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Table 1 The six steps of the ‘PACE Steps to Success intervention’

From: Decreased costs and retained QoL due to the ‘PACE Steps to Success’ intervention in LTCFs: cost-effectiveness analysis of a randomized controlled trial

Step Content of the step
Discussions as the end-of-life approaches Advance care planning discussions with residents and/or families are conducted to elicit wishes and preferences around end-of-life care.
Assessment, care planning and review A ‘Mapping Changes in Condition chart’ is used monthly by nurses and care assistants to plot changes (deterioration and improvement) in a resident’s physical condition.
Coordination of care Using a Palliative Care Register, residents who are identified as expected to live less than 6 months are discussed in detail during monthly multidisciplinary review meetings. A summary sheet is sent to physicians who were not able to attend the meeting.
Delivery of high-quality care Staff learns about symptom control and complex communication skills, with a focus on pain and depression.
Care in the last days of life The Last Days of Life checklist prompts and guides the care in the last days of life, with a focus on recognizing dying, communication with family, regular assessment of symptoms, anticipatory medication prescription, hydration, and psychosocial and spiritual support.
Care after death Reflective meetings following a death are held to support staff and encourage experiential learning.