Case study:

02 February 2009

Implementation of PPC for outpatient haemodialysis patients in Westmorland General Hospital

Key points

Westmorland General Hospital is giving all its haemodialysis outpatients the option of choosing where they wish to die when the time comes.

The hospital’s renal unit decided to introduce the Preferred Priorities of Care (PPC) tool after recognising that some dialysis patients were facing a number of concerns about end of life care issues. These included the fact that some patients lived a long distance away from the hospital as well as worries about carers’ needs and psychological, social and financial issues.

Staff spend time with patients explaining what is involved and helping them complete the PPC form where necessary. They also follow them up on a regular basis and inform GPs about any of their patients who have completed the form.

Although there was initial resistance from some staff, this has been largely resolved. However, it is clear more time is needed to develop the service. In addition communications between the renal unit department and primary care services need to be improved.

It is also apparent that not all staff feel comfortable talking about end of life issues with patients. Communications courses are now being planned for key staff.