Improving End of Life Care in the Acute Setting Developing the End of Life Care Key Worker

1. Improving End of Life Care in the Acute SettingDeveloping the End of Life Care Key Worker Jan Lawton Macmillan Specialist Palliative Care Team Leader St Helens & Knowsley Teaching Hospitals NHS Trust

2. Background Invite from Network to bid for MPET monies: • Self assessment against EoL Quality markers • Must have a measurable action plan Project targets: • 5% reduction in hospital deaths(Sept 2012) • 10% increase in use of Advance Care Planning Framework(Sept 2012) • Increase LCP usage to 50% for anticipated deaths(Sept 2012) • 100% of clinical areas will have an appropriately educated EoLC Key Worker by June 2012 • Provide consistent EoLC education programme to: • Key Workers • Generalist Workforce

3. Background MPET Funding £65K Sept 2011 Appointment of EoLC Facilitator (Sept 2011) Targets,KPI’s, QIPP,CQUINs National guidance Established Trust EoLC Steering group Key enablers LCP RDP ACB EPaCCS ACP Action Plan LCP usage ACP Hospital Deaths Database Key Worker Programme Rolling ward training Rapid Discharge Pathway Sub-groups: Education/Training Project Audit/Outcomes Finance Monitoring spend Sourcing funding Project Timeline Work Streams Strategy Saved bed days PPC achieved

4. Developing and Implementing the End of Life Key Worker Programme

5. Benefits for the Trust • Improved quality of end of life care/ reduction in complaints • Reduction in inappropriate ‘crisis’ admissions and hospital deaths • Deliver national standards and targets • Improve productivity - reduced length of hospital stay and occupied bed days • Improve efficiency • Continued investment and development of the workforce

6. Benefits for the Key Worker • Opportunity to identify and address individual learning and development needs with an identified Specialist Palliative Care mentor • Be supported to attend the Key Worker development programme • Be part of a wider network of generalist nurses with an interest in end of life care • Be supported in moving the end of life care agenda forward in the Acute setting • Develop and add to personal professional portfolio • Increase confidence, skills and knowledge = greater job satisfaction

7. Anticipated attributes of the Key Worker • Band 6/5 - develop junior members of the team • Genuine interest in EoLC - role shouldn’t be viewed just as a ‘must do’ • Developing leadership/ communication skills/ assertive • Able to shift ward culture improve EoL care • Committed - change agent

8. The purpose • Take a lead role in their Ward/Dept and support others in the provision of end of life care • Ensure End of Life Care Tools (ie.Advanced care planning, Liverpool Care Pathway, Enhanced Rapid Discharge Pathway) are promoted and used appropriately in Ward/Dept area • Support the collection of data and complete audits to demonstrate usage of EoLC tools and use as performance feedback • Liaise closely with Specialist Palliative Care team for additional support for self or team as required • Facilitate the transfer of knowledge and information from the EoLC Key worker development programme to other members of the Dept/Ward team • Take responsibility for their own learning

9. The programme • 6 day course over 3month period • Registered nurse from each ward/ clinical dept within the Trust (excludes Theatres/ Obstetrics/ Paediatrics) • Backfill monies allocated to support the release of staff • Delivered off-site by Hospital Specialist Palliative Care Team • Supported individual mentoring

10. Discussions as the end of life approaches Assessment care planning and review Co-ordination of care Delivery of high quality care the acute hospital Care in the last days of life Care after death/ Spiritual care Course content

11. Communication Skills Assessment and planning Symptom management, maintaining comfort and well being Advanced care planning & ability to utilise EoLC tools ie, GSF/ACB/PPC/LCP Overarching values Competency framework

12. Pre & post course training needs analysis Pre & post course skill set assessment Write up of group work Individual study day evaluations Group presentations Course assessment & Evaluation

13. Example TNA questions Questions 32 – 37, please indicate your answer by circling the number where: ‘1= no ability’ and ‘5 = excellent ability’. Q. For patients with life limiting conditions, how would you rate your ability to: • 32. conduct a palliative care assessment? • 1 2 3 4 5 • 33. manage pain • 1 2 3 4 5 • 34. manage breathlessness? • 1 2 3 4 5 • 35. manage nausea and vomiting? • 1 2 3 4 5 • 36. manage symptom control in the last days of life? • 1 2 3 4 5 • 37. diagnose dying? • 1 2 3 4 5 Questions 38 - 42 please indicate your answer by circling the number where: ‘1= no ability’ and ‘5 = excellent ability’. Q. In terms of spiritual care, how would you rate your ability to: • 38. open a spiritual care conversation? • 1 2 3 4 5 • 39. undertake a spiritual care assessment? • 1 2 3 4 5 • 40. record & communicate spiritual needs? • 1 2 3 4 5 • 41. create a spiritual care plan? • 1 2 3 4 5 • 42. explain the meaning of spiritual care? • 1 2 3 4 5

15. Sustainability • On-going support • Monthly CNS: Key Worker catch up/ corridor meeting • Continued mentoring as driven by KW • Role development experience via SPCT (shadowing opportunities) x 2 / month • Formal, structured KW meeting 2hrs/month

16. Sustainability • Measuring improvements in EoLC • Ward based action plans • Deaths: LCP data collection

17. Sustainability • Investment/ raising the profile • Feedback from KW programme to Senior Nurse forum/ Execs/ Governance council • Monthly newsletter

18. Thoughts on Key Worker Programme! “Identified areas that need work” “SMART objectives/ PDSA” “Clarification About pharmacology” “Good group work; Learnt many things” “useful communication skills” “Increased confidence in EoLC” “Learnt about breaking bad news” “useful information re: symptom control” “Learnt how to Facilitate difficult conversations” “understanding quality care in an acute setting” “Enjoyable, informative excellent, enlightening & happy to see the Palliative Care Consultant present “new information on spiritual issues”

19. Questions