midlothian gold standards framework care homes step down sustainability project (september 2009 -...
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Midlothian Gold Standards Framework Care Homes Step Down Sustainability Project(September 2009 - September 2011)
Barbara Stevenson CNSRhona Moyes CNS
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Background to Sustainability Project
• Commenced in March 2007 (18 month project led by J. Hockley, J. Watson and S. Murray from the University of Edinburgh)
• Seven Care Homes in Midlothian, Primary Health Care Teams and specialist palliative care
• GSFCH framework
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Education
• Key champion appointed in each Care Home
• Attended facilitative learning course and GSFCH network workshops
(Foundations in Palliative Care for Care Homes, Macmillan 2004)
• Responsible for cascading training down to their ownStaff
Implementation of systems• Supportive palliative care register (ABCD register) • Adapted Liverpool Care Pathway (LCP) for the last days of life
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Project OutcomesSignificant improvement in:• Care of the dying• Control of symptoms• Continuity of care• Carer support• Continued learning
Increased confidence in:• Communicating with relatives about death and dying• Caring for a dying person
Use of the ABCD Register with the GP
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Outcomes cont.
• Increase in DNACPR status (8% to 71%)
• Increased explicit decision making in end of life care (4% to 55%)
• Fewer deaths in hospital (15% to 8%)
• A reduction of inappropriate hospital admissions (>40%)
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Key Recommendations
• Advanced care planning discussed early in the admission – Communication and decision should emphasise the
appropriateness of allowing a natural death
• DNACPR status addressed on admission to a Care Home
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Recommendations cont.
• Specialist palliative care support for residents with complex needs
• The use of symptom assessment tools
• The adapted Liverpool Care Pathway (LCP) used for all residents for end of life care
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Recommendations cont.
• Organised reflection times following a death (Significant Events Analysis tool)
• Palliative care education for all Care Home staff
• Accreditation status of Care Home with GSFCH programme
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The Step Down Project (September 2009 - September 2011)
Support Care Home Managers to:
• Continue palliative care education
• Consolidate and embed the GSFCH Framework
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Step Down Project cont.
Education
• Induction
• Delivery of Macmillan Foundations in Palliative Care programme
• Develop communication skills
• Assist in complex family situations
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Step Down Project cont.
Systems
• Support staff with the ABCD Register and attend the monthly GP reviews
• Encourage and support staff to use validated symptom assessment tools and adapted LCP
• Encourage the use of the Significant Events Analysis
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Step Down Project cont.
Evidence• Collate end of life data
• Collate education programme evaluation and attendance data
• Support Care Home Managers to develop and gain GSFCH accreditation
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After death data Jan to June 2010 Total number of deaths - 39
• Preferred place of death 36
• Place of death CH - 30 H - 9
• Inappropriate admissions 0
• DNACPR 34
• Advanced care planning 38
• ePCS 36 (Electronic Palliative Care Summary)
• LCP 21
• Anticipatory prescribing 20
• Assessment tools 10
• External support (CNS) 2
• Bereavement support 36
• Significant Event Analysis 15
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Education Data Jan- Aug 2010
05
1015202530n
um
be
r of a
tten
de
es
Induction
Comm
unication
Bereavement
Pain and symptom
s
Shadowing
Trained Staff
Care Assistants
CH Managers
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Challenges To Date
Staffing• Loss of key champions
• Staff turnover
• Management changes
• Cultural differences
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More Challenges
Education• Delivering educational content for trained and untrained staff
• Time allocated for education
• Development of communication skills
• GSFCH systems for use with younger residents
• Embedding the use of the significant events analysis
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......and finally
Difficult but achievable
• Requires commitment from both sides
• Involves ongoing education