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REMEDY : BNSSG referral pathways & Joint Formulary

End of life care and ReSPECT

Checked: 04-09-2020 by Rob.Adams Next Review: 07-04-2021

New ReSPECT form

A new ReSPECT (Recommended Summary Plan for Urgent Care and Treatment) form was released on 3.4.20 which now includes a section for COVID-19.

Details on how to download this onto your EMIS system can be found in TeamNet 

See also information on Advanced Care Plans at the bottom of this page.

End of Life Care -NICE

Please see the NICE guideline on EOL care in the community

COVID-19 rapid guideline: managing symptoms (including at the end of life) in the community

BNSSG End of Life Pack

The BNSSG End of Life COVID Community Guidance Pack - BNSSG End of Life Pack v7 (updated 22/06/20)

Sections 4, 7 and 8 have been added to the CCG website separately so that a link can be sent to carers, nursing homes, etc.

Please find attached Version 7 of the BNSSG EoL Care Community Guidance pack.  

The latest update includes an OOH’s process for Severnside. 

 

Please find attached the BNSSG End of Life pack, that has been developed as a BNSSG guide to support caring for those at EoL during Covid-19.  The is supported by Clinical Cabinet as our local response to EoL care at this time, with the aim of giving everyone support and confidence in best supporting the people we are caring for.
A broad range of clinicians from all organisations across BNSSG have been involved in developing this information.  It has also taken account of best practice across the UK, guidance from professional bodies and regional and national advice/guidance.
 
The pack contains:
  •  Section 1 : BNSSG guidance on community Palliative Care and Anticipatory Prescribing (full range of guidance for complex and non-complex patients) and guidance on managing waste medicines for community teams

  • Section 2 : Advice on Accessing Medicines in BNSSG (a guidance diagram)

  • Section 3: (updated) A Standard Operating Procedure (SOP) for Informal Carer Administration of Subcutaneous Injections in the Community Setting - Exceptional circumstances: Covid-19

  • Section 4: Information leaflet for people caring at home for a relative or friend who is nearing the end of life due to any diagnosis including coronavirus

  • Section 5 (updated): Verification of Death/VoD – overview of guidance, in hours support form for the VoD and full Community Services SOP for registered and unregistered staff aligning with the national guidance released this week

    * Please note for other organisations they may not be able to offer the same level of support to VoD at the current time

  • Section 6: Post End of Life Care in the Pandemic (Community Deaths) SOP for community services

  • Section 7: (updated) End of Life Care Information for Residential Homes

  • Section 8: (updated) End of Life Care Information for Nursing Homes

 
Key messages are:
  • That people continue to use the Anticipatory Prescribing EMIS drug chart and initial options they are used to across the community.  There are now further options in terms of non-oral medications and non-oral and injectable medications for use, with guidance on when these are appropriate.
  •  EoL medicines are as a first line sourced from the pharmacies (supported by regular links to what is available, where and when) followed by stocks across the community sites. 
  • Supportive care (non-drug) is detailed on how to best support a person with symptoms e.g.: shortness of breath.  Fans are not recommended for shortness of breath as they can support the spread of Covid-19.  They can however, still be used if the person affected is in a room on their own, but would need to be off for a family member, carer or clinician was to enter. 
  • Oxygen is not included within the guidance.  There is little evidence of its benefit in palliating symptoms so a focus has been on more supportive measures and drug treatments to minimise symptoms. 
  • We are aware people are likely to be working very differently to their usual practice and want to ensure that you know the system is fully supportive and grateful for everyone’s efforts at this time to best support our population
 
Kate Rush
Medical Director, Sirona care & health

Advanced care plans

Living Wills, Advance Statements and other documents can be completed from the comfort of people’s own homes if need be, with free, specialist support available from charities such as Compassion in Dying, without the need for a solicitor.

The website http://www.mydecisions.org.uk/ guides people through creating a Living Will and/or Advance Statement at their own pace, with further support available on 0800 999 2434.

The website www.dyingmatters.org/overview/resources also has resources for patients and professionals.

BNSSG COVID-19 just in case Drugs Chart protocol

On launching, this protocol will give the option to create either an oral/buccal JIC medication chart,  an injectable JIC medication chart, or a blank chart for you to complete with prepopulated drop down lists. You should not issue both a non-injectable and injectable pack at the same time.

The protocol checks the eGFR using a concept and if the eGFR is less than 30, it will use a different version of the relevant drugs chart which has an alternative dose of morphine liquid for the oral chart, or oxycodone instead of morphine on the injectable chart.

After you have printed and saved the chart, It will then offer to issue the oral / buccal or injectable medication on FP10s, and it is also possible to add syringe driver medications to the chart and then issue the drugs needed for that too.

See the attached files and instructions you need to import this into EMIS and use at your practice.

If you need support with this, please contact one of One Care's digital consultants