Case study:

11 May 2010

Procedures for transporting patients with specialist palliative care needs in London Ambulance Service NHS Trust

Key points

Palliative and end of life patient transport from acute and care home needs have been highlighted as a significant issue.

The following example shows how this need can be addressed.

London Ambulance Service NHS Trust has produced guidance to meet the requirements of patients with specialist palliative care needs when they are being transported by ambulance.

It includes details of ambulance transfers between home, hospice, hospital and nursing or residential home, as well as dealing with a patient who is very ill or dying at home and what happens if the transfer itself risks the death of the patient.

There is also a section on what to do if the patient has died at home.

This covers the issue of when to attempt resuscitation.

The guidance, which is for patients who live in the South East London Cancer Network/ formerly South East London Strategic Health Authority area, aims to ensure that transfers are carried out quickly and preferably in the morning.

It also informs the ambulance crew of the status of their patient and gives them the information to deal sensitively with any needs that might arise during the journey.

In addition, it attempts to clarify the resuscitation status of the patient to ensure staff do not attempt an inappropriate intervention.

One underlying principle is that the patient, family and carers should be involved as far as is possible in all decisions concerning the transfer.

Central to good liaison is the ‘Palliative Care Out of Hours Handover Form’, which should be completed by the patient’s GP, district nurse or Specialist Palliative Care Team (SPCT) and faxed to both the London Ambulance Service and the GP out of hour’s service.

The form should contain resuscitation status and confirmation that death is anticipated.

It should indicate whether clinical nurse specialist verification of resuscitation status is acceptable.

A copy of the form may be found in the, ‘Message in a Bottle’, a system whereby patients leave key information in an agreed place within a labelled container in the patient’s fridge.

Crews will also be aware it would not be appropriate to undertake either basic life support or advanced life support on most patients under the care of a SPCT.

Any deviation from this principle will be documented in the palliative care handover form.