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Choice and control: ensuring patient involvement

Choice and control: ensuring patient involvement. Dr Simone Ali Consultant in Palliative Medicine South Downs Health NHS Trust / The Martlets Hospice. Choice and Control. What is Choice ? “option; alternative; selection; preference; variety; abundance” What is Control ?

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Choice and control: ensuring patient involvement

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  1. Choice and control: ensuring patient involvement Dr Simone Ali Consultant in Palliative Medicine South Downs Health NHS Trust / The Martlets Hospice

  2. Choice and Control • What is Choice? • “option; alternative; selection; preference; variety; abundance” • What is Control? • “manage; organise; be in charge of; have power over; be in command of; direct; rule” • Is Choice/Control a good thing? Always?

  3. Hobson’s Choice?

  4. Initiatives which have helped to enhance choice for dying patients in Brighton and Hove • Gold Standards Framework (GSF) for primary health care teams and some nursing homes • Preferred Place of Care (PPC) • Liverpool Care Pathway (LCP) for the dying patient used and audited by all District Nursing Teams • Verification of Expected Death by District Nurses • Allow a Natural Death / Do Not Attempt Resuscitation (DNAR) Policy

  5. DNAR…do patients have a choice? • Competent patients who don’t want CPR • Yes • Competent patients who do want CPR • If futile, then no • No obligation to discuss with patient • Incompetent patients who can’t tell us • Ascertain previous wishes of patient • Ascertain whether futile

  6. Initiatives which have helped to enhance choice for dying patients in Brighton and Hove • Gold Standards Framework (GSF) for primary health care teams and some nursing homes • Preferred Place of Care (PPC) • Liverpool Care Pathway (LCP) for the dying patient used and audited by all District Nursing Teams • Verification of Expected Death by District Nurses • Allow a Natural Death / Do Not Attempt Resuscitation (DNAR) Policy • Statement of Patient’s Wishes (“Pink Sheet”)

  7. Help the Hospices and The St James’s Place Foundation Awards Programme: “Care Beyond Cancer” • “A patient led clinical directive proforma: development and dissemination” • Supported by Brighton and Hove PCT and Out-Of-Hours (OOH) team • Regular progress reports and audit

  8. Impact of Pink Sheet • Reduction in inappropriate hospital admissions • Reduction in unwanted clinical interventions • Better communication between patient, carers and professionals • Especially helpful out of hours and when patient unable to express wishes • PPC achieved for more patients

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