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

To care to control to comfortTo care to control to comfort

Thank youThank you