Palliative and end of life rapid discharge pathway

Source: National End of Life Care Programme

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Date of publication: March 2012

Publication type: Case study

In a nutshell: In 2009 the University Hospital of North Staffordshire introduced a palliative and end of life rapid discharge pathway for patients in or approaching the terminal phase of their illness.  Discharge is arranged at the earliest opportunity, usually within days or hours.  It is already having a significant impact with around 45 patients a quarter discharged in this way. Unanticipated benefits include the development of strong working relationships between secondary and primary care,  new services being developed and the development of the role of clinical champions for every clinical area who help spread good practice (there are 50 at present).

Length of publication: 1 webpage

Acknowledgement: National End of Life Care Programme

Anticipatory care planning and integration: A primary care pilot study aimed at reducing unplanned hospitalization

Source: British Journal of General Practice, 2012, 62, (595) (e113-e120)

Date of publication: February 2012

Publication type: Article

In a nutshell: This article reviews a pilot study in Scotland which aimed to provide anticipatory care plans (ACPs) for patients who were at risk of hospital admission. Patients’ wishes in the event of sudden deterioration in their health were recorded.  The pilot achieved statistically significant reductions in unplanned hospitalisation for patients with multiple morbidities and  demonstrates the potential for providing both better care as well as better value for health and social care services.

Length of publication: 8 pages

Some important notes:  Please contact your local NHS Library for the full text of the article. Follow this link to find your local NHS Library.

Acknowledgement: Embase

End-of-life care pathways as tools to promote and support a good death: a critical commentary

Source:  European Journal of Cancer Care

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Date of publication: January 2012

Publication type: article

In a nutshell:  This paper challenges whether end-of-life care (EoLC) pathways facilitate the accomplishment of a ‘good death’. EoLC pathways are widely recommended as ‘best practice’. However there are concerns about the efficacy of care pathways with regard to their impact on patient care.  Further examination of two EoLC pathways reveals how biomedical aspects of care are privileged. Despite this evidence indicates EoLC pathways may facilitate a particular type of ‘good death’, especially one associated with the dying process and framed within biomedicine.

Length of publication: 11 pages

Acknowledgement: BNI

A residential aged care end-of-life care pathway (RAC EoLCP) for Australian aged care facilities.

Source: Australian Health Review Vol. 35(3) p350-356

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Date of publication: August 2011

Publication type: Article

In a nutshell: The objective of this study was to develop, implement and evaluate an end-of-life (terminal) care pathway for Australian residential aged care facilities that improves resident and health system outcomes. The residential aged care end-of-life care pathway was developed by a multidisciplinary collaboration of government and non-government professionals and incorporated best clinical management for dying residents to guide care and increase palliative care capacity of generalist staff. Results indicated that the pathway, delivered within a care framework that guides provision of palliative care, resulted in improved resident outcomes and decreased inappropriate transfers to acute care settings.

Length of publication: 7 pages

Some important notes: Contact your local health library for a copy of this article. Follow this link to find you local health library.

A framework for the best end of life care planning

Source: Nursing & Residential Care, 2011, 13(3) p.137-40

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Date of publication: March 2011

Publication type: Article

In a nutshell:  The National End of Life Care Programme has published a guide to improving the care of dying people in care homes.  This article, aimed at care home managers, discusses how it can help them to optimize end of life care in their homes. It advocates a six-step pathway, provides illustrative case studies, information about quality markers, suggestions for staff training and finally, it provides sources of further information.

Length of publication: 4 pages

Some important notes: An NHS Athens password is required to access this article.  Follow this link to find your local NHS Library.

Acknowledgement: BNI

Nurses’ views on using the Liverpool Care Pathway in an acute hospital setting

Source: International Journal of Palliative Nursing, 2011, 17(5) p.239-44

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Date of publication: May 2011

Publication type: Article

In a nutshell: This article describes a piece of qualitative research exploring nurses’ perceptions and experiences of using the Liverpool Care Pathway (LCP) for patients dying in an acute setting. The research examined the experiences of general nurses, and compared them with those of LCP link nurses who have a special interest in palliative and end-of-life care, through the use of focus groups.

Length of publication: 6 pages

Some important notes: An NHS Athens password is required to access this article online. Follow this link to register for Athens.

Acknowledgement: BNI

Spreading best practice in dementia and end of life care

Source:  Advancing Quality Alliance

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Date of publication:  April 2011

Publication type:  Case Study

In a nutshell:   Led by Greater Manchester and Cheshire Palliative Care Network, this project aims to build on existing end of life care tools such as the Gold Standard Framework and the Liverpool Care Pathway.  The objective is to provide sets of tools that equip GP and out-of-hours providers to make better decisions about end of life care for dementia suffers which will result in the provision of more appropriate care and significant cost savings. 

Length of publication: 2 pages

Transition to adult services for children and young people with palliative care needs: a systematic review

Source: Archives Disease in Childhood, 2011, 96(1) p.78-84

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Date of publication: January 2011

Publication type: Article

In a nutshell: This systematic review looks at the transition process from child to adult services for young people requiring palliative care. The impact of care provided is considered and this is accompanied by a discussion on what factors facilitate or act as a barrier to successful transition. The reviewers looked at 92 studies and their conclusions include:

• There’s no evidence of transition services that address “palliative care” as an overall concept.
• Transition programs that exist are mainly condition-specific.
• No long-term outcome data exist to compare the effectiveness/cost effectiveness of the condition-specific or generic transition models.
• Effective transition programs should be multidisciplinary, bespoke for the patient and navigated with the aid of a designated key worker.

Length of publication: 7 pages

Some important notes: This article is available in full text to all NHS Staff using Athens, for more information about accessing full text follow this link to find your local NHS Library.

Acknowledgement: BNI

End of life care in adults pathway published on Map of Medicine

 Source:  Map of Medicine 

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Date of publication:  December 2010

Publication type:  News item

In a nutshell:  This new pan-specialty pathway extends beyond purely palliative care pathway that it replaces.  It incorporates physical needs, practical and social needs, psychological and spiritual needs, support for families and patients priorities and preferences.  It is based on high-quality guidance from national sources including the Gold Standards Framework and NICE.

2010 Annual Evidence Update on End of Life Care

Source: NHS Evidence

Follow this link to view the update in full.

Date of publication: November 2010

Publication type: Annual Evidence Update

In a nutshell:  This year’s Annual Evidence Update (AEU) produced by the commissioning and innovation and improvement specialist collections is on end of life care. The AEU aims to bring together the latest knowledge and evidence about contemporary aspects of end of life care. Patient experience, measurement, pathways and access to services are all covered.

Some important notes: To get full access to the resource you will need an NHS Athens account. Please click here to register for an account. If you need further help please  click here to contact your local NHS library.

Using prognostic indicator guidance to plan care for final stages of life

Source: Primary Health Care

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Date of publication: July 2010

Publication type: Article

In a nutshell: The author describes how clinicians and healthcare providers could improve predictions of patients needs as they near the end of their lives by using  prognostic indicator guidance.   Primary care teams along with care homes and hospitals that use this method of identification, assessment and planning find it much easier to provide top quality proactive care where it is most needed.  They also find they are better able to adhere to patients’ wishes and avert crises as well as reducing inappropriate hospital admissions and hospital deaths.

Length of publication: 4 pages.

Some important notes: This article is available in full text with an NHS Athens account.  If you do not have an NHS Athens account please contact your local NHS Library for the full text of the article. Follow this link to find your local NHS Library.

End of Life Care Strategy: Second Annual Report

Source:  Department of Health

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Date of publication:  August 2010

Publication type: Annual Report

In a nutshell:  The progress made in improving standards of end of life care in England over the past year to August 2010 is reviewed including: 

• The challenges of end of life care and how they’ve been met
• The sociological aspects of death and dying
• The EoLC pathway
• Care settings
• Carers and families
• EoLC workforce
• Measurement and research in EoLC
• How to ensure services develop

Length of publication:  89 pages

A proposed systems approach to the evaluation of integrated palliative care

Source: BioMed Central Palliative Care,  2010; 9: 8.  Published online doi: 10.1186/1472-684X-9-8.

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Date of publication: May, 2010

Publication type: Article

In a nutshell:  This article proposes a strategic approach to evaluate palliative care networks (PCNs) with particular emphasis on how well professionals collaborate, how client-centred their focus is and how community-ready they are.  The proposed systems approach is designed to guide evaluation of PCNs in order to promote collaboration and establish networks that provide optimum care for patients.

Some important notes: Available with an Athens password from BioMed Central – if you don’t have an Athens password please contact your local NHS Library for the full text of the article.   Follow this link to find your local NHS Library

What “best practice” could be in Palliative Care: an analysis of statements on practice and ethics expressed by the main Health Organizations

Source: Biomed Central BMC Palliative Care, 2010, 9(1) doi:10.1186/1472-684X-9-1 

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Date of publication:  January 2010

Publication type:  Report

In a nutshell: 

This report seeks to determine if an implicit model of best practice in palliative care currently exists.  The researchers conducted a qualitative analysis of the statements on practice and ethics of palliative care from publications produced by the main health organizations involved in service design and delivery to establish which dimensions of end-of-life care are taken into consideration in developing models of care.  A total of 34 organizations were identified, 7 international organisations, and 27 organisations operating on the national level in four different countries (Australia, Canada, UK and United States).  The report concludes that there is no consensus about what constitutes best practice for end of life care however, examples of best practice are discussed.

Length of publication: 9 page report