Network End of Life Care Home Link Nurse

Report
The North West End of Life Care Programme
for Care Homes
Facilitator - Alison Doyle
Induction
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Introductions
Ground rules
End of life care drivers
The Route to Success in Care Homes
Overview of Six Steps Programme
Portfolios
Change management
Audit Cycle
Group work
The way forward
Objectives
 Identify National, Regional and Local end of
life care drivers
 Understand the programme
 Commence the audit process
 Have an understanding of your role and
responsibilities
 Commence an End of Life Care Policy
End of Life Care
‘Care that helps all those with advanced, progressive,
incurable illness to live as well as possible until they die. It
enables the supportive and palliative care needs of both
patients and family to be identified and met throughout the
last phase of life and into bereavement. It includes the
management of pain and other symptoms and provision of
psychological, social, spiritual and practical support’
(National Council for Palliative Care)
Palliative Care - WHO 2002
• Provides relief from pain and other distressing
symptoms
• Affirms life and regards dying as a normal process
• Intends neither to hasten or postpone death
• Integrates the psychological and spiritual aspects of
care
• Offers support system to help patients live as actively
as possible until death
• Offers support system to help families cope
Palliative Care
• Team approach to address needs
• Will enhance quality of life, may positively
influence the course of illness
• Applicable early in the course of the illness,
with other therapies intended to prolong life,
e.g., chemo, radiotherapy, investigations to
better understand and manage distessing
symptoms.
End of Life Care Strategy 2008
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1/2 million people die each year
58% deaths - hospital
18% deaths - home
17% deaths - care home
4% deaths - hospice
Most people would prefer NOT to die in hospital
End of Life Care Strategy 2008
• Vast majority of deaths = over 18yrs (99%)
• Most deaths occur in the over 65’s
• By 2030 - over 65yrs, 86% of deaths
over 85 yrs, 44% of deaths
• Over 85 yrs = more likely to be in care home (currently)
• 1/5 NHS spending is on EOLC
• 40% who die in hospital don’t have medical conditions that medics can
fight
(Demos UK, 2010)
End of Life Care Strategy 2008
AIM:
• Better access to high quality care at end of life
• Available wherever the person may be
• Achieved through 10 objectives
End of Life Care Strategy 2008
Objectives:
• Increase public awareness
• Ensure dignity and respect
• Optimum quality of life (symptoms)
• Access to holistic care services
• Needs identified, documented, acted on,
reviewed
• Coordinated services
End of Life Care Strategy 2008
• High quality care in last days of life and after
death, in all care settings
• Carers supported
• Health care professionals supported with
training and education
• Services - good value for money
NW EOLC Clinical Pathway Group
Key recommendations:
• Robust integrated commissioning framework
with strategic leadership in every PCT
• Quality standards and measures
• Raising public awareness
• Build on success of EOLC tools
• Advance Care Planning - all sectors
NW End of Life Care Clinical
Pathway Group
Headline aim
To reduce hospital deaths by 2012 by 10%
NHS Sefton EOLC Strategy
• Recognises palliative care - availability to non cancer
patients
• More investment in services from NHS
• Implement NICE Guidance on Supportive & Palliative
Care for Adults with Cancer 2004
• Implement recommendations of NHS North West
EOLC Clinical Pathway Group (Incl’ reducing hospital
deaths by 10%)
• Increase use of nationally recognised EOLC tools
(LCP 100% uptake)
CQC
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
• 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. LCP
• The least possible disruption to the individual and their family and those close to them
(see CQC Guidance for inspectors)
End of Life Care
Quality Markers and Measures
Care homes • Based on structures and processes of care likely to
achieve good outcomes
• Consistent with holistic approach to care
• Designed as supportive guide
• Do not always require new ways of working/thinking
12 quality markers (generic)
Quality markers dementia and end of life care
(Living well with Dementia (DH, 2009)
End of Life Care Quality Markers
For Care Homes
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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
wish
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
management
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
QIPP
‘One of the most significant NHS policies all
organisations connected to the NHS will have
to take on board’
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Effects every department and individual
Identification of efficiency savings
Reinvestment to deliver quality
improvements
QIPP
Example
• Fractured neck of femur - redesign of service,
improved quality by improving m.d. and cross agency
teamwork =
reduced mortality, reduced time to theatre
earlier mobilisation, reduced length of stay
reduced readmissions.
QIPP
Quality
•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
Innovation
•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
Productivity
•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
Prevention
•Reduction in hospital admissions at end of life from
Care homes
•Reduction of isolated working
Six Steps
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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
Managing Change
Why change?
• Response to government initiatives
• Response to audit, reflective practice,
complaints, critical incidents
• Diversity of patient demand
Barriers to Change
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Awareness, knowledge
Motivation
Acceptance and belief
Skills
Practicalities
Identify barriers to change
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Talk to key people
Observe clinical practice
Use of questionnaires
Focus groups
Brain storming
Change Models
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The 7 S Model
5 Whys
PESTELI
Force Field Analysis
Ready for Change?
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What do your colleagues think?
Conflict with other important initiatives?
Identified key frameworks?
Consider how change has been successfully
implemented in the past, what works best?
• Leading your project - SWOT analysis
• Action plan
Emotional Cycle of Change
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Panic
Despair
Blind optimism
Cautious optimism
Denial
Confidence in the future
Success
Attitudes to Change
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Innovators (venturesome)
Early adopters (respectable)
Early majority (deliberate)
Late majority (skeptical)
Laggards (traditional)
Managing Change
“Involvement is the key to implementing
change and increasing commitment….. It acts
as a catalyst in the change process”
(Covey, 1992)
Resources
• www.nhsleadershipqualities.nhs.uk (LQF)
• www.nice.org.uk (How to change practice)
• www.sdo.nihr.ac.uk (Managing change in the
NHS)
What is Audit?
Simply put….
“A tool to aid you in improving patient care by looking at
current practices and making changes where
necessary”
Difference between Audit and
Research
Research
Quest for new knowledge
Seeks to define best
practice
Audit
Evaluates conformity with
knowledge that’s has been
tested and proven to be
acceptable to the majority
Seeks to evaluate if best
practice is being delivered
‘What is the right way?’
‘Doing it right’
Simple Rules
Clinical Audit
Measures existing practice against
evidence-based clinical standards
Research
Generate new knowledge where there is
no or limited evidence available and which
has the potential to be transferable.
Service
evaluation
Service/practice evaluation evaluates the
effectiveness or efficiency of an
existing/new service/practice that is
evidence based with the intention of
generating information to inform local
decision making. E.g. baseline audit,
benchmarking, clinical effectiveness study.
Audit Cycle
Why Audit?
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Consistency of care and treatment
Improve access, equity of healthcare
Improve quality and effectiveness of care
Improve satisfaction
Improve awareness of guidelines and standards
Identification of training needs
Quality assurance
Risk management, reduction in
complaints/litigation
Death and Dying
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Taboo
Coped well in past
How would most wish to die?
How will most die if we don’t make changes?
People need to talk about dying, not euphemisms
ACP should be the standard
What is a ‘good death’?
• Being treated as an individual, dignity and
respect
• Without pain and/or other symptoms
• In familiar surroundings
• In company of close family and friends
What makes a good death?
Exercise
1. The Resident
2. The Family
3. The Carer
Expectations of an End of
Life Care Home
Representative
Attend all of the Six Steps to Success workshops
Take lead role, support and develop others in EOLC
Keep knowledge and skills up to date
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
• Ensure EOLC tools promoted and used in care home
• To be a link with the local End of Life Care Facilitator
• Initiate change management within the home
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End of Life Care Policy
Summary
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End of Life Care Drivers
Six Steps to Success programme
Change management
Audit
Your role and responsibilities
Portfolio of evidence
End of Life Care Policy, philosophy
To do
Any Questions?

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