The Gold Standards Framework Proactive Identification Guidance (PIG) - The National GSF Centre’s guidance for clinicians to support earlier identification of

General Medical Council – 2010 This updated 6th edition of the GSF PIG, renamed as Proactive www.gmc-uk.org/static/documents/content/End_of_life.pdf Identification Guidance and formally known as Prognostic Indicator The GMC definition of End of Life Care; ‘People are ‘approaching the Guidance, aims to enable the earlier identification of people nearing the end of life’ when they are likely to die. [...] The 3 key steps of GSF PIG and GSF – Early proactive identification of patients is the Step  3   Do  they  have   Reassess   Identify regularly  crucial first step of GSF, used by Specific  Clinical   patients who may be in their last year of life many thousands of doctors and Indicators?   and identify their needs-based code/stage nurses in the community and hospitals. [...] • Unable to walk without assistance and • Patients with poor tolerance of dialysis with change of modality. [...] • Urinary and faecal incontinence, and • Patients choosing the ‘no dialysis’ option (conservative), dialysis withdrawal or • No consistently meaningful conversation and not opting for dialysis if transplant has failed. [...] • Unable to do Activities of Daily Living (ADL) • Difficult physical or psychological symptoms that have not responded to specific • Barthel score >3 treatments.