Lightning Learning: GREAT Palliative Discharge
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.
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.
Around 1-in-3 patients admitted as an emergency will die within 12 months of admission/discharge. Patients with the highest Frailty Score (7 or greater) have the highest risk of dying during an admission.
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 primary care.
Information included on a GREAT discharge can support the patient, family and staff when a patient is readmitted.
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.