A Treatment Escalation Plan (TEP) is a communication tool which is helpful in hospital when a person with serious illness has the potential for acute deterioration or may be coming towards the end of their life. Sometimes doing everything possible may actually lead to harm – to more suffering and distress rather than less - and without any particular gain. What can be done and what should be done may not necessarily be the same thing. Treatment Escalation Plans should be discussed and made based on personalised realistic goals rather than ‘one size fits all’ treatment.

Crucially, a TEP provides on-call hospital staff with immediately accessible guidance about how to respond to an individual in times of crisis, especially out of hours and at weekends. A TEP becomes particularly important when there is agreement that interventions or referrals for more intensive care that are contrary to a person’s wishes or are futile or burdensome should not be undertaken. Equally in many patients who may have an agreed DNACPR, a TEP clarifies all the treatments and care that should continue.

The TEP being used in NHSGGC has recently been updated (Oct 2020) and is accessible via the following link:

Treatment Escalation Plan (PDF)

Copies for your department can be ordered from GRI Medical Illustration (Medical.IllustrationGRI@ggc.scot.nhs.uk or 0141 211 (2) 4692) quoting order number mi-314118.

In severe illness quality of care becomes more important than ever but the goals of treatment are different for different people. Hospital care is becoming more and more complex and both patients and their families are particularly vulnerable to the impact of errors, harms and poor communication. It is especially important for hospital staff to understand and respect the values and preferences of the people they are looking after and to discuss with them a plan for emergencies.

Print copies of this outpatient information leaflet can be requested from medical illustration (ref: 251911 v5.0 GGC0055).

These services located within the main atrium of most NHSGGC hospital sites and these services are there to support patients, visitors and staff with:

• Provision of a 2-day patient emergency food bag to people experiencing poverty, money difficulties, or social isolation (includes brief conversation about emergency fuel and money)
• Information and onward referral to money advice and financial inclusion services
• Referrals to local food banks, information on food shopping/delivery services and pharmacy pick up services
• Referral to social isolation support groups, crisis support and carers centres
• Information relating to support with mental wellbeing including stress, anxiety and spiritual care
• Help navigating health services & support with health literacy
• Lifestyle services and NHSGGC Support and Information Services
  

View the NHSGGC consent policy

View the full guideline and poster: Polypharmacy review in adults living with moderate to severe frailty: clinical guideline 1013