Case study:

11 May 2010

Implementing a coding system to identify residents nearing the end of life in Sussex

Key points

A group of care homes (nursing) in Sussex have adopted a ‘traffic light’ system to help anticipate when residents are approaching the end of their lives and plan care accordingly.

Residents at Sussex Health Care, a group of homes catering for the elderly mentally infirm and people with learning disability and physical disability, are coded from A-D depending whether their prognosis is in years, months, weeks or days.

Those on C and D are reviewed weekly while those on A and B are reviewed monthly at a meeting which then agrees care plans to suit each individual’s circumstances.

The new approach was introduced as part of a general attempt to raise awareness of end of life care but also because staff were facing difficulties anticipating some residents’ care needs in the last stages of life.

The new arrangements – which have been in operation since last June – encourage more in-depth work with residents and mean that more are now dying where they wish to die.

They have also led to better partnership working with GPs and the specialist palliative care service. For instance, there is better coordination with the out-of-hours service as well as more anticipatory prescribing by GPs.

GSF care home facilitator Nikki Sawkins admits even the best laid plans cannot cover all eventualities.

For instance, some residents coded A (that is, predicted to survive for years), died suddenly.

But staff are now able to recognise that this does happen sometimes.

‘It was challenging to do first time round, but it really works and is now part of practice,’ said one GSF care home coordinator.