidance on all core topics is made available • NHS QIS to work with Boards and SPPC to agree a national guideline for each core topic and a robust mechanism for reviewing and updating.

  7. Guideline Development Process

  8. 2012 • National Palliative Care Guideline project started • Supported by Scottish Partnership Palliative Care (SPPC) and Healthcare Improvement Scotland (HIS) • Co-chairs: Dr Paul Baughan, GP, Dollar and clinical lead NHS FV Dr David Gray, Consultant in Palliative Medicine Accord Hospice, Paisley • Aim to include a mix of professionals including pharmacy, primary care and public representation

  9. Choosing the Project Steering Group:

  10. The Guideline Project Steering Group:

  11. The Guideline Project Steering Group:

  12. Not aiming for 29 sets of these:

  13. HIS agreed to provide methodological advice NES agreed to provide librarian support Methodological Rigour:

  14. Survey Monkey: June – August 2012 – 628 responses: - highlighted many things liked in existing guidelines - some areas that would like to see developed - suggestions about formatting / accessibility

  15. Subgroup 1- PainLeads: Sheila Scragg and Fiona Sneddon • Pain Assessment • Pain Management • Neuropathic Pain Management • Choosing and Changing Opioids

  16. SG 2 – Gastro-intestinal careLeads: Tim Morgon and Alison MacRobbie • Anorexia/Cachexia • Bowel Obstruction • Constipation • Diarrhoea • Hiccups • Nausea and Vomiting • Oral Care

  17. SG 3 – End of Life and EmergencyLeads Rosalie Dunn and Sandra McConnell • Care in last few days of life • Complex discharge for end of life care • SC hydration • Emergencies – fits/ MSCC/Bleeding • OOH Handover Information • Uncontrolled severe distress • Last days of life - Renal Disease

  18. SG 4 – Psychological and MiscellaneousLeads: Claire Sharp and Karen Menzies • Delirium • Depression • Hyercalcaemia • Pruritis • Sweating • Syringe pumps

  19. SG 5 – Respiratory CareLeads: Fiona Downs and Shirley Kelly • Breathlessness • Weakness/Fatigue • Cough

  20. Produced with support of Scottish Palliative Care Pharmacists Association Alfentanil Fentanyl Patches Fentanyl Nasal Spray (Pecfent) Fentanyl Sublingual (Abstral) FentanylBuccal (Effentora) Ketamine Levomepromazine Lidocaine Methadone Methylnaltrexone Midazolam Naloxone Octreotide Oxycodone Phenobarbital (Phenobarbitone) Medicines Information Sheets

  21. Subgroup Initial drafts: • Internal review of initial guidelines • Each subgroup reviewed other subgroups’ work • Steering group meetings held at GMC

  22. Outcome of Internal Review of Guidelines

  23. Public and User Focus Group: • Supported by Scottish Health Council / SIGN User Involvement Officer • Meeting in Edinburgh with carers and members of public • Helped to ensure focus and balance was right

  24. External Review • Co-ordinated independently by Dr Paul Keeley • Experts identified from around UK • Comments to subgroups • Each comment logged and considered • Final drafts to Medical Writers for readability

  25. Paper presented to national Directors of Pharmacy Letter sent to each health board ADTC recommending adoption of guidelines Some Health Boards have already approved, others still to discuss Area Drugs Therapeutics Committee Approval

  26. Open consultation

  27. http://www.testing29.scot.nhs.uk/

  28. HIS will take ownership of the guidelines SHOW will host App Accessibility

  29. The Future • HIS is developing a light touch process to ensure the currency of the guidelines in the future • Patient Information update – a separate project with dedicated funding and resources? • Electronic teaching modules for medical staff Fiona Downs

  30. Thank you to all who contributed http://www.testing29.scot.nhs.uk/guidelines/about-the-guidelines/contributors.aspx

  31. How can you help? • Familiarise yourself with the guidelines • Discuss them with colleagues • Refer to them for clinical advice or when teaching • Ask your health board / MCN how they are promoting them

  32. Choices and decisions towards the end of life Annual Conference 2014 #sppc2014 RCPE-WIFI Password: chiron1681

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