Caroline Flynn, Elaine Horgan and Christine Taylor
Concept To develop a low cost, consistent end of life care programme, available to all care homes. It will support the development of nominated staff in residential and nursing homes to become End of Life Care Home Representatives (champions) implementing organisational change utilising the Route to Success for care homes.
Why? Fits with the End of Life Care Strategy, identifying the need for a cultural shift in attitude and behaviour across the health and social care workforce 10% reduction in inappropriate hospital deaths (North West Healthier Horizons 2008) Provide stronger partnerships between the NHS and the independent care sector Address the key components of End of Life Care education to support care homes in providing end of life care i.e. ACP, communication skills and LCP Improving equity of quality end of life care for all residents in a care home
4.39 End of Life Care Strategy 2008 Good PCTs 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
QIPP Quality Innovation Productivity Prevention Improve the resident and family experience of end of life care in a care home setting Enhance care delivery within the care home at end of life A skilled workforce A low cost Network EOL programme providing a consistent approach across PCTs with a wide access to all care homes Can support care homes who currently have high recorded admissions to the acute sector for end of life care Develop a care home representative to take responsibility for the future development of end of life care provision in their care home Enhanced end of life care Enhanced MDT working Deliver choice at end of life Wider awareness and implementation of End of life care Development of PCT End of Life Care home representative Groups Address equity Reduction in hospital admissions at end of life from Care homes Reduction of isolated working
CQC
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 and 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. LCP? The least possible disruption to the individual and their family and those close to them (see CQC Guidance for inspectors)
End of Life Care Quality Markers For Care Homes Action Plan for EOL Mechanisms to discuss and record wishes (ACP) Resident s 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
End of Life Care Training Matrix Gold Standards Framework All care homes to access End of Life Care training Macmillan Foundations in Palliative Care Pack /TRIBAL Six Steps to Success Other Education Programmes
Overview of the Six Steps to Success 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
Recruitment Local awareness raising session Participation agreement to be signed Registration
Expectations of an End of Life Care Home Representative 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 and social services To be a link with the local End of Life Care Facilitator Initiate change management within the home
Induction Workshop Attendance from care home representative and manager/matron Portfolio of evidence Completion of knowledge, skills and confidence audit Pre programme audit on end of life care activity National, regional and local driving forces Introduction to the Six Steps to Success programme Audit cycle/change management Roles and responsibilities of care home representative Commence an end of life care policy/action plan
Six 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
Conclusion Workshop Review of the programme Individual feedback on progress Portfolio review Issues and challenges Post programme audit Completion of End of Life Care Policy
Celebration On Completion of the six step programme the End of Life Care Representative will become the Care Home End of Life Care Champion The Care Home Representative will receive a certificate of attendance Care home will receive a dated certificate on completion of portfolio
Sustainability Care home 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
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 Recruitment Presentation V1 07092011