6 STEPS TO SUCCESS ACHIEVING QUALITY IN END OF LIFE CARE IN RESIDENTIAL HOMES

1. 6 STEPS TO SUCCESSACHIEVING QUALITY IN END OF LIFE CARE IN RESIDENTIAL HOMES Pam Williams Clinical Nurse Educator End of Life Care April 2011

2. Objectives of the session • By the end of the session you should be able to; • Identify the national, regional and local end of life drivers • Understand the programme • Commence the audit process • Have an understanding of your role & responsibilities as end of life lead for your home • Be aware of the End of Life Care Policy we are working with

3. National drivers

4. End of life care strategy (2008) • “Good PCT’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 a appropriate access to GP, District nursing and specialist palliative care advice” • DOH, 2008, End of Life Care Strategy p95

5. EOLC quality markers • 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

6. The Quality, Innovation, Productivity and Prevention (QIPP) programme is all about ensuring that each pound spent is used to bring maximum benefit and quality of care to patients.(Dept of Health 2010)

7. Care Quality Commission 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 • Systems in place to access relevant members of PHCT • 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. Liverpool Care Pathway

8. Regional Drivers HEALTHIER HORIZONS 10% reduction in inappropriate hospital deaths ( North West Healthier Horizons 2008)

9. North West End of Life Care Model

10. Local Drivers NHS Warrington • Improve quality and equity of care for all residents of Warrington • Improve local accessibility to end of life care training • Improve knowledge, skills and confidence around palliative and end of life care for staff working in all areas of care • Achieve 10% reduction in hospital deaths • Improve uptake of end of life care tools i.e. PPC,LCP • Improve choice at end of life • Improve accessibility to expertise at end of life • Reduce inappropriate admissions to hospital at end of life • Utilise resources more effectively to achieve better value for money for the community

11. Some definitions- group work; • Palliative Care; • End of life Care;

12. Some definitions • Palliative care; • the active holistic care of patients with advanced progressive illness. Management of pain and other symptoms and provision of psychological, social & spiritual support is paramount. The goal of palliative care is achievement of the best quality of life for patients & their families… • (National council of palliative care)

13. And…. • Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering, by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. (World Health organisation WHO)

14. Palliative care philosophy • Focus on quality rather than quantity of life • Life affirming but death accepting • Effective communication at all levels • Respect for autonomy and choice • Effective symptom control • Holistic, multi professional approach • Caring about both the person and those that matter to that person

15. Definition of end of life • The period of time marked by disability or disease that is progressively worse until death. The final stage of the journey of life. • all those with advanced, progressive, incurable conditions (doh 2006)

16. Overview Of The Programme • Induction workshop • Six Steps to Success workshops • Supporting education: communication skills, Advance Care Planning and Liverpool Care Pathway for the dying patient (LCP) • Conclusion workshop • Continuation of care home forum

17. The 6 Steps • 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

18. 1 2 3 4 5 Advancing disease Increasing decline Last Days of Life First Days after Death Bereavement 1 year 6 months Death 1 year North West End of Life Care Model

19. What is a good death? • From the perspective of; • The patient • The relative • The care staff

20. End of Life Care Policy for Residential homes • Each of the 6 Steps relates to the policy

21. Expectations of attendees (end of life leads) • Regularly meet with other End of Life Care Home Representatives • Develop other learners in end of life care • 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 • To be a link with the local End of Life Care Facilitator • Initiate change management within the home

22. Evaluation • Ongoing evaluation throughout the course • Pre and post-course audits • Audit of ACP and LCP • National roll out of the Six Steps to Success Programme.

23. Sustainability • Forum continues regularly • External speakers • Staff agendas • Continuing access to education and support End of Life Care Home Forum will be a valuable resource group to drive and trial new initiatives in End of Life Care for the care home sector i.e. E –learning

24. AN INTRODUCTION TO CHANGE MANAGEMENT

25. Change Management • Identify an area for change • What happens now • What should happen-research best practice • How are you going to make the change? • Obtaining permission, communicating, timing, resources needed, ethics & legalities? • Monitoring & evaluating

26. Things to consider • The wider picture; • Politics- what is current thinking • Economics- is there a cost • Social- the effect on people • Technological- do you need equipment etc • Ecological- does this effect the environment • Legislative- what is the law • Industrial- how will this effect your business

27. Sharing your learning • 4 ways; • Simple - posters, memos • Education – teaching sessions • Leadership – by example in practice • Audit – by evaluating the changes and proving the benefits

28. WHAT IS AUDIT? & HOW DO WE DO IT?

29. The audit cycle

30. Measuring success with audit • Keep it simple; • What do you need to measure- quantity/quality • What do you need? • A system • Resources • A plan • Who will do it • Feedback to staff, management and the group

31. What are we measuring? FACTS • Changes in plan of care; • Hospital admissions • Uptake of end of life tools • Quality of care EMOTIONS • Feelings & thoughts • Family/carer support

32. TOOLS • FACTS • Data collection • EMOTIONS • Reflection of staff • Reflection of families i.e. spoken or written

33. YOUR CHANGE MANAGEMENT PROJECT • Some ideas; • Information giving; leaflets, staff sharing • Areas of care i.e. oral care, feeding & fluids, skin care, use of equipment • Bereavement support; book of remembrance, memorial tree • Introducing an assessment tool i.e. pain, Barthel score.

34. Creating a philosophy for end of life • End of life care requires an active, compassionate approach that treats, comforts and supports individuals to enable them to live as well as possible until they die. It includes physical care, management of pain and other symptoms; the provision of psychological, social, spiritual and practical support is also important and it encompasses support for families and friends up to and including the period after death (Four Seasons Wilmslow 2011)

35. Can you now…? • Identify the national, regional and local end of life drivers • Understand the programme • Commence the audit process • Have an understanding of your role & responsibilities as end of life lead for your home • End of Life Care Policy

36. HOMEWORK • Keep the handouts and portfolio in a safe place and bring them to each session • Complete the post death audit form and bring to the next session • Feed back the contents of this workshop to all staff and share the philosophy for end of life care with them • Share the information from the programme with GP’s and other members of your wider team and engage their support for you during the programme

37. Thank you ANY QUESTIONS? Look forward to seeing you at workshop 1 Pam Williams Tel 01925 579201 Email; Pamela.williams@warrington-pct.nhs.uk