July 13, 2020

EPaCCS: Supporting clinical decision making in Out of Hours Care for patients at the end of life

As a GP providing out of hours care to our local population, historically providing truly collaborative palliative care has been difficult because of the lack of information on areas such as diagnosis and prognosis and the lack of sharing of advance planning that outline patients’ wishes about preferred place of care and death. In the past, the system was reliant on GP practices uploading information to the out of hours system and this information was often very brief – mainly concerning resuscitation status but little else. With the advent of EPaCCS this has revolutionised the information we receive and our ability to tailor care to the patient’s wishes. I am seeing the benefit of this with every shift I work out of hours.

One example is of a lady with ovarian cancer. Her EPaCCS record shared information on diagnosis, prognosis, preferred place of care (PPC), preferred place of death (PPD) and showed that she was prescribed anticipatory medication and a DNACPR form was in place. This allowed me to make decisions comfortably about this patient without having to phone the patient and speak to her or her relatives about her wishes. I was informed out of hours that she had been having haematemesis and that she had dropped her haemoglobin (was becoming anaemic). Because of the EPaCCS record, I knew this lady was in the last days of her life and that her PPC and PPD was home. This allowed me to leave the patient at home, safe in the knowledge that this was her wish, and allowed me to alter the anticipatory medications to ensure she was as symptom free as possible in her last days of life. Without this knowledge, this would have ended up with the patient possibly being visited or even admitted, potentially causing distress to both the patient and family unnecessarily.

I encourage everyone to continue to complete and upload EPaCCS records so that we can improve our offer of excellent palliative care for all our patients and their loved ones.

Dr Jenni Lawrence Macmillan GP Lead NHS Scarborough and Ryedale CCG
Humber Coast & Vale STP EPaCCs Programme

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