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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 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

to care to control to comfort
To care to control to comfort
  • Past – history
  • Present – current role and outcomes
  • Possibilities – the future
to care to control to comfort3
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
to care to control to comfort4
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
to care to control to comfort5
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
to care to control to comfort6
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
to care to control to comfort7
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
to care to control to comfort8
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
to care to control to comfort9
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”
to care to control to comfort10
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
to care to control to comfort11
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
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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

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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

to care to control to comfort14
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
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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
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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
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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
to care to control to comfort18
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