Transcript Scoping Exercise of Education and Training in End of Life Care












8 Universities (Pre-Registration 32/19)
5 Universities (Post Reg 22/12)
11 Acute NHS Trusts
8 Hospices
2 Independent care home companies/I care home
11 PCTs
5 Councils
NW Ambulance Service
3 Other
43 Trainers (39)
268 Staff (215)
Lancashire
Merseyside
Cumbria
Geographical Spread
Greater
Manchester
Cheshire
1
Acute
Trust
2
2
6
PCT
6
1
4
Hospice
4
1
Council
2
1
Care
Homes
THREE REGIONALLY
Other
University
Pre
1
1
1
1
2
1
2
3
3
1

Nursing (16)

Medicine (5)

Social Work (1)
yes
66%
(40%)
no
34%
(missing)


5 out of 31 respondents said their courses
had shared learning across disciplines on the
course
Of those this included:
◦
◦
◦
◦
◦
Nurses
Medical students
AHPs
Social Workers
Assistant Health Care Practitioners
Discussions as EOL
15%
approaches
17%
Assessment, care
planning and review
Co-ordination of patient
15%
18%
care
Delivery of high quality
services
19%
Care in the last days of
16%
life
Care after death
Referral to coroner
Verification of death
Bereavement support
Cultural and religious practices
Preferred place of care
Liverpool care pathway
No
Role of out of hospital services
Out of hours services
Hospital specialist palliative care teams
Referral to and use of community specialist…
Rapid response services
Discharge planning
Coordination of services
Assessment of the patient's capacity (Mental…
Yes
Advance care planning
Function of the supportive care register
Use of the "surprise question"
0
2
4
6
8
10
12
14
16
Yes
Indications for the use of a syringe driver in palliative care
Use of steroids
Terminal restlessness and agitation
Management of the last few days of life
Hypercalcaemia
Superior vena cava obstruction
Spinal cord compression
Respiratory tract secrections
Haemoptysis
Cough
Breathlessness
Intestinal obstruction
Nausea and vomiting
Pain
0
2
4
6
8
10
12
14
A
80
NHS Northwest
70
EOL Care Model
60
Liverpool Care
Pathway
50
Preferred Priorities
40
for Care
30
Gold Standards
Framework
20
End of Life Care
10
Strategy
0
Never heard of
it
Have a copy
Have read it Use in teaching
(missing)
By a
mentor in
practice
Commonly face to face
teaching, simulation
and use of case
scenarios
Service users/carers
involved in 1/3 of
cases
Personal values and
reflection covered
(1/3)
Teaching
Role play
Blended
approach
(multiple
methods)
Assessment
30
Yes
25
20
(missing)
15
10
5
0
Needs
assessment of
patient
Needs
assessment of
carer
Developing a
care plan that
records
patient
preferences
Developing a
care plan that
records carer
preferences
Involving
patients in
treatment
decisions
Involving
carers in
treatment
decisions
Ensuring that
all health and
social care
staff have
access to the
care plan







Recognised educator to work alongside preregistration teams
Incorporate generalist palliative care from
year 1 medicine
Access to skilled mentors
Theme through three years
Module dedicated to EOLC at end of course
More patient and carer input
Use new nursing standards
5 Universities
22 Course/Module Leaders (12)
14
12
10
8
6
4
2
0
Monitor and audit quality
Use the Liverpool Care Pathway or equivalent
Establish workforce development in end of life care
Ensure services are in place 24 hours a day, seven days a…
Co-ordinate care across organisations
Ensure carers' needs are assessed and recorded
Ensure patient choices are documented and communicated
Offer a care plan to those patients approaching the end…
Identify those patients approaching the end of life
Set up an organisational action plan
0
1
2
3
4
5
6
7
Discussions as EOL
0%
approaches
Assessment, care
13%
23%
planning and review
Co-ordination of
patient care
16%
Delivery of high quality
16%
16%
services
Care in the last days of
life
Care after death
16%
Other
Do you use the PPC Tool?
11
12
10
8
6
4
4
Yes
No
4
3
2
0
Never
Heard of (missing)
heard of it it but use
other tool
12
10
8
6
4
2
0
Yes
No
(missing)
Yes
27%
No
50%
5%
18%
Never heard of it
(missing)
Care after death: Verification of death
Care in the last days of life: Cultural and religious…
Care in the last days of life: Liverpool care pathway
Coordination of care: Out of hours services
No
Yes
Coordination of care: Rapid response services
Coordination of care: Coordination of services
Advance care planning
Discussions at the end of life: Assessment, care…
0
1
2
3
4
5
6
7
8
9

11 Acute NHS Trusts
8 Hospices
2 Independent care home companies/I care
home
11 PCTs
5 Councils
NW Ambulance Service
3 Other

43 Trainers (39)






2%
2%
Yes
24%
No
Don't know
72%
(missing)
Yes: 2008
Yes: 2009
Yes: 2010
Intend to: 2011
No plans
(missing)
3%
14%
7%
45%
17%
14%
22
25
20
15
10
5
0
12
16
10
6
8
2
5
4
1
Indications for the use of a syringe driver…
Use of steroids
Terminal restlessness and agitation
Management of the last few days of life
Hypercalcaemia
Superior vena cava obstruction
Spinal cord compression
Respiratory tract secrections
Haemoptysis
Cough
Breathlessness
Intestinal obstruction
Nausea and vomiting
Pain
0
5
10
15
20
25
30
30
25
20
15
10
5
0
24
16
14
7
12
7
1
0
1
2









Team trainers
General Nursing staff
Specialist nursing staff
Medical staff
Specialist medical staff
GPs
AHP
Ext company/trainer
Other
37%
29%
85%
8%
51%
20%
17%
14%
26%
Lecture Discussion
Role
Play
37
63 80
29
Case
Studies
Vignettes
/Pt stories
Seminars/
Small group
work
Video
37
71
48
Raise awareness
10%
19%
31%
Develop individual
competencies
Discuss Trust
objectives
Redesign practice
12%
28%
Other












Number of missing responses
Limited sample although reasonable spread
Focus tends to be on nursing staff/IPL not well embedded
Staff report mixed competence in skills albeit these are
growing
PPC not used in teaching on university courses
Significant amount of training taught in house
Varied knowledge of EOLC tools and strategies
Teaching approaches seem in line with skills required
Opportunities for learning seem to be there – APPLICATION
There appears to be a gap in what is taught, learnt and
applied when one compares views
Is practical assessment lacking?
Largely taught post qualification and through in-house
training