Lightning Learning: Treatment Escalation Planning
STOP!
You’ve arrived on shift and the patient handed over to you is suddenly looking worse… Don’t you wish someone had made a plan?
What are Treatment Plans?
- Proactive, individualised care plans for patients at risk of deteriorating.
- Can be a formal document like ReSPECT or a documented discussion in the notes.
- A collaborative plan to decide what would happen if the patient suddenly became more unwell.
- A guide to which life-sustaining therapeutic interventions would be appropriate if the patient deteriorated.
- They may include life-saving interventions like CPR, but also things like further blood tests, arterial blood gases and IV access, as well as end of life decisions.
LOOK
Around 1-in-3 patients admitted as an emergency will die within 12 months of admission.1
DO consider an HONEST and ReSPECTFUL treatment planning discussion for:
- Patients with an uncertain recovery.2
- Patients at risk of deterioration or death. Consider SPICT guidance.3
- Patients with frailty scores of 7, 8 and 9.
- Patients with a palliative diagnosis.
DO include interventions like CPR, invasive and non-invasive ventilation, but ALSO things like chaplaincy and preferred place of death.
DO write the plan clearly in the notes.
DO communicate appropriate elements of the plan to the patient’s community team. Consider a GREAT discharge.4
DO review the patient and plan regularly to ensure that it is still appropriate.
DON'T assume that what you or a patient’s relative wants is what the patient wants – ASK THEM!
