St Leonard’s Care Home Project

1. St Leonard’s Care Home Project By Alison Skelton and Lynda Ruddock Clinical Nurse Educators

2. Background to the Project • To celebrate St Leonard’s 30th Year, a fantastic opportunity was sanctioned by the trustees to deliver palliative and end of life care training to care homes across the Vale of York as part of a two year project. • A thank you to people in the locality who have supported the hospice during this time by providing education and training back into the community. • As part of the two year project the training provided is delivered free of charge.

3. Aims and Objectives • Improve care home staff confidence and skill in relation to palliative and end of life care. • Build on and develop existing knowledge around palliative and end of life care and care delivery for care home staff. • To empower staff members both registered and non registered to be able to deliver good quality end of life care. • Reduction in inappropriate hospital admissions and emergency call outs at the end of life. • To represent and promote the ethos of the hospice within the wider community.

4. Where did we start? • Started in post November 2015. • Research • Introductions at the CCG Care Home Forum. • Independent Care Group, communicated through their networks. • Dr David Mazza, cascaded information regarding the project and contact details for the team to Vale of York GP’s. • Meeting with Saint Catherine's Hospice – Education and Clinical Support for Care Homes. • 1st training session delivered 18th January 2016.

5. What do we do? • Identify care homes which have shown an interest in undertaking the training. • Meet with care home managers/senior nurses to discuss their organisation and training needs of their team and to negotiate training dates and venue. • Using research undertaken from the onset of the project, training sessions are structured around the needs of the care home, but also in line with national legislation in particular focusing on the 6 C’s. • Nursing Homes – 2 day training per session. • Others – 1 day training per session.

6. Palliative and End of Life Care Training Day One

7. Palliative and End of Life Care Training Day Two

8. Palliative and End of Life Care Training

9. Training Sessions delivered • Number of education sessions delivered since January 2016 – August 2016 – 34 • Total number of care home staff attended training-150 • Number of training sessions cancelled – 4 • Mean average number of attendees per group – 5 • Training delivered either at St Leonard’s Hospice or off site.

10. Training Venues

11. Follow up

12. How do we evidence? Pre and post training questionnaires using the Linkert Scale. Knowledge around palliative and end of life care and measurement of confidence. Training Evaluation 6 month knowledge and confidence questionnaires. Impacts on service

13. What has the evidence shown so far?Knowledge • Results from 2 care homes • Positive responses in regards to Thoughts around Palliative and end of life care, focusing on knowledge highlighted in areas around: • Nutrition and Hydration • The purpose of palliative care inclusive of dignity and choice • Awareness of spirituality • Symptom awareness and management

14. What has the evidence shown so far?Confidence • 59% increase in confidence around Advance care planning • 41% increase in confidence around recognising when a person is dying • 59% increase in awareness of who to contact to provide specialist advice and support • 31.5% increase in recognising own limitations and where to access support in order to give the best possible care • 24% increase around understanding the spiritual needs of a person and why this needs to be addressed • 37% (Nursing Home) increase in confidence understanding the term dignity and choice at the end of life • 48% increase in communication around end of life

15. Potential Cost Savings • Audit carried out identified high admission rates for care home residents at the end of life between 2014-2015 • Audit looked at individuals dying in the acute setting within 72 hours of admission • Following the completion of training post 6 months, amount of deaths and place of deaths reviewed at particular care home • Pre training the care home had 7 residents at the end of life all of whom were admitted to hospital and died within the acute setting • Post training 8 deaths between Jan 2016 – Aug 2016 1 hospital admission • 7 residents died in THEIR home and were nursed by the care • home staff

16. Challenges faced • Discussion causing staff to become emotional and reflect on their personal experiences during breaks or at the end of sessions • Staff Professionalism • Staff engagement • Size of care home training rooms vs. size of staff groups • Non attendance of staff • Technology • Time Keeping • Culture/Language

17. What have we learnt? • Ground Rules • Self sufficiency • Flexibility • Self Care • Timing of evaluation forms • Ice breakers/Interactive group work • Assertiveness • Professionalism

18. Support • To enable us to deliver the training. • Each other • Line Manager • Director of Clinical Services • Education sub-committee • Lead Nurse for End of Life Care for York and Scarborough • Macmillan Nurses • Community Matron

19. What’s next? Beaumont Care November 2016 Contact made with Arc Light and training sessions planned for December 2016 Contact made with HMP Full Sutton and training sessions planned for early 2017 Continuation of training to perspective care homes across the locality

20. And after a long day………

21. Any Questions?