Enhancing Palliative and End-of-Life Care: London Ambulance Service NHS Trust Strategies

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Dr Diane Laverty
Macmillan Nurse Consultant Palliative & EoLC
London Ambulance Service NHS Trust
 
LAS Strategy for
Palliative & End of Life Care
 
Almost 2 million calls to 999
Attended 1.1 million incidents
PC coded calls – 3111
31% average of PC calls conveyed to ED
 
What Do We Do? (1.4.17- 31.3.18)
 
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The 3 P’s:
P
reserve life
P
romote recovery
P
revent
deterioration
 
 
 
Resuscitation
decisions
 
Bereavement
 
National
strategy
 
Holistic
care
 
 
Reversible emergencies
 
Advance care
planning
 
Symptom Control
 
Decision Making
 
Paediatrics
 
Communication
 
Non expert clinicians
Time pressured situations
No pre-existing knowledge of
patient/family
Limited documentation/information
Variable OOH provision for specialist
support
 
 
 
 
The EoLC Challenge for LAS
 
What information can help us look after
your patients?
 
 
How can we stop unnecessary conveyances
to ED & keep patient at home – if that is
their wish?
 
 
CMC plan, detailing:
Personal & professional contact details
PPC/PPD/DNACPR decisions
Patient/family awareness
Treatment escalation plans
Symptom control hints & tips, including non
pharmacological interventions
 
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Anticipatory medications when it is clear your
patient is nearing end of life
Paramedics CAN administer anticipatory
medications
Clear, unambiguous drug prescription /
authorisation chart & stock balance chart
 
Anticipatory Medications
 
Creation of Appropriate Care Pathways (ACP’s)
Collaboration between hospices and LAS
Identifying SPA / 24/7 advice & support service
 
If you know/think you have one, please contact
us!
 
Advice, Collaboration & Support
 
What Can You Do?
 
Can you be sure that your
patients who are nearing EOL have
a CMC care plan and anticipatory
medications available?
Do you have a system/process
OOH for access to advice &
support? Can we create an
appropriate care pathway
together?
Would you be able to offer
paramedic placement
opportunities for shared learning ?
 
THANK YOU!
 
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London Ambulance Service NHS Trust implements strategies focusing on palliative and end-of-life care, including training ambulance clinicians, making resuscitation decisions, addressing challenges, coordinating care, and administering anticipatory medications. These initiatives aim to improve patient outcomes and reduce unnecessary hospital conveyances, ensuring holistic and patient-centered care.


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  1. LAS Strategy for Palliative & End of Life Care Dr Diane Laverty Macmillan Nurse Consultant Palliative & EoLC London Ambulance Service NHS Trust

  2. What Do We Do? (1.4.17- 31.3.18) Almost 2 million calls to 999 Attended 1.1 million incidents PC coded calls 3111 31% average of PC calls conveyed to ED Average On Scene Time (min) Conveyed to ED Sector Name Total EOLC ED % 178 North Central Sector 509 74 34.97% 591 69 212 North East Sector 35.87% 921 77 248 North West Sector 26.93% 608 76 181 South East Sector 29.77% 486 71 138 South West Sector 28.40% London Ambulance Service NHS Trust

  3. Ambulance Clinicians Training The 3 P s: Preserve life Promote recovery Prevent deterioration London Ambulance Service NHS Trust

  4. Resuscitation decisions Decision Making Bereavement Paediatrics Advance care planning Reversible emergencies Symptom Control Communication National strategy Holistic care London Ambulance Service NHS Trust

  5. The EoLC Challenge for LAS Non expert clinicians Time pressured situations No pre-existing knowledge of patient/family Limited documentation/information Variable OOH provision for specialist support London Ambulance Service NHS Trust

  6. What information can help us look after your patients? How can we stop unnecessary conveyances to ED & keep patient at home if that is their wish? London Ambulance Service NHS Trust

  7. Coordinate my Care (CMC) CMC plan, detailing: Personal & professional contact details PPC/PPD/DNACPR decisions Patient/family awareness Treatment escalation plans Symptom control hints & tips, including non pharmacological interventions London Ambulance Service NHS Trust

  8. Anticipatory Medications Anticipatory medications when it is clear your patient is nearing end of life Paramedics CAN administer anticipatory medications Clear, unambiguous drug prescription / authorisation chart & stock balance chart London Ambulance Service NHS Trust

  9. Advice, Collaboration & Support Creation of Appropriate Care Pathways (ACP s) Collaboration between hospices and LAS Identifying SPA / 24/7 advice & support service If you know/think you have one, please contact us! London Ambulance Service NHS Trust

  10. What Can You Do? Can you be sure that your patients who are nearing EOL have a CMC care plan and anticipatory medications available? Do you have a system/process OOH for access to advice & support? Can we create an appropriate care pathway together? Would you be able to offer paramedic placement opportunities for shared learning ? London Ambulance Service NHS Trust

  11. THANK YOU! London Ambulance Service NHS Trust

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