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Kirklees and Calderdale PCTs Palliative Care Education in Nursing Homes The role and outcomes of the Macmillan CN

Kirklees and Calderdale PCTs Palliative Care Education in Nursing Homes The role and outcomes of the Macmillan CNS – nursing homes Friday 6 th July 2007 Rosaleen Bawn Macmillan Clinical Nursing Specialist – Nursing Homes. To care to control to comfort. Past – history

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Kirklees and Calderdale PCTs Palliative Care Education in Nursing Homes The role and outcomes of the Macmillan CN

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  1. Kirklees and Calderdale PCTsPalliative Care Education in Nursing Homes The role and outcomes of the Macmillan CNS – nursing homes Friday 6th July 2007 Rosaleen Bawn Macmillan Clinical Nursing Specialist – Nursing Homes

  2. To care to control to comfort • Past – history • Present – current role and outcomes • Possibilities – the future

  3. To care to control to comfort • Past • National documents • Palliative Care Education in Nursing Homes (Froggatt 2000) • National Minimum Standards (DoH 2003) • Building on the Best (2003) • Improving Palliative and Supportive Care (DoH 2004) • Getting rid of terminal illness category (CSCI 2006) • Introductory guide to end of life care in care homes (NCPC 2006) • Regional strategy • YCN – identified area of need • Local findings • Work of Anne Boyce • Steering/planning groups

  4. To care to control to comfort • Present – the role • The role has the luxury of having education as the core component – remain completely focussed • To inform a strategy whereby palliative care delivered in nursing homes is further developed/improved • To identify palliative care education needs within nursing homes across both Calderdale and Huddersfield PCT’s • To facilitate palliative care education in care homes to ensure residents receive the best of care

  5. To care to control to comfort • Person centred • Improve and further develop the palliative care provided for residents in care homes • Figures – 1573 approx • Complex needs of residents • Education – needs based – changes practice • Self directed learning – eg e-learning; Macmillan – Foundations in Palliative Care

  6. To care to control to comfort • Preparation (1) • Relationship building • Identifying key homes/personnel • Visiting each of the 49 care homes with nursing (6 -100) • Base line information • 51% die following general deterioration; 34% acute episode; 9% terminal illness; 6% sudden (Froggatt 2000) • Palliative care directory • Palliative care education - directory • Palliative care educational needs – competency document

  7. To care to control to comfort • Preparation (2) Targets: • 100% homes had Palliative Care Directory • 100% homes received Palliative Care Education Directory • At least 50% homes had attended/received Palliative Care Principles education sessions • 100% homes had access to OOH priority line • 10% homes joined Gold Standards Framework phase

  8. To care to control to comfort • Partnership • If a goal is perceived as irrelevant to the core group then it will not happen • Working with all levels of care home staff • Working with: • Palliative care colleagues Educationalists • Commissioners PHCTs • CSCI Social Services • National teams many others

  9. To care to control to comfort • Outcomes (1): • 100% received both Directories • OOH priority line now available to all homes • 2 homes already doing GSF a further 7 homes have completed current phase = 18% • “gained confidence and improved credibility” • “greater understanding of symptom control” • “much more proactive – use of hand-over form” • “confirmed that our practice was of a good standard” • “before doing GSF our residents would have been admitted to hospital – now we keep them here” • “education programmes excellent” “more reflective”

  10. To care to control to comfort • Outcomes (2) • All homes are aware of the need for syringe driver training and updating • Audit revealed: • 10% (n=5) own a syringe driver (3 never serviced) • 15% did not know where to obtain S/D • 50% have a named nurse(s) proficient in use of S/D (1-9) • 70% aware of S/D training • 18% attended S/D training • 14% did not know who to contact if problems with S/D • 86% knew to contact DNs; Hospice; Mac Ns

  11. To care to control to comfort • Outcomes (3): • Continually update the nursing home website • 5 Residential Homes have requested palliative care education • Education – competency document (60% n=30 return) • 90% received palliative care principles education • Other subjects delivered include: • GSF; ICP; Pain; Nausea & Vomiting; Breathlessness; Spirituality; Depression; Mouth Care; Breaking Bad News; Communication; Bereavement • A total of 196 attended the rolling programme • A total of 173 attended in-house programme

  12. PRE-EDUCATION – PALLIATIVE CARE C1A – Communication with PHCTs C1B – Communication with staff/residents C2 – Co-ordination C3 – Control of symptoms C4 – Continuity – OOH C5 – Continued Learning C6A – Carer’s support C6B – Bereavement support C6C – Staff support C7 – Care of the dying patient POST – EDUCATION – PALLIATIVE CARE

  13. PRE-EDUCATION – SYMPTOM CONTROL 1 – Pain management 2 – Nausea & Vomiting 3 – Breathlessness 4 – Agitation 5 – Pall/Onc Emergencies 6 – Constipation 7 – Mouth Care 8 – Spirituality 9 - Depression POST EDUCATION – SYMPTOM CONTROL

  14. To care to control to comfort • Other outcomes: • Link Nurse Group • GSF support group • Presented at local, regional and national conferences – to share the work undertaken • Links with Colleges of Further Education • Newsletters – circulated to all nursing homes; GP practices, DN teams and SPCT • Care Home Managers’ Forum

  15. To care to control to comfort • As a result there have been an increase in calls to SPCT for advice and support • District Nurses report an increase in calls also • Nursing Home staff report they feel more confident in calling GP – have the evidence • Nursing Home staff have used this Macmillan CNS to direct them to the appropriate professional – 23 enquiries

  16. To care to control to comfort • Possibilities – the future (1) • To build on current successes • Continue to embed palliative care into practice • To support homes that have been unable to attend or host education • Promote S/D training • Identify inappropriate hospital admissions

  17. To care to control to comfort • Possibilities – the future (2) • Re-visit Managers’ Forum • Pilot Integrated Care Pathway for the Dying Patient • “Shadowing” and/or role exchange • Communication between secondary care and care homes • Continually assess and re-evaluate

  18. To care to control to comfort • Its about believing that something can change • Remaining passionate, motivated and committed • To celebrate what has been achieved, learn from disappointments and look to the future • Palliative care is the right of every person and it is the responsibility of each health care professional to understand and adopt the palliative care principles • We are here because we care, we want to control and wish to comfort always

  19. To care to control to comfort Thank you

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