To put it bluntly, they have killed people and no-one has batted an eyelid. How can this be? How can this be?
The Amber is going for Gold
Dr. Adrian Hopper and his team from Guy's & St. Thomas' have gone global and coasted off to OZ to address a conference in connection with rolling out Amber at nine sites across New South Wales (NSW).
End of life conflict
End of life conflict is defined as disagreement which occurs about the goals of care or treatment decisions at the end of life and where such conflict is not resolved by the usual recourse to time and further discussion between the patient, the family and the treating clinicians, as appropriate
(NSW Health 2010, Conflict resolution in end of life settings project report).
When is the point of 'End of Life' reached? When the diagnosis of 'dying' is made...?
The document discusses the need for 'conflict resolution'. In what context...?
- Potentially avoidable conflicts between families and the health care team, or within the health care team, about the best course of treatment and care for the dying patient
- Care being delivered in acute settings when better patient outcomes could be delivered in supported community or home environments
Medical treatment is intended to intervene to promote recovery. That is the upsize perspective. The downsize perspective is that it prolongs the dying process and 'forestalls death'.
Life-sustaining treatment is any medical intervention, technology, procedure or medication that is administered to forestall the moment of death, whether or not the treatment is intended to affect life threatening diseases or biological processes. These treatments may include, but are not limited to, mechanical ventilation, artificial hydration and nutrition, cardiopulmonary resuscitation or certain medications (including antibiotics).
Conflict resolution through
discussion grooming -
Some health professionals in NSW have expressed concern that discussing and documenting end of life concerns with families will lead to family complaints, conflicts about end of life decisions, and legal exposure. Sensitively conducted and inclusive conversations with patients and families and thorough documentation generally reduce the likelihood of family complaints and risk.The important context to remember is that Amber was responsible for upsizing LCP quotas where it was used.
The net is being trawled wider.
What is to be done?
- Improve identification of dying patients using the Between the Flags Program.
- Pilot an End of Life Observation Chart based on Between the Flags Program documentation that helps monitor the quality of care provided to dying patients, including escalation for clinical review.
The Between the Flags program is a standardised program devised by the Clinical Excellence Commission (CEC) in collaboration with the NSW Health quality and Safety Branch (QSB) to identify and early manage deteriorating patients. This net is now become a trawl just as similar schemes are being employed here.
And the Pathway is Legion -
The SPICT now has its own website which depicts a watermarked June 2013 version. This has been edited in the following manner:
Eating less; difficulty maintaining nutrition.
…………Choosing to eat and drink less; difficulty maintaining nutrition
Unable to communicate meaningfully; little social interaction.
…………No longer able to communicate using verbal language; little social interaction.
Kidney failure due to another life limiting condition or treatment.
…………Kidney failure complicating other life limiting conditions or treatments.
Has needed ventilation for respiratory failure.
…………Has needed ventilation for respiratory failure or ventilation is contraindicated.
The unwatermarked July 2012 version is still available online.
The CPPPC is being rolled out in five regions in Belgium -
We are starting the implementation of a Care Pathway of Primary Palliative Care (CPPPC) in five regions in Belgium, to be used in a first phase by the primary health care team, aiming to extend it later on by hospital staff. This CPPPC will start with early identification of palliative patients by using the Surprise Question and the Supportive and Palliative Care Indicators Tool. The second step is individualized advance care planning, aiming to design an individual care plan that grows over the time, fed by multiple discussions with all stakeholders taking care of the palliative patient, including hospital staff. We hope that, from a long-standing relationship and “knowing the patient’s and family’s wishes”, this way of providing care will lead to a better palliative as well as end-of-life care, both in the outpatient and in the inpatient settings .
The CPPPC, in the same manner as the LCP and Microsoft Windows, is being tested 'live'. It is untrialled and untested.
We believe that to evaluate a complex intervention like our Care Pathway it is not enough to find associations and correlations in quantitative databases. We will evaluate the CPPPC by quantitative means, but partly inspired by the LCP cautionary tale, we will also interview users of our Care Pathway (health care professionals, patients and family members) to find the specific contexts in which and psychosocial mechanisms through which the CPPPC works the best, and in which it doesn’t work.
Microsoft uses the punters to iron out the issues. Here, they will use the corpses. These are people!
Wait a minute. The Surprise Question, the Prognostic Indicators...
The LCP by any other name might smell as sweet the sweet smell of death.
And the CPPPC is an 'evaluative' tool. Might this form part of the randomised trial of the Liverpool Care Pathway proceeding in Flanders' Fields...?
Dundee Dignity Care Pathway? This has travelled afield also -
The British Journal of Community Nursing discusses the implementation of this 'care intervention'.
While the All Ireland Institute of Hospice and Palliative Care is bringing psychometric skills into the community setting to give the blarney that extra edge and has recruited a Project manager to oversee this -
The Summer 2013 issue of GP Exchange at Norfolk Community Health and Care NHS Trust reports -
We have been awarded £100,000 from Skills for Care to bolster our ‘Six steps to success in end of life care’ training course. The course is aimed specifically at supporting care home staff to be more confident and competent at assessing and delivering palliative care.
The Six Steps to Success became infamous last year using gross educational material such as this...
NHS Calderdale CCG is tendering for an Integrated End of Life Care Pathway -
The NCPC Reports -
The Leadership Alliance for the Care of Dying People (LACDP) will operate under the chairmanship of Dr Bee Wee, National Clinical Director for End of Life Care at NHS England, to respond at a strategic and system-wide level to the report following the independent review of the Liverpool Care Pathway (LCP).
Everyone is going for pole position. No-one wants to be left on the sidelines.
The N&MC reports on this also.
They are focussed on ensuring...
high quality, compassionate care and support for all those who are dying, as well as their families and friends. [Claire Henry and Anita Hayes]
|- Mail Online|
Should they not refocus?
They are themselves responsible for many of these poor people going to an early grave -
Tens of thousands of patients are dying needlessly in hospital every year from kidney failure linked to dehydration, NHS officials have revealed.
They calculate that up to 42,000 deaths a year would be avoided if staff ensured patients had enough to drink and carried out simple tests.
NICE, the NHS watchdog, is today issuing guidelines to staff to help them prevent deaths from the condition – known as acute kidney injury – which is common in the elderly and patients with heart disease, diabetes and blood infections.
They need guidelines to provide nutrition and hydration?
They are a death cult.
And they are legion...