The International Collaborative's innovative 10/40 Model for Best Care for the Dying Person is a continuous quality improvement programme that can transform care for the dying within a clinical environment in a measurable and sustainable way.
The aim of the 10/40 Model is to translate the excellent hospice care model into other healthcare settings and to develop outcome measures using a clinical document for the last hours or days of life to ensure that dying people can be provided with safe, high quality care by appropriately-educated staff working within a supportive organisational governance structure.
Founded on international evidence that identifies the ten key principles for best care for the dying person and incorporating the 40 outcomes that support quality and safety in individualised patient care, the 10/40 Model provides a platform from which an organisation can develop its own robust Clinical Document/Care Plan to suit its local context and governance arrangements, with the assurance that it is based on a valid, reliable and transferable international evidence base in care for the dying, developed by the Collaborative over many years.
For most organisations, the introduction of the 10/40 model will require change on many levels - change that is only possible if staff at all levels are empowered, enabled, and engaged in the process. We therefore provide our members with a comprehensive Ten Step Implementation Plan, underpinned by a robust Continuous Quality Improvement Framework and guidance as required from our network of national Reference Centres.
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Want to know more? Email the Coordinating Centre with your questions.
The 10/40 Model is derived from ten key principles and 40 goals of care that transcend international and cultural boundaries and apply irrespective of the place of care.
THE TEN PRINCIPLES OF BEST CARE FOR THE DYING PERSON
Recognition that the person is in the last few days and hours of life should be made by the multidisciplinary team (ideally a doctor and a nurse) and documented by the senior healthcare professional responsible for the person’s care.
1
Communication of the recognition of dying should be shared with the person where possible and deemed appropriate and with those important to them.
2
The dying person and those important to them (relative, carer, or advocate) should have the opportunity to discuss their wishes, feelings, faith, beliefs, and values.
3
Anticipatory prescribing for symptoms that can be expected (e.g. pain) should be available.
4
All clinical interventions are reviewed in the best interests of the individual person.
5
There should be a review of hydration needs, including the commencement, continuation or cessation of clinically assisted (artificial) hydration.
6
There should be a review of nutrition needs, including the continuation or cessation of clinically assisted (artificial) nutrition.
7
There should be a full discussion of the plan of care with the dying person, where possible and deemed appropriate, and with those important to them.
8
There should be regular reassessments of the dying person at least every four hours, or at each contact in the community setting. Review by the multidisciplinary team at least every 48 hours.
9
Care for the dying person and those important to them immediately after death is dignified and respectful.
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THE TEN STEP IMPLEMENTATION MODEL
PHASE 1
Introduction
Step 1
Step 2
Step 3
Preparation of the environment to establish the International Collaborative 10/40 Model within an organisation.
Attend Foundation Course.
Auditing the current care documentation using the Clinical Document Audit Toolkit.
Development of a new Clinical Document and submission for congruence assessment.
PHASE 2
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Implementation
Step 4
Step 5
Commencement of education programme in pilot site(s).
Implementation of the new clinical document into pilot sites.
Reflective practice.
PHASE 3
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Development
Step 6
Step 7
Step 8
Maintenance and improvement of competencies.
Evaluation and further training.
Continuous development of competencies in order to embed the 10/40 Model in the clinical environment.
PHASE 4
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Sustainability
Step 9
Step 10
Organisational education strategy to ensure that all staff who work with and care for dying people are properly trained.
Establishment of the 10/40 Model within the governance/performance agenda of the organisation.
Establishment of an International Collaborative Reference Centre.