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Revised guidance will help identify end of life care patients earlier

Author: Leila Hawkins
04 April 2017

Updated guidance has been published for healthcare professionals to identify patients who need end of life care sooner.

The National Gold Standards Framework Centre (GSF) have revised their ‘Proactive Identification Guidance’(PIG), the tool that since 2001 has helped doctors, nurses and care home staff increase  rates of identifying patients by up to ten times, both in the UK and internationally.  The tool is co-badged by the Royal College of General Practitioners, and recommended as best practice.

Earlier recognition of decline leads to earlier anticipation of likely needs, better planning, fewer crisis hospital admissions and, more importantly, care tailored to peoples’ wishes.

PIG’s early alerting tool remains the same, but has been fully updated in accordance with current expert opinion.  It is an easy to use, three step process, starting with the straightforward question, ‘would you be surprised if the patient were to die in the next year?’ The second step offers general indicators of decline and increasing needs, while the third step suggests specific clinical indicators.

Professor Keri Thomas OBE, GSF Clinical Director, announced details of the updated PIG and its use in practice at the GSF conference in Wolverhampton last week.  She said:

“Identification is the absolutely crucial first step towards giving quality proactive, person-centred end of life care and the new PIG is designed to make that process more straightforward, particularly those with varying trajectories who are traditionally hard to identify. Only once it has been established that someone is approaching the end of life is it possible to perform the other critical tasks involved in GSF - planning and assessing people’s care in line with their wishes.

“PIG is an indispensable tool for professionals in hospitals, general practice and care homes enabling doctors and nurses recognise people across a range of conditions, thereby laying the foundations for good care helping them to live well, and when the time comes, to die well, where they would chose.”

It’s already proven to be effective in Australia and New Zealand,  where published research showed it’s helped with the identification of over 30% of hospital patients. Research in the UK has found benefits for patients with COPD and liver disease.

Evidence from eight GSF accredited hospital wards with a range of specialities shows that they were  identifying 32% of patients on average.  In community hospitals, this figure rose to 59%.

A number of leading figures have welcomed the new guidance and acknowledged the positive impact PIG has had on end of life care over the past 15 years.

Pete Nightingale, former RCGP Lead for End of Life care and current Macmillan UK GP Advisor, said:

“PIG is the tool that all GP practices in my area use to help identify people approaching the end of their lives, and has contributed to 61% of deaths now occurring outside hospital in North Lancashire. It has played a genuinely significant role in ensuring people receive the care they want, where they want.”

Professor Lisa Bayliss-Pratt, Director of Nursing & Deputy Director of Education and Quality, said:

“The Proactive Identification Guidance will help nurses with the important task of earlier identification of people nearing the end of their life who may need additional supportive care. These patients must receive high quality end of life care and have access to the support they need and deserve.”

For more information visit the GSF website.

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