Transcript Network End of Life Care Home Link Nurse

The North West End of Life Care Programme
for Care Homes
Facilitator– Helen O’Neil
Introductions
• Helen O’Neil - Facilitator
01524 382538
E-mail [email protected]
• Jenny Lowe – Tutor in Palliative Care
www.endoflifecumbriaandlancashire.org.uk
Induction Programme
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Introductions, Housekeeping and ice breaker
Session Agreements
Plan for day and objectives
End of life care drivers
The Route to Success in Care Homes
Overview of Six Steps Programme
Change management
Audit Cycle
Role of champions
Group work on what is a good death
Policy
To do list
Evaluate and close
Objectives
 Understand the key elements of the programme
 Identify National, Regional and Local end of life
care drivers
 Begin to develop a philosophy for end of life
care
 Commence the audit process
 Have an understanding of your role and
responsibilities
 Begin an End of Life Care Policy
 Understand change management and the audit
cycle
Clarification of Terms
Palliative care
• Is applicable early in the course of illness when cure is no longer an option
• Aims to improve quality of life of patients facing life-threatening illness
• Offers a support system to help patients live as actively as possible until death
• May be given for an extensive period of time
Supportive Care
• All people with chronic illness need supportive care
• Helps people & family’s cope better with their chronic debilitating illness
• Not disease or time specific, ‘less end stage’
Terminal care
• Is applicable when dying is diagnosed i.e. care in last hours and days of life
Definition of End of
Life Care
End of Life Care encompasses the services that support those with
advanced progressive incurable illness to live as well as possible until they
die
People likely to die within months, weeks or days of life
These services support the end of life care needs of patients, families & carers
to be identified & met throughout the last phase of life and into bereavement
It includes the management of ALL symptoms & includes ALL services in any
setting, that provide an integral part of end of life care
End of life care builds on, and involves, the use of the End of Life Tools
Liverpool Care Pathway (LCP), the Gold Standards Framework (GSF), & the
Preferred Priorities (place) of Care (PPC)
End of Life Care Strategy
(July 2008)
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Promoting high quality care for
all adults at the end of life
• “How people die remains in the memory of those who live on”
(Dame Cicely Saunders Founder of the Modern
Hospice Movement)
End of Life Care Strategy – National Driver
(July 2008)
“Good Primary Care Trust’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 appropriate access to GP, District nursing and specialist palliative
care advice”
DOH, 2008, End of Life Care Strategy p95
Quality Markers for Care Homes
• Action plan for EoLC
• Mechanisms in place to discuss, record & communicate wishes
• Residents EoLC needs assessed & regularly reviewed
• Nominated Keyworker in place
• Use of the LCP
• Families involved in decision making
• Other residents supported
• Quality of EoLC Audits & ongoing reviews
• Identified training needs of all staff (TNAs) inc. Communication
skills/ACP/Symptom control etc.…
• Review of transfer of patients…
Care Quality Commission CQC (2010)
End of Life Care Prompts/Guidance for Inspectors
• Care plans in place for all EoLC residents
• Do staff have knowledge & skills to deliver quality EoLC?
• Needs assessment reviewing e.g. pain, tissue viability, nutritional needs etc.
• Use of tools of assessment & use of EoLC tools e.g. LCP
• Respecting choice & recording wishes
• Systems in place for specialist referral when needed
• Information sharing & supporting dignity
• Respect for value and beliefs
• Involving & supporting families
Local Drivers
Northwest Primary Care Trust
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Proportion of Deaths in Care homes
Use of Care Pathway in Care homes
Use of PPC in Care homes
Also Primary care, Acute hospital, hospice
Unsure that care for individuals is
coordinated across organisational
boundaries 24/7
The North West End of Life Care Model
Six Steps to Success
Six Steps
• Step 1 Discussions as the end of life approaches
• Step 2 Assessment, care planning and review
(followed by a stand alone study day for the
champion and ANY care home staff on
Communication skills, Advance care planning,
Mental Capacity Act, Advance Decision to Refuse
Treatment, Do Not Attempt CPR, Lasting power of
Attorney and Best Interest decisions)
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
(followed by another full study day for the
champion and ANY staff covering the
Liverpool Care Pathway)
Step 6 Care after death
Change Management
Why change?
•Response to government initiatives
•Response to audit, reflective
practice, complaints, critical incidents
•Diversity of patient demand and
changes in population
Before starting organizational change,
ask yourself
• What do we want to achieve with this change
• How will we know that the change has been
achieved?
• Who is affected by this change and how will they
react to it?
• How much of this change can we achieve
ourselves
• What parts of the change do we need help with?
Change Management
There are four responses to change
Victim
Critic
Bystander
Navigator
Change management entails
thoughtful planning and sensitive
implementation, and above all,
consultation with, and involvement of,
the people affected by the changes.
Change must be realistic, achievable
and measurable.
• Poor planning
• Involve team
• End users not
consulted
• Communicate
constantly
• Poor follow-up
• Plan properly
• Don’t give up!
Group work
• How has change been successfully
implemented in your care home
previously?
• What are the potential problems with the
Six Step Programme for your care home?
• What can you do to make the change a
success?
• What help do you need?
20 minute comfort break
What is Audit?
Simply put….
“A tool to aid you in improving
patient care by looking at current
practices and making changes
where necessary”
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
Roles and Responsibilities of
Champion
• Attend all of the Six Steps to Success workshops and
mandatory study days
• 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
To do list
• Start to produce your care home’s
philosophy on end of life care
• Complete knowledge Skills and
Confidence Audit- all champions
• Complete Quality Markers Audit
• Complete Post Death Information Audit
• Draft the Key Principles section of policy
Any Questions?
Our next meeting will be on 8th February
1 – 5pm here in the Oak Centre
(support day 23rd Jan 1pm-3pm if needed)
Any queries please contact Helen O’Neil at the
Hospice either by phone 01524 382538
by e-mail on:
[email protected]
www.endoflifecumbriaandlancashire.org.uk
Thanks for all your hard work today!