PEPSI COLA Communication Pro Forma - East Midlands Cancer ...

PEPSI COLA Communication Pro-FormaSSocialSupportConsider Date / Signature Patientsneedsare met• Care for carers• Practical/family support____/____/____ □• Occupational/financial welfare supportservices• Social & recreational activitiesPatients needs not met(what needs doing Action Plan)IInformationCommunication• Identify the key team as per EMCN MDTpolicy• Liaison with MDT/PHCT or the receivinghealth care worker• Appropriate patient information leaflets____/____/____□CControlOOut of Hours• Discussion around patient choice• Patient dignity• Treatment options/plans discussed• Preferred place of care documented• Advanced care planning• Communication to out of hours service(OOH)• Access to drugs/equipment• Ensure continuity of care____/____/________/____/____□□LLiving withyour illness• Follow up care• Rehabilitation support• Patient/carer expectations• End of life care planning (if appropriate)• Liverpool Care Pathway• GSF register____/____/____□AAfter Care• Future support - family/patient• Discharge planning• Reassessment• Bereavement follow up____/____/____□Kindly reproduced and adapted from the GSF toolkit 2004 by The Mount Vernon Cancer Network