Care Planning on the GM Care Record
Integrated care planning in the GM Care Record is creating a more connected approach that places patients at the centre of their care journey. Sharing care plans with everyone involved in a person’s care ensures better coordination, improved outcomes, and a more streamlined experience for both patients and care providers.
Scroll down for information on care plans for End of Life, Heart Failure, Dementia Wellbeing, and Integrated Care and Support Plan.
EPaCCS
Electronic Palliative Care Coordination System for seamless end of life care
Heart Failure
Proactive plans, contributed to by everyone involved in care - including patients
Dementia Wellbeing
Personalised care planning for people living with dementia and their carers
Integrated Care & Support
All about me, lifestyle & environment, care & support, plus contingency planning
Electronic Palliative Care Coordination System (EPaCCS) Care Plan
GMCR EPaCCS end-of-life care planning ensures patients’ wishes are respected and shared with everyone involved in their care.
Benefits include:
- Recording and sharing vital end-of-life information
- Respecting patient wishes such as preferred place of care
- Clear communication between health and care providers, carers and family
- Available 24/7 – improving co-ordination of care
- Reducing unnecessary medical intervention
Heart Failure Care Plan
The digital care plan aids earlier detection and supports patients who proactively manage their condition through the My GM Care app.
Benefits include:
- Instant access to patient information, medications, blood pressure and outpatient letters
- No need to call and email for extra information
- Patients self-report blood pressure, weight and mood directly into the the care plan via My GM Care
- Assessment of symptoms prior to review
Dementia Wellbeing Care Plan
Created with Dementia United and the Alzheimer’s Society, this digital plan ensures personalised care and support planning is available for everyone involved in each patient’s care.
Benefits include:
- Standardised care planning accessible via EPR or web browser
- Continuity of care and communication
- Carer access to wellbeing plan via My GM Care
- Better quality, more proactive care
Integrated Care and Support Plan (ICSP)
Integrated Care planning & Support care plan has four sections that capture detailed patient information crucial for personalised care planning:
About: includes faith, beliefs, ‘what matters to me’
Lifestyle & environment: includes hearing, vision smoking, alcohol, language, mobility, key safe, and carer info – important for discharge from hospital
Care & support: includes goals and hopes – supporting long term condition management
Contingency plan: what to do in an emergency situation, including anticipatory medication
