The amber stage signifies that a patient is deteriorating now. The prognosis is thought to be weeks and the patient may be becoming more unwell week to week.
If an individual has a rapidly deteriorating condition that may be entering a terminal phase they may need Fast track NHS continuing healthcare funding to enable their needs to be met urgently (e.g. to allow them to go home to die or appropriate end of life support to be put in place). Consider using the NHS Continuing Healthcare Fast Track Tool.
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Prognosis of a few weeks
A deterioration indicating the patient is entering the final weeks of their life should trigger a review of all Care Plans. Check patients and carers understand as much as they wish to about what is happening now prognosis is short. Any changes to an individual’s priorities for care should be clearly documented. Professionals should continue to deliver high quality care, anticipating physical care needs, maintaining good symptom control, giving considering to psychological and spiritual issues and supporting carers.
NHS Continuing Healthcare funding includes a fast track process which can be used by a senior clinician for people with rapidly deteriorating health needs and allows any such needs to be met urgently (for example, to be at home to die). Assessment will include evidence of diagnosis and prognosis where these are available, together with details of both immediate and anticipated healthcare needs.
When outlining reasons why a a clinician considers that a person has a rapidly deteriorating condition that may be entering a terminal phase, the clinician should consider the following definition of a primary health need:
Primary Health need arise where nursing or other health services required by the person are (a) where the person is, or is to be, accomodated in a Care Home, more than incidental or ancillary to the provision of accommodation which a Social Services authority is, or would be but for person’s means, under a duty to provide; or (b) of a nature beyond which a social services authority who primary responsibility is to provide social services could be expected to provide.
Anticipatory medication should be provided at this stage, after discussions with the patient and carer. If needed, such medication will help control distressing symptoms of pain, restlessness and agitation, nausea and vomiting, and respiratory tract secretions, without delay. Symptom Management Guidelines are available at http://book.pallcare.info
See appendix B for anticipatory medication guidance.
The carer’s needs should be regularly reviewed, udpated and shared to ensure that the appropriate type and level of support is in place to enable them to cope, especially if the patient has chosen to die at home. Information should be provided on how to access advice and support if a crisis arises.
Communication of information to other providers is essential at this time using the EPaCCS Template.
Things to consider at this stage
Fast Track Continuing Care [icon name=icon-circle-arrow-right]
Anticipatory Prescribing [icon name=icon-circle-arrow-right]
DNACPR – Do Not Attempt Resuscitation [icon name=icon-circle-arrow-right]
Relevant Services [icon name=icon-circle-arrow-right]