Pam Williams
Clinical Nurse Educator
End of Life Care
April 2011
Objectives of the session
• By the end of the session you should be able to;
• Identify the national, regional and local end of
life drivers
• Understand the programme
• Commence the audit process
• Have an understanding of your role &
responsibilities as end of life lead for your home
• Be aware of the End of Life Care Policy we are
working with
National drivers
End of life care strategy (2008)
“Good PCT’s working with local authorities will wish to commission services
from care homes which:
Residents approaching the end of life are on an end of life care register
Each resident is offered a care plan, which clearly identifies their needs and
preferences for care
Staff receive the training and support they need to provide end of life care
There is a appropriate access to GP, District nursing and specialist palliative
care advice”
DOH, 2008, End of Life Care Strategy p95
EOLC quality markers
Action Plan for EOL
Mechanisms to discuss, record wishes (ACP)
Residents needs assessed and reviewed
Nominate a key worker for each resident at EOL
Residents who are dying are entered onto a care pathway
Families and Carers are involved in decisions at EOL to the extent they
Other Residents are supported following a death
Quality of EOL care is audited and reviewed
Process to identify training needs of all workers, common requirements –
communication skills, assessment and care planning, ACP and symptom
Training needs addressed for those staff initiating ACP
Aware and encourage attendance to EOL care training
Review all transfers in and out of the care home at EOL
The Quality, Innovation, Productivity and Prevention (QIPP) programme is
all about ensuring that each pound spent is used to bring maximum
benefit and quality of care to patients.(Dept of Health 2010)
•Improve the resident and family experience of end of life care in a care
home setting
•Enhance care delivery within the care home at end of life
•A skilled workforce
•A low cost Network EOL programme providing a consistent approach across
PCT’s with a wide access to all care homes
•Can support care homes who currently have high recorded admissions to
the acute sector for end of life care
•Develop a care home representative to take responsibility for the future
development of end of life care provision in their care home
•Enhanced end of life care
•Enhanced MDT working
•Deliver choice at end of life
•Wider awareness and implementation of End of life care
•Development of PCT End of Life Care home representative Groups
•Address equity
•Reduction in hospital admissions at end of life from Care homes
•Reduction of isolated working
Care Quality Commission
CQC (2010) End of Life Care Prompts Care Homes: Guidance for Inspectors
How should a care home that provides end of life care support the person?
CQC questions to consider…
• Do staff have knowledge & skills to identify EoLC needs. A relevant care
assessment is in place
• Systems in place to access relevant members of PHCT
• Needs assessment reviewing, pain, tissue viability, nutritional needs etc
• Are residents and loved ones included in the decision making process.
• Are residents given the opportunity to discuss PPC
• Is there a policy & training for staff with clear records if a DNAR is recorded
• Do the staff use a pain chart
• Do documents used support end of life planning e.g. Liverpool Care Pathway
Regional Drivers
10% reduction in
inappropriate hospital
deaths ( North West
Healthier Horizons
North West End of Life Care Model
Local Drivers
NHS Warrington
• Improve quality and equity of care for all residents of Warrington
• Improve local accessibility to end of life care training
• Improve knowledge, skills and confidence around palliative and end
of life care for staff working in all areas of care
• Achieve 10% reduction in hospital deaths
• Improve uptake of end of life care tools i.e. PPC,LCP
• Improve choice at end of life
• Improve accessibility to expertise at end of life
• Reduce inappropriate admissions to hospital at end of life
• Utilise resources more effectively to achieve better value for money
for the community
Some definitions- group work;
• Palliative Care;
• End of life Care;
Some definitions
• Palliative care;
• the active holistic care of patients with
advanced progressive illness.
Management of pain and other symptoms
and provision of psychological, social &
spiritual support is paramount. The goal of
palliative care is achievement of the best
quality of life for patients & their families…
(National council of palliative care)
• Palliative care is an approach that
improves the quality of life of patients and
their families facing the problem
associated with life-threatening illness,
through the prevention and relief of
suffering, by means of early identification
and impeccable assessment and
treatment of pain and other problems,
physical, psychosocial and spiritual.
(World Health organisation WHO)
Palliative care philosophy
Focus on quality rather than quantity of life
Life affirming but death accepting
Effective communication at all levels
Respect for autonomy and choice
Effective symptom control
Holistic, multi professional approach
Caring about both the person and those
that matter to that person
Definition of end of life
• The period of time marked by disability or
disease that is progressively worse until
death. The final stage of the journey of life.
• all those with advanced, progressive,
incurable conditions (doh 2006)
Overview Of The Programme
• Induction workshop
• Six Steps to Success workshops
• Supporting education: communication skills,
Advance Care Planning and Liverpool Care
Pathway for the dying patient (LCP)
• Conclusion workshop
• Continuation of care home forum
The 6 Steps
Step 1 - Discussions as the end of life approaches
Step 2 - Assessment, care planning and review
Step 3 - Co-ordination of care
Step 4 - Delivery of high quality care in care homes
Step 5 - Care in the last days of life
Step 6 - Care after death
North West End of Life Care Model
Advancing disease
1 year
Increasing decline
6 months
Last Days of Life
First Days after
1 year
What is a good death?
• From the perspective of;
• The patient
• The relative
• The care staff
End of Life Care Policy for
Residential homes
• Each of the 6 Steps relates to the policy
Expectations of attendees
(end of life leads)
Regularly meet with other End of Life Care Home Representatives
Develop other learners in end of life care
Build resource files within the care home
Produce a portfolio to evidence the implementation of the programme that could be
shared with regulatory bodies (CQC), commissioners, social services
To be a link with the local End of Life Care Facilitator
Initiate change management within the home
Ongoing evaluation throughout the course
Pre and post-course audits
Audit of ACP and LCP
National roll out of the Six Steps to Success
• Forum continues regularly
• External speakers
• Staff agendas
• Continuing access to education and
End of Life Care Home Forum will be a valuable resource group to drive
and trial new initiatives in End of Life Care for the care home sector i.e. E –
Change Management
• Identify an area for change
• What happens now
• What should happen-research best
• How are you going to make the change?
• Obtaining permission, communicating,
timing, resources needed, ethics &
• Monitoring & evaluating
Things to consider
The wider picture;
Politics- what is current thinking
Economics- is there a cost
Social- the effect on people
Technological- do you need equipment etc
Ecological- does this effect the environment
Legislative- what is the law
Industrial- how will this effect your business
Sharing your learning
• 4 ways;
Simple - posters, memos
Education – teaching sessions
Leadership – by example in practice
Audit – by evaluating the changes and
proving the benefits
The audit cycle
Measuring success with audit
Keep it simple;
What do you need to measure- quantity/quality
What do you need?
A system
A plan
Who will do it
Feedback to staff, management and the group
What are we measuring?
• Changes in plan of care;
• Hospital admissions
• Uptake of end of life tools
• Quality of care
• Feelings & thoughts
• Family/carer support
• Data collection
• Reflection of staff
• Reflection of families i.e. spoken or written
• Some ideas;
• Information giving; leaflets, staff sharing
• Areas of care i.e. oral care, feeding &
fluids, skin care, use of equipment
• Bereavement support; book of
remembrance, memorial tree
• Introducing an assessment tool i.e. pain,
Barthel score.
Creating a philosophy for end of life
• End of life care requires an active,
compassionate approach that treats, comforts
and supports individuals to enable them to live
as well as possible until they die. It includes
physical care, management of pain and other
symptoms; the provision of psychological, social,
spiritual and practical support is also important
and it encompasses support for families and
friends up to and including the period after death
(Four Seasons Wilmslow 2011)
Can you now…?
• Identify the national, regional and local
end of life drivers
• Understand the programme
• Commence the audit process
• Have an understanding of your role &
responsibilities as end of life lead for your
• End of Life Care Policy
• Keep the handouts and portfolio in a safe place
and bring them to each session
• Complete the post death audit form and bring to
the next session
• Feed back the contents of this workshop to all
staff and share the philosophy for end of life care
with them
• Share the information from the programme with
GP’s and other members of your wider team and
engage their support for you during the
Thank you
Look forward to seeing you at workshop 1
Pam Williams
Tel 01925 579201
[email protected]

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