The Guidance promotes earlier identification of people of people nearing the end of life, and the subsequent inclusion of their preferences for end of life care on the End of Life Register. This leads to earlier planning and better coordinated care, which aims to meet their individual preferences for end of life care, including the preferred place of care.
The philosophy of the Guidance is one of predicting needs rather than exact prognostication. The information includes a definition of end of life care (GMC 2010).
The Guidance describes three triggers that suggest patients are nearing the end of life:
Trigger 1 – The surprise question;
Trigger 2 – General indicators of decline;
Trigger 3 – Specific clinical indicators related to certain conditions.
The Guidance includes a flow diagram which supports the application of the three triggers. Specific clinical indicators for the more common life limiting illnesses are included, ie cancer, organ failure, renal disease, general neurological diseases, frailty, stroke and dementia.
Having followed the above Guidance, and gained a view of the patient’s likelihood of being in the last 12 months of life, the information is used in conjunction with the NWEoLC Model to facilitate MDT agreement as to where on the NWEoLC model the patient should be coded. The actions listed within the supporting Good Practice Guide can then be applied in a timely manner to help support the patient and their family as they face end of life.