Hartor is listening

The Aims of ‘Hartor is listening’ project

We know that about 1% of the general population die each year. In the Plymouth/West Devon region that would be aprox 5000 patients. The percentages of adult hospital inpatientswho are in the last year of life are considerably higher (up to 40%). The majority of these deaths are expected and the health community can have a proactive approach to their care in the last year of life if this is recognised and anticipated.

We also know that significant distress can occur for patients and their families when good quality communicationopportunities are missed. Many patients require a number of admissions to hospital in the last year of their life; a hospital admission therefore could be a good opportunity to recognise and initiate some of these conversations.

The ‘Hartor is listening’ project aim is specifically looking at how we can recognise the patients who are the end of life population, how we can document these conversations and how we can relay that information to continue the support for end of life patients in the community and achieve true choice at the end of life.

The 5 steps

Step 1 ‘identify’

Recognise that the patient is likely to be in the last year of life.

Tools available

  • Supportive and Palliative care Indicators (SPICT)
  • Guide
  • Prognostic tool
  • poor prognostic indicators as described in Derriford ‘Poor Prognosis letter’
  • the use of the End of life Salusto guide white board meetings

Step 2 ‘communicate’

Improve/sustain the quality of the sensitive end of life discussions with the patient and/or their family.

Increase staff confidence in their communication

Tools available

  • SPACE communication training.
  • Communication training on the wards.
  • Resuscitation leaflet

Step 3 ‘document’

Improve the documentation of sensitive communication with patients and their families on the ward

Tools available

  • Use of the sensitive communication sheet.

Step 4 ‘plan’

The role of the use of advance care planning and the tools to support this

Tools available

  • Advance care planning documentation.
  • Thinking ahead document.
  • Living well document.
  • Devon planning for your future care.
  • Information about lasting power of attorney application.
  • Information about advance decisions to refuse treatment documentation (ADRT).

Step 5 ‘inform’

Improve the discharge of end of life patients, including the information relayed to the GP on discharge and information when readmitted.

Tools available

  • The GREAT discharge proforma.
  • Poor prognosis letter template.
  • Just in case prescriptions.
  • The use of Electronic palliative care coordination system (EPPACS) .

Step 1 ‘identify’

  1. Supportive and palliative care indicators (SPICT)
  2. Guide
  3. Prognostic tool
  4. Derriford ‘poor prognostic tool’ template

Step 2 ‘communicate’

  1. SPACE communication
  2. Patient resuscitation leaflet
  3. Links to communication training and aids

Step 3’ document’

  1. ‘sensitive communication sheet

Step 4 ‘plan’

  1. Advance care planning documents
  2. ACP guide
  3. Introduction to acp article
  4. Thinking ahead
  5. Living well document
  6. Planning for your future
  7. Lasting power of attorney
  8. Advance decision to refuse treatment
  9. Guide
  10. Document

Step 5 ‘Inform’

  1. GREAT discharge proforma
  2. Poor prognosis letter
  3. Template
  4. Example letter
  5. Guide to just in case prescribing

#hartorislistening