Gold Standards Framework: New identification guidance provides boost for end of life care
National Gold Standards Framework Centre (GSF) (31 March 2017): Care for people nearing the end of life received a major boost today with the publication of new fully updated guidance to help health and social care providers identify these patients earlier.
The National Gold Standards Framework Centre (GSF), launched a new revised version of its identification tool, PIG, which has since its original launch in 2001 helped doctors, nurses and care home staff, both in the UK and internationally, increase identification rates by up to ten times, paving the way for improved care for people at the end of their life. It is co-badged by the Royal College of General Practitioners, and recommended as best practice.
The new ‘Proactive Identification Guidance’, was formerly known as the GSF RCGP Prognostic Indicator Guide. This change of name is indicative of the move towards supporting earlier identification of patients leading to more proactive care and prediction of needs, and away from challenges of specific clinical prognostication that can sometimes hamper this approach. The essence of the PIG early alerting tool remains the same, but has been fully updated in accordance with current expert opinion.
Professor Keri Thomas OBE, GSF Clinical Director, announced details of the updated PIG and its use in practice at the GSF conference in Wolverhampton today. Guidance on its use, background to its development and evidence from across the world of its effectiveness in different settings and conditions can be found on the GSF website from 5 April.
Examples of PIG’s effectiveness can be found in published research from Australia and New Zealand where it helped the identification of over 30% of hospital patients. Research from the UK affirms its value with patients with COPD and liver disease, and evidence from Italy describes its use in cardiac patients
A number of leading figures have already welcomed the new guidance and acknowledged the positive impact PIG has had on end of life care over the past 15 years.
Pete Nightingale, former RCGP Lead for End of Life care and current Macmillan UK GP Advisor, said: “PIG is the tool that all GP practices in my area use to help identify people approaching the end of their lives, and has contributed to 61% of deaths now occurring outside hospital in North Lancashire. It has played a genuinely significant role in ensuring people receive the care they want, where they want.”
Professor Lisa Bayliss-Pratt, Director of Nursing & Deputy Director of Education and Quality, said: “The Proactive Identification Guidance will help nurses with the important task of earlier identification of people nearing the end of their life who may need additional supportive care. These patients must receive high quality end of life care and have access to the support they need and deserve.”
The new PIG has taken two years to develop in partnership with a number of leading professional organisations who provided expert clinical guidance, including British Geriatrics Society, British Thoracic Society and others.
PIG is an easy to use tool to help professionals more easily and effectively identify those people who are approaching the final months of life. It’s a three-step process, starting with the straightforward question, ‘would you be surprised if the patient were to die in the next year?’ The second step offers general indicators of decline and increasing needs while the third step suggests specific clinical indicators relating to three trajectories.
Prof Thomas said: “Identification is the absolutely crucial first step towards giving quality proactive, person-centred end of life care and the new PIG is designed to make that process more straightforward, particularly those with varying trajectories who are traditionally hard to identify. Only once it has been established that someone is approaching the end of life is it possible to perform the other critical tasks involved in GSF - planning and assessing people’s care in line with their wishes.
“PIG is an indispensable tool for professionals in hospitals, general practice and care homes enabling doctors and nurses recognise people across a range of conditions, thereby laying the foundations for good care helping them to live well, and when the time comes, to die well, where they would chose.”
Evidence from eight GSF accredited hospital wards with a range of specialities, shows that they were, on average, identifying 32% of patients. In community hospitals, this figure rose to 59%. An assessment of effectiveness in 17 GSF accredited practices showed that 60% of all patients that died had been identified and were on their end of life care register.
Earlier recognition of decline leads to earlier anticipation of likely needs, better planning, fewer crisis hospital admissions and, more importantly, care tailored to peoples’ wishes.
For more information about the 6th edition of PIG visit the GSF website http://www.goldstandardsframework.org.uk or contact or 01743 291891.