Presentation on theme: "Facilitator– Helen O’Neil"— Presentation transcript:
1 Facilitator– Helen O’Neil The North West End of Life Care Programme for Care HomesFacilitator– Helen O’Neil
2 Introductions Helen O’Neil - Facilitator 01524 382538 Jenny Lowe – Tutor in Palliative Care
3 Induction Programme Introductions, Housekeeping and ice breaker Session AgreementsPlan for day and objectivesEnd of life care driversThe Route to Success in Care HomesOverview of Six Steps ProgrammeChange managementAudit CycleRole of championsGroup work on what is a good deathPolicyTo do listEvaluate and close
4 Objectives Understand the key elements of the programme Identify National, Regional and Local end of life care driversBegin to develop a philosophy for end of life careCommence the audit processHave an understanding of your role and responsibilitiesBegin an End of Life Care PolicyUnderstand change management and the audit cycle
5 Clarification of Terms Palliative care• Is applicable early in the course of illness when cure is no longer an option• Aims to improve quality of life of patients facing life-threatening illness• Offers a support system to help patients live as actively as possible until death• May be given for an extensive period of timeSupportive Care• All people with chronic illness need supportive care• Helps people & family’s cope better with their chronic debilitating illness• Not disease or time specific, ‘less end stage’Terminal care• Is applicable when dying is diagnosed i.e. care in last hours and days of lifeUnderpinning the six steps programme is the North West End of Life Care Model which uses a whole system approach for all adults with a life limiting diseases regardless of age and settings moving from recognition of need for end of care, to care after death. Each workshop is colour matched to the north west end of life care model.
6 Definition of End of Life Care End of Life Care encompasses the services that support those with advanced progressive incurable illness to live as well as possible until they diePeople likely to die within months, weeks or days of lifeThese services support the end of life care needs of patients, families & carers to be identified & met throughout the last phase of life and into bereavementIt includes the management of ALL symptoms & includes ALL services in any setting, that provide an integral part of end of life careEnd of life care builds on, and involves, the use of the End of Life ToolsLiverpool Care Pathway (LCP), the Gold Standards Framework (GSF), & the Preferred Priorities (place) of Care (PPC)
7 End of Life Care Strategy (July 2008) Promoting high quality care forall adults at the end of life“How people die remains in the memory of those who live on”(Dame Cicely Saunders Founder of the Modern Hospice Movement)There are 8 workshops and 2 additional mandatory stand alone education modules which are open to all staff not just those undergoing the six steps a full day workshops,After step 2 the first full day education module is around, communication skills, ACP, MCA, Advance decision to refuse treatment, do not attempt resuscitation orders, lasting power of attorney and Best Interest Decision making.After step 5 the second full day mandatory course is on the LCP.The length of time it takes to deliver the programme is flexible and dependant on each local area, for example one half day workshop per month over 8 months.
8 End of Life Care Strategy – National Driver (July 2008) “Good Primary Care Trust’s working with local authorities will wish to commission services from care homes which:Residents approaching the end of life are on an end of life care registerEach resident is offered a care plan, which clearly identifies their needsand preferences for careStaff receive the training and support they need to provide end of life careThere is appropriate access to GP, District nursing and specialist palliativecare advice”DOH, 2008, End of Life Care Strategy p95
9 Quality Markers for Care Homes Action plan for EoLC• Mechanisms in place to discuss, record & communicate wishes• Residents EoLC needs assessed & regularly reviewed• Nominated Keyworker in place• Use of the LCP• Families involved in decision making• Other residents supported• Quality of EoLC Audits & ongoing reviews• Identified training needs of all staff (TNAs) inc. Communication skills/ACP/Symptom control etc.…• Review of transfer of patients…
10 Care Quality Commission CQC (2010) End of Life Care Prompts/Guidance for Inspectors• Care plans in place for all EoLC residents• Do staff have knowledge & skills to deliver quality EoLC?• Needs assessment reviewing e.g. pain, tissue viability, nutritional needs etc.• Use of tools of assessment & use of EoLC tools e.g. LCP• Respecting choice & recording wishes• Systems in place for specialist referral when needed• Information sharing & supporting dignity• Respect for value and beliefs• Involving & supporting families
11 Local Drivers Northwest Primary Care Trust Proportion of Deaths in Care homesUse of Care Pathway in Care homesUse of PPC in Care homesAlso Primary care, Acute hospital, hospiceUnsure that care for individuals is coordinated across organisational boundaries 24/7
12 The North West End of Life Care Model Underpinning the six steps programme is the North West End of Life Care Model which uses a whole system approach for all adults with a life limiting diseases regardless of age and settings moving from recognition of need for end of care, to care after death. Each workshop is colour matched to the north west end of life care model.
15 Six Steps Step 1 Discussions as the end of life approaches Step 2 Assessment, care planning and review (followed by a stand alone study day for the champion and ANY care home staff on Communication skills, Advance care planning, Mental Capacity Act, Advance Decision to Refuse Treatment, Do Not Attempt CPR, Lasting power of Attorney and Best Interest decisions)
16 Step 3 Co-ordination of care Step 4 Delivery of high quality care in care homesStep 5 Care in the last days of life(followed by another full study day for the champion and ANY staff covering theLiverpool Care Pathway)Step 6 Care after death
17 Change Management Why change? Response to government initiatives Response to audit, reflective practice, complaints, critical incidentsDiversity of patient demand and changes in population
18 Before starting organizational change, ask yourself What do we want to achieve with this changeHow will we know that the change has been achieved?Who is affected by this change and how will they react to it?How much of this change can we achieve ourselvesWhat parts of the change do we need help with?
19 Change Management There are four responses to change Bystander Victim CriticNavigator
20 Change management entails thoughtful planning and sensitive implementation, and above all, consultation with, and involvement of, the people affected by the changes.Change must be realistic, achievable and measurable.
21 Poor planningEnd users notconsultedPoor follow-upInvolve teamCommunicateconstantlyPlan properlyDon’t give up!
22 Group workHow has change been successfully implemented in your care home previously?What are the potential problems with the Six Step Programme for your care home?What can you do to make the change a success?What help do you need?
26 Why Audit? Consistency of care and treatment Improve access, equity of healthcareImprove quality and effectiveness of careImprove satisfactionImprove awareness of guidelines andstandardsIdentification of training needsQuality assuranceRisk management, reduction incomplaints / litigation
27 Roles and Responsibilities of Champion Attend all of the Six Steps to Success workshops and mandatory study daysTake lead role, support and develop others in EOLCKeep knowledge and skills up to dateBuild resource files within the care homeProduce a portfolio to evidence the implementation of the programme that could be shared with regulatory bodies(CQC), commissioners, social servicesEnsure EOLC tools promoted and used in care homeTo be a link with the local End of Life Care FacilitatorInitiate change management within the home
28 To do listStart to produce your care home’s philosophy on end of life careComplete knowledge Skills and Confidence Audit- all championsComplete Quality Markers AuditComplete Post Death Information AuditDraft the Key Principles section of policy