A series of mix and match cards providing practical examples of changes you can make and how to implement them to improve care and quality at every step of the pathway for patients with COPD and asthma.

1. 12 NHS
Success principles NHS Improvement
Making a real difference Lung
TO W
TWELVE:
A
End of life care for chronic
RD
S THE E
ND obstructive pulmonary diease
(COPD) patients
Recognising dying in COPD patients is difficult as there are few reliable prognostic
indicators, so death may appear sudden and unexpected where it occurs during an
exacerbation. This can make it difficult to provide patients and families with a timely
opportunity to plan for future care, which can help them prepare appropriately and
ensure their needs are actively addressed at end of life. Fewer than 50% of services
for COPD have formal arrangements for patients to access specialist palliative care
or support.
Why?
If a patient is within 12 months of end of life then being added to an end of life
register will trigger supportive care pathways and access to palliative care. This will
ensure that specific end of life care needs and wishes are met.
How?
• Raise the topic with patients following a period of wellness as opposed to an
acute care setting following an acute exacerbation
• Recognising when proactive treatment is no longer appropriate
• Identify patients approaching last year of life using trigger tools e.g. The surprise
question www.goldstandardsframework.org.uk
The surprise question
‘Would you be surprised if this patient were to die in the
next 6-12months’
An intuitive question integrating co-morbidity, social and other factors. If you
would not be surprised, then what measures might be taken to improve their
quality of life now and in preparation for the dying stage.
The surprise question can be applied to years/months/weeks/days and trigger
the appropriate actions.
The aim is to enable the right thing to happen at the right time eg if days,
then begin a care pathway for the dying. Some clinicians find it easier to ask
themselves ‘Would you be surprised if this patient were still alive in 6-12
months?’
CONTINUED»»

2. • Discuss with the patient what the ceiling of treatment should be during an
exacerbation e.g would the patient wish to have NIV, has there been a discussion
about resuscitation status?
• Implement Advance Care Planning to document patients’ wishes
• Consider other triggers for end of life discussions such as the need for Non
Invasive Ventilation, severe disease on optimal therapy with more than three
admissions in the preceding 12 months, unremitting breathlessness, housebound
and requiring assistance with washing and dressing
• Support staff to consider end of life discussion and referral to palliative care
• Add patients to the Gold Standard Framework (GSF) register
• Conduct multidisciplinary team (MDT) assessment of GSF review
• Refer to end of life care services if appropriate
• Provide additional measures for palliation of breathlessness (e.g. opiates).
Resources
End of life care resources can be found at:
www.improvement.nhs.uk
An Outcomes Strategy for Chronic
Obstructive Pulmonary Disease (COPD)
and Asthma in England
www.dh.gov.uk/en/Publicationsand
statistics/Publications/PublicationsPolicy
AndGuidance/DH_127974