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Kirklees and Calderdale PCTs Palliative Care Education in Nursing Homes

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

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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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