Reflections on Treatment Escalation Planning from a seminar hosted by Professor Alison Richardson

In September 2015, we hosted a seminar to look at the challenges of implementing Treatment Escalation Plans, specifically the Devon TEP experience, but also directly from the delegates themselves. It was also an opportunity to hear about findings from work done during the early stages of the Wessex TEP project and hear the latest update from the national TEP working group from one of the co-chairs, Dr David Pitcher.

The key aim of the TEP project led by the NIHR CLAHRC Wessex is that by the end of 2017 anticipatory decisions about CPR and other life sustaining treatments will be recorded using the same documentation, be valid across all care settings, in three localities in Wessex and a plan agreed to support implementation in Wessex.

Dr Michael Mercer and George Lillie
Dr Michael Mercer and George Lillie

Presentations on the implementation experiences and learnings from the Devon TEP, first in the acute setting and then more widely across Devon were drawn out by our guest speakers Dr Michael Mercer and George Lillie. They demonstrated real leadership and resilience over many years’ of implementation since 2006, while acknowledging there is still plenty of room for improvement.

Professor Alison Richardson from CLAHRC Wessex and Dr David Pitcher from Resuscitation Council
Professor Alison Richardson from CLAHRC Wessex and Dr David Pitcher from Resuscitation Council

It was very helpful to follow this with a national perspective from Dr David Pitcher, Vice President of the Resuscitation Council (UK), particularly in his role as co-lead of a national working group that is working towards a national TEP form within the next year.

Dr Susi Lund provided a summary of a scoping exercise undertaken as part of our preliminary work to determine the extent to which NHS organisations were using a TEP, and if so what form it took. This work has revealed there are a plethora of initiatives across the country, both in primary and secondary care and underlined the need for a consistent approach if we are to reach a situation where a TEP can cross boundaries and hints at the challenge to be overcome if as we progress towards a unified approach.

The workshops posed a series of questions about the challenges of implementation, and the insights gathered during our discussions will be really useful to both inform the next stage of the project and the national work.

It was fantastic to see such an informed and varied audience at the seminar; representatives came from all parts of the Wessex region (and beyond) and a wide range of organisations in the health and social care world.  A number of organisations have already implemented a version of a TEP, whereas others are waiting for national developments to unfold. There is a willingness to share experiences and resources developed to date.

Our PPI lead Jim Watt who attended, said ‘I thoroughly enjoyed the day today. Venue was excellent, food delicious, organisation smooth, administration spot on, company hugely interesting, my time was well spent. Thank you.’

I hope the attendees at the event, together with others who couldn’t be there but have expressed an interest, can become a virtual ‘community of practice’ for the Wessex region. I am sure that if we work collaboratively and harness the palpable energy at this event, we can find a way towards a solution that benefits patients and their families in the Wessex region and across the country.

Dr Amanda Cummings and PPI champion Jim Watts
Dr Amanda Cummings and PPI champion Jim Watts

We keep in touch about the project through a number of routes, specifically the Wessex Palliative and End of Life Care Network Boards, through our existing working groups and as a member on the national working group. If you want to keep in contact going forward, we will be posting updates on the CLAHRC Wessex website.



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