Lightning Learning: GREAT Palliative Discharge
““People nearing the end of life can benefit from discussing and recording their care preferences in a process known as Advance Care Planning.””
STOP!
Gold Standards Framework (GSF) Register
Consider requesting this from GP for any patient who is likely to be in the last year of their life. Let the GP know if you have made a referral to community palliative care.
Resuscitation Status
Discuss the benefits/burdens of CPR with the patient and family and include decision on discharge summary.
End of Life Medications and/or Medication Review
For the last days of life: prescribing for pain, agitation, nausea/vomiting, secretions, breathlessness. Include DN authorisations and water for injection.
For the last months, weeks or days of life: what medications could be stopped or reviewed?
Advance Care Planning
Discuss and record patient’s priorities and goals. Request GP updates the Integrated Care Plan.
Treatment Escalation Plan
Consider potential emergencies; record if re-admission is not wanted by the patient. Prompt GP follow-up, especially if the prognosis is short. Consider an Emergency Healthcare Plan (found on ICE). Gain senior doctor, patient and family involvement.
LOOK
Around 1-in-3 patients admitted as an emergency will die within 12 months of admission or discharge.
Many patients have frequent contact with hospital services in their last year of life.
Important conversations which take place in hospital are infrequently shared with community services.
A GREAT discharge can support the patient, family and staff when a patient is readmitted.
A GREAT discharge may be a helpful communication framework for…
Patients at risk of dying in the coming hours or days.
People with advanced, progressive, incurable conditions.
Patients with high Clinical Frailty Scores (the cohort with CFS 7-9 have a 1-year mortality risk of 50%).
People with end stage chronic medical conditions.
LEARN
Remember that the discharge letter goes home with the patient.
Involve patients and families with any decisions that are made about them, applying principles of the Mental Capacity Act 2005.
Nothing on this letter should be a surprise to the patient or family.
