UK – Scotland
Lead SPICT Partner: Dr Kirsty Boyd
In NHS Lothian, the SPICT and the ‘Guide to using SPICT’ have been sent to all GPs to help them identify patients for assessment and then anticipatory care planning using the Scottish electronic Key Information Summary record. A pilot research study has developed a simple search algorithm that GP practices can run as a screening tool in their electronic patient record system to provide a list of patients to be discussed at the practice multi-disciplinary palliative care meetings.
In acute hospitals, the SPICT general indicators are being used to help staff in acute admissions units identify and manage patients admitted with acute medical problems who also have one or more advanced, progressive conditions.
Many palliative care education programmes in Lothian (and other parts of Scotland) use SPICT in teaching health and social care professionals about identifying people who might benefit from the holistic assessment and care that are central to a palliative care approach at the same time as optimal management of the patient’s illnesses.
Contact: Dr Kirsty Boyd
Crosshouse Hospital, NHS Ayrshire and Arran
Dr Pamela Mackenzie is developing a Renal Supportive Care Programme in Ayrshire and Arran for people with renal disease whose health is deteriorating such that they can benefit from a palliative care approach alongside ongoing treatment of their underlying medical conditions.
Part of this service improvement has involved a project specifically within the Renal High Dependency Ward, to identify patients within the acute renal ward setting who may have supportive/ palliative care needs. All patients admitted to the Renal High Dependency Ward have a Treatment Escalation Plan completed within 24 hours of admission. If a patient is felt to be at risk of deteriorating/ dying, a Renal Supportive Care Trigger Tool is completed which identifies patients who may have unmet palliative care needs, who can be referred to the Renal Supportive Care Programme.
The SPICT indicators were used to develop the ‘Trigger Tool’ (download below). The Trigger Tool is part of a range of resources developed by Dr Mackenzie with Tracey Dodds and Elaine Street, Renal HDU Supportive Care Link Nurses, to support shared decision making and to develop a person-centred approach to planning supportive/ palliative care within the context of a busy acute clinical area.
The other resources include advance care plan with patient information leaflet, end of life care plan, symptom control and anticipatory prescribing in renal disease and rapid discharge planning.
Contact: Dr Pamela Mackenzie
We are implementing the national palliative and end of life action plan throughout NHS Grampian and SPICT is a key element within the programme to help to identify patients in:
- Primary care
- Community hospitals
- Care homes
- Acute hospitals
Contact: Dr Sally Lawton
NHS Forth Valley (Forth Valley Royal Hospital)
Clinical Lead – Dr Dan Beckett (Lead Acute Physician)
Using SPICT encourages a ‘thinking ahead’ approach to care and avoids acute episodes of care being looked at in isolation.
SPICT multidisciplinary working group – Jennifer Wilson (Lung Cancer CNS), Evelyn Paterson & Mairi Armstrong (Palliative Care CNSs), Dr Stan Wright (Respiratory Physician), Elizabeth Ramage (Respiratory Ward Charge Nurse), Olwyn Lamont (Respiratory CNS), Paul Baughan (Lead Cancer GP), Dr Gill Foster (Hospice Associate Specialist)
SPICT is being introduced into the Acute Medical Unit (AMU) and the general medical wards in Forth Valley Royal Hospital ( a large district general hospital in central Scotland) as part of an ongoing project to improve recognition and responses to the ‘deteriorating patient’.
Early anticipation, collaborative care planning and decision-making are the primary drivers for this project. In AMU, when a patient is identified as deteriorating on the National Early Warning Score (NEWS) alert system, SPICT is used as part of the assessment process. The goal is to help staff use a structured response to physiological deterioration. The outcome of the assessment might include appropriate anticipatory care planning for people with life limiting conditions where escalation of care may not be appropriate. Using the SPICT helps staff identify unmet palliative/supportive care needs.
In the general medical wards, all admissions will be screened with SPICT. Using SPICT encourages a ‘thinking ahead’ approach to care and avoids acute episodes of care being looked at in isolation. Staff are encouraged to recognise the uncertain but predictable patterns that emerge with advanced long term illnesses and other life limiting conditions and provide appropriate care, based on a changing health picture. This will influence decision making and care in a positive way and present previously missed opportunities to have important discussions that will influence decision making and future care.
SPICT will form part of core documentation for all patients (on the reverse of the NEWS chart). Alongside education on the use of NEWS chart and reliable response stickers, staff will also receive education in key aspects of advance and anticipatory care planning (ACP or AnCP). All ward staff are encouraged to recognise the important role they play in this process and the need to ensure any care planning discussion is documented and communicated to Primary Care Teams at discharge.
SPICT is also being used to promote awareness of electronic Key Information Summaries (KIS). The eKIS is an online care plan completed by practice staff in Primary Care that can be viewed during unscheduled/ emergency care episodes. The information provided to GPs on discharge from hospital can about a patient’s anticipatory care plan in the event of further deterioration can then be added to the eKIS.
It is hoped that SPICT will link with Scotland-wide initiatives such as; DNACPR (Do not attempt CPR), anticipatory care planning and electronic patient care plans/ records such as KIS to promote high quality, coordinated supportive & palliative care.
Palliative care across acute hospital sites. The service is provided by a mixture of generalist and specialist staff.
Uses of SPICT
Plan to use to trigger ACP conversations.
Contact: Gillian Sherwood