1. A Palliative Care Resource Scheme
Yvonne Rees Maria Parry
Sylvia Weaver

2. Background
12 month training scheme for registered nurses and allied health professionals that marries together clinical practice and education.
A collaborative programme between Cwm Taf LHB and the University of Glamorgan.
Operational since 2004

3. Aims
To facilitate integration of palliative care philosophy into clinical areas
To improve patient outcomes
To enable the practitioner to act as a knowledgeable resource and role model
To help the Trust meet the All-Wales standards for palliative care
To influence the pattern of referrals to the Specialist Palliative Care Team (SPCT)
To help facilitate staff development through “In-house” training

4. Recruitment onto the Scheme
Potential candidates are required to:
Demonstrate a specific interest in palliative care
Demonstrate an ability to disseminate knowledge
Be in a position to implement change at ward/patient level
Formal application process / informal interview / letter of support from ward manager

5. Components of the Scheme
Shadow PCNS for one week
Shadow PCNS for one session per month
Attend meetings monthly with the PCNS and fellow resource ‘students’
Choose one of four options from the university module choices or complete a clinical project
Complete an audit
Four study days over the twelve months

6. University of Glamorgan Faculty of Health Sport & Science
Current Courses Utilised
Palliative Care Taught Module
BSc Cancer Care (Hon’s)
Proposed Pg cert Palliative Care 6

7. Outcome 1 an evolving process…
Increased knowledge, skills and confidence of nurses
Increased information at ward level for all members of the MDT
The design and use of assessment charts to address the most common problems experienced by this group of patients
The design and implementation of a discharge planner
The use of the Palliative Care Outcome Scale (POS) to help ensure a more patient-centred approach to care.
The introduction of the ‘Green Card’ system in collaboration with the pharmacy department.

8. …Outcomes 2…
Increased number of referrals from wards where input from SPCT had been limited
A change in referral patterns resulting in only those with complex needs being seen and those with less complex needs requiring telephone advice only
An increase in the use of the ICP for the Last Days of Life
The introduction of the symptom assessment chart into other areas and audit of its’ use
One OT taking most of the referrals within the DGH of palliative care patients for discharge planning
A successful bid for and appointment of an OT to the SPCT

9. …Outcome 3 …
A training programme regarding the discharge of palliative care patients which will be evaluated by an audit of discharges
An audit of admissions and transfers of palliative care patients in and out of MAU
A plan to introduce the Integrated Care Pathway for the Last Days of Life into ITU and a change of emphasis regarding end of life care there
Hopefully this will lead to further work with the A&E and the bed-management team and a change in policy to help improve this process for patients and their families.

10. …Outcome 4 …
Mouth care audit which links with the integration of oral care into the Fundamentals of Care programme
6 Resource Nurses have completed a degree-level module in palliative care, 2 are currently undertaking a degree in cancer care and 1 plans to undertake a post-graduate degree in palliative care
2 Resource Nurses have secured posts within the speciality of palliative care

11. Summary and Future
Not immediate results it is a twelve month programme
Emphasis not on individual nurses gaining credit but practice being changed
Time is needed = responsibility to the ward
Continue limit theory practice gap – good links
Emphasis on multi professional working
Aim for 2 nurses per ward post scheme
Development of resource forum
International Journal of Palliative Nursing Vol 15 no 8 (2009)
Don’t give up…….. 11

12. What they say…
“Big learning curve” “In my opinion the palliative care resource scheme is excellent. I had an interest in palliative care and I was able to increase my knowledge whilst on the scheme. I feel it is essential to shadow the nurse specialists at every given opportunity, read the suggested articles, attend the meetings and have discussions with other scheme members” “Enabled me to instigate the introduction of the end of life care pathway specific to the needs of ITU patients”

13. What they say…
“It has greatly increased my awareness of services available to palliative care patients and also the structure of the palliative care team. My knowledge of symptom control has also been enhanced, which I hope I will be successful in cascading to my colleagues. I am far more aware of the impact of effective communication between members of a truly multidisciplinary team and the benefits this provides to improving patient care. The scheme has made me feel part of this team. It has highlighted to me areas of my own practice which can be improved and hopefully will have a positive impact on care for patients on my ward”.

14. Comments from Ward Managers
“N… used the knowledge she developed to teach staff on the ward. The use of the last days of life pathway increased and the understanding of its’ use improved. Giving study time was a problem. N…. did part of the scheme in her own time”
“D.. is able to teach the junior staff who can be reluctant to give large doses of analgesics. We start care pathways sooner. Can be difficult to give study leave – there needs to be a pattern with the days”