Advanced Care Plans

Question 1

What is advanced care planning?

Answer 1

A discussion or series of detailed discussions with the patient, where their wishes are explored and their aims of their ongoing care to help create an individualised care plan when they are approaching their last phase of life.

Question 2

It is quite hard to identify patients who are at their end of life when they have a lot of co morbidities, what is one way of doing this?

Answer 2

Gold standards framework- used by GPS and identifies patients approaching their last days

Question 3

How do we communicate patients best wishes?

Answer 3

ReSPECT forms 
(DNAR decisions, ceiling of care documentation) 

Advanced care plan (mostly completed by GPS)

Emergency health care plans are done to give time for advanced care plans to be done

Question 4

What is meant by ceiling of care?

Answer 4

How much medical intervention is appropriate

What are the patients wishes

Ie: they may be appropriate for CPAP but may not wish to have it

Question 5

What are the most common meds used in palliative care?

Answer 5

Morphine- for pain and breathlessness
Midazolam (SC) for agitation
Glycopyronnium SC for troublesome oral secretions
Levopromazine SC for nausea and vomiting

Question 6

Who is part of the end of life care and support?

Answer 6

GPs and district nurses

Palliative care…
Community teams 
In reach across UHL 
Formal referral to outpatients
LOROS - local hospice

Question 7

What pharmacokinetics make people more at risk of polypharmacy when they are older?

Answer 7

Renal- the renal function decreases with age, some medications use creatinine clearance not eGFR to influence the dosing

Volume of distribution- some drugs with high volumes (lithium and diazepam) require fat to distribute, fat may be decreasing in older age

Liver function