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
Dec 31, 2015
Kirklees and Calderdale PCTsPalliative Care Education in Nursing
Homes
The role and outcomes of the Macmillan CNS – nursing
homes
Friday 6th July 2007
Rosaleen BawnMacmillan Clinical Nursing Specialist –
Nursing Homes
To care to control to comfortTo care to control to comfort
Past – historyPast – history
Present – current role and outcomesPresent – current role and outcomes
Possibilities – the futurePossibilities – the future
To care to control to comfortTo care to control to comfort
PastPast– National documentsNational documents
Palliative Care Education in Nursing Homes (Froggatt 2000)Palliative Care Education in Nursing Homes (Froggatt 2000)National Minimum Standards (DoH 2003)National Minimum Standards (DoH 2003)Building on the Best (2003)Building on the Best (2003)Improving Palliative and Supportive Care (DoH 2004)Improving Palliative and Supportive Care (DoH 2004)Getting rid of terminal illness category (CSCI 2006)Getting rid of terminal illness category (CSCI 2006)Introductory guide to end of life care in care homes (NCPC 2006)Introductory guide to end of life care in care homes (NCPC 2006)
– Regional strategyRegional strategyYCN – identified area of needYCN – identified area of need
– Local findingsLocal findingsWork of Anne BoyceWork of Anne BoyceSteering/planning groupsSteering/planning groups
To care to control to comfortTo care to control to comfort
Present – the rolePresent – the role
The role has the luxury of having education as the core The role has the luxury of having education as the core component – remain completely focussedcomponent – remain completely focussed
To inform a strategy whereby palliative care delivered in To inform a strategy whereby palliative care delivered in nursing homes is further developed/improvednursing homes is further developed/improved
To identify palliative care education needs within nursing To identify palliative care education needs within nursing homes across both Calderdale and Huddersfield PCT’shomes across both Calderdale and Huddersfield PCT’s
To facilitate palliative care education in care homes to To facilitate palliative care education in care homes to ensure residents receive the best of careensure residents receive the best of care
To care to control to comfortTo care to control to comfort
Person centredPerson centredImprove and further develop the palliative Improve and further develop the palliative care provided for residents in care homescare provided for residents in care homesFigures – 1573 approxFigures – 1573 approxComplex needs of residentsComplex needs of residents
Education – needs based – changes Education – needs based – changes practicepracticeSelf directed learning – eg e-learning; Self directed learning – eg e-learning; Macmillan – Foundations in Palliative CareMacmillan – Foundations in Palliative Care
To care to control to comfortTo care to control to comfort
Preparation (1)Preparation (1)
Relationship building Relationship building – Identifying key homes/personnel Identifying key homes/personnel – Visiting each of the 49 care homes with nursing (6 -100)Visiting each of the 49 care homes with nursing (6 -100)
Base line informationBase line information– 51% die following general deterioration; 34% acute 51% die following general deterioration; 34% acute
episode; 9% terminal illness; 6% sudden (Froggatt 2000)episode; 9% terminal illness; 6% sudden (Froggatt 2000)– Palliative care directoryPalliative care directory– Palliative care education - directoryPalliative care education - directory– Palliative care educational needs – competency documentPalliative care educational needs – competency document
To care to control to comfortTo care to control to comfort
Preparation (2)Preparation (2)Targets:Targets:
100% homes had Palliative Care Directory100% homes had Palliative Care Directory
100% homes received Palliative Care Education 100% homes received Palliative Care Education DirectoryDirectory
At least 50% homes had attended/received Palliative At least 50% homes had attended/received Palliative Care Principles education sessionsCare Principles education sessions
100% homes had access to OOH priority line100% homes had access to OOH priority line
10% homes joined Gold Standards Framework phase 10% homes joined Gold Standards Framework phase
To care to control to comfortTo care to control to comfort
PartnershipPartnership
If a goal is perceived as irrelevant to the core If a goal is perceived as irrelevant to the core group then it will not happengroup then it will not happen
Working with all levels of care home staffWorking with all levels of care home staff
Working with:Working with:Palliative care colleaguesPalliative care colleagues EducationalistsEducationalistsCommissionersCommissioners PHCTsPHCTsCSCICSCI Social Services Social Services National teams National teams many others many others
To care to control to comfortTo care to control to comfort
Outcomes (1):Outcomes (1):100% received both Directories100% received both DirectoriesOOH priority line now available to all homesOOH priority line now available to all homes2 homes already doing GSF a further 7 homes 2 homes already doing GSF a further 7 homes have completed current phase = 18%have completed current phase = 18%
– ““gained confidence and improved credibility”gained confidence and improved credibility”– ““greater understanding of symptom control”greater understanding of symptom control”– ““much more proactive – use of hand-over form”much more proactive – use of hand-over form”– ““confirmed that our practice was of a good standard”confirmed that our practice was of a good standard”– ““before doing GSF our residents would have been before doing GSF our residents would have been
admitted to hospital – now we keep them here”admitted to hospital – now we keep them here”– ““education programmes excellent” “more reflective”education programmes excellent” “more reflective”
To care to control to comfortTo care to control to comfort
Outcomes (2)Outcomes (2)All homes are aware of the need for syringe driver All homes are aware of the need for syringe driver training and updatingtraining and updating
Audit revealed:Audit revealed:– 10% (n=5) own a syringe driver (3 never serviced)10% (n=5) own a syringe driver (3 never serviced)– 15% did not know where to obtain S/D15% did not know where to obtain S/D– 50% have a named nurse(s) proficient in use of S/D (1-9)50% have a named nurse(s) proficient in use of S/D (1-9)– 70% aware of S/D training70% aware of S/D training– 18% attended S/D training18% attended S/D training– 14% did not know who to contact if problems with S/D14% did not know who to contact if problems with S/D– 86% knew to contact DNs; Hospice; Mac Ns86% knew to contact DNs; Hospice; Mac Ns
To care to control to comfortTo care to control to comfort
Outcomes (3):Outcomes (3):Continually update the nursing home websiteContinually update the nursing home website5 Residential Homes have requested palliative 5 Residential Homes have requested palliative care educationcare educationEducation – Education – competency document (60% n=30 return)competency document (60% n=30 return)
90% received palliative care principles education90% received palliative care principles educationOther subjects delivered include:Other subjects delivered include:
– GSF; ICP; Pain; Nausea & Vomiting; Breathlessness; GSF; ICP; Pain; Nausea & Vomiting; Breathlessness; Spirituality; Depression; Mouth Care; Breaking Bad Spirituality; Depression; Mouth Care; Breaking Bad News; Communication; BereavementNews; Communication; Bereavement
A total of 196 attended the rolling programmeA total of 196 attended the rolling programmeA total of 173 attended in-house programmeA total of 173 attended in-house programme
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
1 – Pain management
2 – Nausea & Vomiting
3 – Breathlessness
4 – Agitation
5 – Pall/Onc Emergencies
6 – Constipation
7 – Mouth Care
8 – Spirituality
9 - Depression
PRE-EDUCATION – SYMPTOM CONTROL
POST EDUCATION – SYMPTOM CONTROL
To care to control to comfort To care to control to comfort
Other outcomes:Other outcomes:Link Nurse GroupLink Nurse Group
GSF support groupGSF support group
Presented at local, regional and national Presented at local, regional and national conferences – to share the work undertakenconferences – to share the work undertaken
Links with Colleges of Further EducationLinks with Colleges of Further Education
Newsletters – circulated to all nursing homes; GP Newsletters – circulated to all nursing homes; GP practices, DN teams and SPCTpractices, DN teams and SPCT
Care Home Managers’ ForumCare Home Managers’ Forum
To care to control to comfortTo care to control to comfort
As a result there have been an increase in calls As a result there have been an increase in calls to SPCT for advice and supportto SPCT for advice and support
District Nurses report an increase in calls alsoDistrict Nurses report an increase in calls also
Nursing Home staff report they feel more Nursing Home staff report they feel more confident in calling GP – have the evidenceconfident in calling GP – have the evidence
Nursing Home staff have used this Macmillan Nursing Home staff have used this Macmillan CNS to direct them to the appropriate CNS to direct them to the appropriate professional – 23 enquiriesprofessional – 23 enquiries
To care to control to comfortTo care to control to comfort
Possibilities – the future (1)Possibilities – the future (1)
To build on current successesTo build on current successes
Continue to embed palliative care into Continue to embed palliative care into practicepractice
To support homes that have been unable to To support homes that have been unable to attend or host educationattend or host education
Promote S/D trainingPromote S/D training
Identify inappropriate hospital admissionsIdentify inappropriate hospital admissions
To care to control to comfortTo care to control to comfort
Possibilities – the future (2)Possibilities – the future (2)
Re-visit Managers’ ForumRe-visit Managers’ Forum
Pilot Integrated Care Pathway for the Dying Pilot Integrated Care Pathway for the Dying
PatientPatient
““Shadowing” and/or role exchangeShadowing” and/or role exchange
Communication between secondary care and Communication between secondary care and
care homescare homes
Continually assess and re-evaluateContinually assess and re-evaluate
To care to control to comfortTo care to control to comfort
Its about believing that something can change Its about believing that something can change Remaining passionate, motivated and committed Remaining passionate, motivated and committed To celebrate what has been achieved, learn from To celebrate what has been achieved, learn from disappointments and look to the futuredisappointments and look to the futurePalliative care is the right of every person and it Palliative care is the right of every person and it is the responsibility of each health care is the responsibility of each health care professional to understand and adopt the professional to understand and adopt the palliative care principlespalliative care principlesWe are here because we care, we want to We are here because we care, we want to control and wish to comfort alwayscontrol and wish to comfort always