Liverpool Care Pathway in Nursing Homes

1. Liverpool Care Pathwayin Nursing Homes Pat Mowatt Education Facilitator for Palliative Care for the Nursing Homes

2. Purpose of Post • To provide education for trained nurses to underpin the introduction of the Liverpool Care Pathway and / or the Gold Standards Framework to nursing homes in Bradford & Airedale.

3. Drivers • NICE guidance Improving Supportive & Palliative Care for Adults with Cancer 2004 • B & A’s Palliative Care Education Strategy • National Minimum Standards: Care homes for Older People 2003 • Competency framework for Cancer Nursing 2004 • CSCI consultation around Terminal Illness registration March 2005

4. Statistics • July2004 69 nursing homes in Bradford & Airedale • ? number registered to take Terminally Ill patients • July 2004 16 taking up palliative care NVQ training • May 2005 8 more taking up NVQ training • Total 24 now doing NVQ palliative care training • More joining project

5. Planning • Registering with Liverpool • Adaptation of LCP • Consultation with: • local specialist palliative care services • CSCI • H M Coroner • Nursing home nurse managers • GPs & deputising service • Lead cancer nurses • Cross PCT drug group

6. Planning • Adaptation of LCP • More detailed criteria for inclusion on LCP • Included specific goal about completion of OOH handover form • Drug guidance developed to tally with acute sector LCPs • Included local contact numbers for specialist palliative care advice

7. Planning • Interviews with Nurse Managers • Negotiate commitment to education programme & LCP • Registration with Liverpool • Nomination of NH lead for project • Base review of 20 expected deaths • Education programme • Audit of LCP usage

8. Education Programme • Competency documents • 7x 2 hour in-house sessions built around principles of GSF covering: • Principles of palliative care, teamwork & specialist palliative care services, assessing palliative care needs • Pain management • Communication issues & psychosocial & spiritual care • Symptom management • Management of the last few days of life – LCP • Bereavement & staff support • Hot topics & consolidation • Repeat sessions as needed

9. Introductory phaseMy role • Contact with GPs to gain co-operation with project • NH visits to support nurses & GPs in early days of usage of LCP • Immediate audit & feedback - both verbal & written

10. Review • Review 3 months later – use of LCP, changes to practice, need for education, repeat of competency document • Encourage to attend Liverpool study days • Arrangements for ongoing support • Further education sessions • Local support group • Network & local facilitators

11. Results • 8 NHs signed up to LCP • 4 NHs ready to use LCP • 4 LCPS used so far in 2 NHs • Comments: • It enabled us to get everything in for the end stage • The family said they had no regrets about transferring her here (from hospice)

12. Problems • Duplication in documentation initially • Additions needed for care after death: • Name of GP certifying death • Cause of death • Name of undertaker • Burial or cremation • Sceptics

13. Problems • Not just one GP per NH • Getting new staff on board • Staff moving on • Coaxing PCTs & PHCTs to get actively involved with education in NHs • Long term sustainability • NH staff need to commit time to audit, analyse variances & reflect

14. Benefits • Step by step approach to clinical interventions & reduces variations in patient care • Patient centred care with measurable outcomes • Identifies what NH does well • Identifies areas for improvement e.g. systems, education • Greater effectiveness, efficiency & quality of care