8.4.20 Treatment escalation plans
Guidance has been sent on advanced care planning from the region
- A joint statement from RCGP, BMA, CQC and Care Provider Alliance on advance care planning was issued on 1 April and can be found here.
- Joint Guidance from RCGP, Royal College of Nurses and others has been issued and can be found in the RCGP resource hub.
- For Individuals with suspected Covid-19 who are frail, their Treatment Escalation Plans or Advance Care Plans should be reviewed. Plans are made in discussion with their registered GP and should be made available from GP records to CHIE and SCR so other health professionals including paramedics have access. This will support them to understand and act on the Treatment Escalation Plan. In some cases this may mean palliative care at home, or in other community settings under development.
- Identified High Risk Groups, already on an irreversible deteriorating trajectory:
Discussion with the patient about their TEP would suggest they would not be suitable for ventilation. Hospital admission would not be desirable regardless of Covid diagnosis.
- Identified High Risk Groups, but well and without a plan:
For situations where this feels particularly difficult consider using two stages. Remote consultations are not ideal. GPs have suggested a conversation setting the scene with the patient suggesting they discuss with family and friends following this up the next day for a decision. Given the rapidly changing situation it is not felt that challenging patients’ wishes at this point offers any benefit should they develop Covid.
To summarise this guidance we have developed the TEP flow diagram
- Further resources and learning from international sources to support communication with patients and help consider the psychological impact of Covid are included below:
- In some cases independent advocacy may be necessary; these services are limited and may be operating remotely. If face to face is necessary, PPE equipment for advocates will need to be sourced.
- Recording frailty scores and patents wishes in the Ardens/Qmasters template will help to ensure the patients receives the most appropriate care, should they deteriorate. A link to the clinical frailty scale is included below.
- The Clinical Frailty Score cannot be used on people under 60, people with a learning disability, autism or a stable long term physical need. National guidance to support care planning is available at this location: