1. Cardiff and Vale Last Days of Life Care Pathway
CARDIFF AND VALE NHS TRUST YMDDIRIEDOLAETH GIG CAERDYDD A’R FRO
Cardiff and Vale Last Days of Life Care Pathway
How did we do it and where are we now ?
Andrea Rich CNS Palliative Care

2. Identification of training needs
2 main hospitals in Cardiff- UHW/ University hospital Llandough
5 peripheral hospitals including mental health units
Identified that 48 wards /specialities across the Trust needed care pathway teaching
SPCT took lead on ICP implementation in the Trust

3. Introduction of Pathway
Jan piloted on 3 wards
Jan 2004 – main teaching commenced
By 2006 virtually all wards taught
Currently now completing teaching for EMI wards

4. Training to date Nearly 2000 qualified nurses have been trained
Allied Health Professionals e.g. Physios
Health care support workers
Consultants
Medical Staff

5. Variance Sheet Returns
Initial difficulty (’04/ ’05)
Bereavement offices on both sites now support
2004 – 7 returns
2005 – 87 returns
2006 – 139 returns
2007 – 564 returns 47 a month)

6. Audit of variance sheets 2006
Two tier audit using all the variance sheets
received between April- Dec 2005 (no.82)

7. First Audit Aims
Identify which variances from the pathway were being recorded
Identify which areas the pathway were being used
Identify if symptoms remained ongoing and problematic
Identify areas of further education

8. First Audit results Identified which variances were being recorded
Widely used throughout the two main hospitals
Symptoms appeared to last for a maximum of 3 days
However – this was limited information

9. Second audit aims
18 variance sheets that had previously been audited were randomly selected (10 UHW / 8 Llandough)
To compare the variance sheets with the completed pathways to identify which variances were ticked and not recorded
Identify how many pathways were being used without the SPCT
Identify if problems remained ongoing was a referral made to the SPCT
Identify areas of further education.

10. Second audit Results Greater Insight although small audit
Variances were being ticked on the pathway and not recorded on the variance sheet e.g. communication
All symptoms had been recorded on the variance sheets (100%)
50% of the pathways were used without the involvement of the SPCT
Areas of further education identified

11. Ongoing Education
2007 teaching continued on the wards informally / update teachings
Peripheral hospital teaching completed
EMI ward teaching commenced
2007 Rolling link nurse programme set up – nurses to sustain the teaching

12. What now ?

13. Review of Variance sheets Jan – March 2008 (no. 139)
Able to identify :
No. of sheets returned each month
How many sheets had diagnosis recorded (no.13)
Patients age
Patients sex
Which wards were using the pathway (average of 23 wards each month)
Patients length of stay on pathway

14. More information was needed to:
Identify areas of further education, gaps in practice
Record the no. of cancer/non-cancer patients
To monitor against national standards i.e. NSF for older people
To indicate quality of end of life care in the Trust
To identify areas of good practice

15. Outcome - Monthly variance sheet data now being
recorded by team and monitored

16. Thank You
Any Questions?