‘Going for Gold’ Evidence of Dignity in Care

Nikki Sawkins GSF National Nurse Lead

Plan of session

• Background to GSFCH training programme • Key Topic – Dignity • Accreditation and the 20 standards • Examples in practice - Dignity • Shared experiences in practice

This is about life before death

“Our aim is that every person should be able to live well and die well in the place and in the manner of their choosing”

The Gold Standards Framework

A framework to deliver a ‘gold standard of care’ for all people approaching the end of their lives

A system - focussed organisational approach to

optimising

the care delivered by

generalists.

Background to the GSFCH

Overview of Gold Standards Framework in Care Homes

Training Programme

• Based on GSF Primary Care now used by most GP practices in UK at least at basic level 1. ‘Next stage primary care’ – embed further, training programme, new resources • GSF in Care Homes programme • Now used by nearly 1000 homes homes using showcased examples developed 5 years ago in 2004, rooted and grown from experience of care homes staff • Training run by GSF Centre in annual phases –commissioned/ open • Integrating experience, adaptations and learning from accredited • Accreditation Going for Gold since 2008 - twice a year - 100 homes/ year • Solid ‘gold club’ of accredited homes – supported and endorsed • A national momentum of best practice in end of life care in care homes

GSF Care Homes Programme

“

The biggest palliative care initiative in care homes so far

”

Aims 1.

2.

3.

To improve quality of end of life care for all residents To improve collaboration with primary care and specialists To reduce hospitalisation in the last stages of life, enabling more residents to die with dignity in the care home

3 stage process

Preparation, training and consolidation + accreditation Stage I Preparation 3-6 months

  

Stage II Training workshops in 9 months

    Enrolmen t of Care Homes Awareness Raising Meeting ADA Before Local Coordinator s Meetings Workshop 1 Workshop 2 Workshop 3 Workshop 4 ADA After

Stage III Consolidation + Sustainability 9 – 12 months

      Ongoing ADA Final Appraisal GSFCH Accreditation

What are we aiming for?

• A gold standard of care for residents • A gold standard of care for their families • Job satisfaction, confidence, rewards and enjoyment for us as staff • Benefits to the owners, the GP/ primary care teams, the PCT, the NHS and the wider community • Best care for us if/ when we need it……

Key themes in GSF • • • • • Pre-planning of care Making the system work, so you can focus on real care You’re doing well- but you can do even better enabling and encouraging all Communicating well Aspiring to the best

Pre-planning of care • Documenting and coding • Planning meetings - thinking what if…?

• Meeting needs - use of Needs Support Matrix, • Advance Care Planning discussions with resident + family , • Planning ahead with GPs e.g. anticipatory prescribing, handover forms OOH • Use of LCP/ICP/min protocol

Making the system work, so you can focus on real care • Once set up - runs smoothly • Preventing crises • Working smarter • Enjoy better work • Spend more time with people

You’re doing well- but you can do even better Enabling and encouraging all • Build on good practice • Improve confidence of staff • Everyone is involved - all staff aware and working together to ensure high standard • Adapt and use tools, protocols, policies etc so that they become part of your home • Embedding the work- so it remains if a key person leaves

Communicating well • Staff pre-empt issues • Better working with GPs • Better working with others eg hospice • Honest discussions with residents and families • Team spirit • Documentation clear

Aspiring to the best • Are you the best you could be ?

• Can we guarantee best care every time- gold care? • What would it take to get there?

20 Key standards Accreditation checklist 1. Leadership + support 2. Team-working 3. Documentation 4. Planning meetings 5. GP Collaboration 6. Advance Care Planning 7. Symptom control 8. Reduce hospitalisation 9. DNAR +Vo D policies 10. Out of hours continuity 11. Anticipatory prescribing 12. Reflective practice+ audit 13. Education + training 14. Relatives 15. Care in final days 16. Bereavement 17. Dignity 18. Dementia 19. Spiritual care 20. Sustainability

Key Topic – workshop 1 - Dignity • ‘What do you see nurse when you look at me?’ DVD • Discussion and debate • Re-look at Dignity related issues as a team – guidance in Good Practice Guide • How do you engage all staff? Cultural issues? • Key elements highlighted – Dignity Conserving Care, RCN ‘Dignity – at the heart of everything we do’ • Workshop 2 – Speed dating – sharing of experience and information, challenges and solutions

ABCD of Dignity conserving care

• By Harvey Chochinov (in Good Practice Guide)

A- Attitude

•

B- Behaviour

•

C- Compassion

•

D- Dialogue

Bringing it all together…..

…..how can we do the right thing at the right time for the right person every time ?

…can we all talk the same language?

Key components of GSF & EOLC

Education Co-ordination Identification Ongoing assessment communication Assessment of need Team approach Implementing an advanced care plan

• Dignity in good end of life care e.g. respect, autonomy, choice, humanity of each person • Breakdown in dignity when things go wrong crisis – admission, deaths in A&E, poor symptom control, not respecting pt wishes • Improved dignity – ethos of good individualised care, enhances choice, control, self determination, pt choice at centre • Family discussions and information • Enhancing the skills of staff, improved confidence, improved communication

Standard 17 Ensuring the dignity of residents is part of policies and practices of home, particularly related to care in the dying phase, including compassionate holistic care Evidence Evidence of policy statements and practice on ensuring dignity Attention to detail in practice and policies, tools and resources and individual care plans provided by all staff

What are the drivers for GSFCH?

• Professional pride • Staff job satisfaction, • Staff retention and recruitment • Good reputation • Work smarter so more time for people • Fewer sent to hospital • More Money !! • Attracts more residents • Owner/ Policy/ external pressure

Don’t forget - its fun too!

Don’t forget - its fun too!

For more information on GSF

National GSF centre – Walsall Judy Simkins - GSF Administrator [email protected]

Tel: 01922 604666 Nikki Sawkins – GSFCH Lead Nurse [email protected] Mobile - 07825197625 • Email: [email protected]

• New Website Launch: 15 th July www.goldstandardsframework.nhs.uk

• NHS End of Life Care Programme www.endoflifecare.nhs.uk