1. Liverpool Care Pathway in Nursing Homes Pat Mowatt Education Facilitator for Palliative Care for the Nursing Homes

2. Purpose of Post To provide education for trained nurses to underpin the introduction of the Liverpool Care Pathway and / or the Gold Standards Framework to nursing homes in Bradford & Airedale. To provide education for trained nurses to underpin the introduction of the Liverpool Care Pathway and / or the Gold Standards Framework to nursing homes in Bradford & Airedale.

3. Drivers NICE guidance Improving Supportive & Palliative Care for Adults with Cancer 2004 NICE guidance Improving Supportive & Palliative Care for Adults with Cancer 2004 B & A’s Palliative Care Education Strategy B & A’s Palliative Care Education Strategy National Minimum Standards: Care homes for Older People 2003 National Minimum Standards: Care homes for Older People 2003 Competency framework for Cancer Nursing 2004 Competency framework for Cancer Nursing 2004 CSCI consultation around Terminal Illness registration March 2005 CSCI consultation around Terminal Illness registration March 2005

4. Statistics July 2004 69 nursing homes in Bradford & Airedale July 2004 69 nursing homes in Bradford & Airedale ? number registered to take Terminally Ill patients ? number registered to take Terminally Ill patients July 2004 16 taking up palliative care NVQ training July 2004 16 taking up palliative care NVQ training May 2005 8 more taking up NVQ training May 2005 8 more taking up NVQ training Total 24 now doing NVQ palliative care training Total 24 now doing NVQ palliative care training More joining project More joining project

5. Planning Registering with Liverpool Registering with Liverpool Adaptation of LCP Adaptation of LCP Consultation with: Consultation with: local specialist palliative care services local specialist palliative care services CSCI CSCI H M Coroner H M Coroner Nursing home nurse managers Nursing home nurse managers GPs & deputising service GPs & deputising service Lead cancer nurses Lead cancer nurses Cross PCT drug group Cross PCT drug group

6. Planning Adaptation of LCP Adaptation of LCP More detailed criteria for inclusion on LCP More detailed criteria for inclusion on LCP Included specific goal about completion of OOH handover form Included specific goal about completion of OOH handover form Drug guidance developed to tally with acute sector LCPs Drug guidance developed to tally with acute sector LCPs Included local contact numbers for specialist palliative care advice Included local contact numbers for specialist palliative care advice

7. Planning Interviews with Nurse Managers Interviews with Nurse Managers Negotiate commitment to education programme & LCP Negotiate commitment to education programme & LCP Registration with Liverpool Registration with Liverpool Nomination of NH lead for project Nomination of NH lead for project Base review of 20 expected deaths Base review of 20 expected deaths Education programme Education programme Audit of LCP usage Audit of LCP usage

8. Education Programme Competency documents Competency documents 7x 2 hour in-house sessions built around principles of GSF covering: 7x 2 hour in-house sessions built around principles of GSF covering: Principles of palliative care, teamwork & specialist palliative care services, assessing palliative care needs Principles of palliative care, teamwork & specialist palliative care services, assessing palliative care needs Pain management Pain management Communication issues & psychosocial & spiritual care Communication issues & psychosocial & spiritual care Symptom management Symptom management Management of the last few days of life – LCP Management of the last few days of life – LCP Bereavement & staff support Bereavement & staff support Hot topics & consolidation Hot topics & consolidation Repeat sessions as needed Repeat sessions as needed

9. Introductory phase My role Contact with GPs to gain co-operation with project Contact with GPs to gain co-operation with project NH visits to support nurses & GPs in early days of usage of LCP NH visits to support nurses & GPs in early days of usage of LCP Immediate audit & feedback - both verbal & written Immediate audit & feedback - both verbal & written

10. Review Review 3 months later – use of LCP, changes to practice, need for education, repeat of competency document Review 3 months later – use of LCP, changes to practice, need for education, repeat of competency document Encourage to attend Liverpool study days Encourage to attend Liverpool study days Arrangements for ongoing support Arrangements for ongoing support Further education sessions Further education sessions Local support group Local support group Network & local facilitators Network & local facilitators

11. Results 8 NHs signed up to LCP 8 NHs signed up to LCP 4 NHs ready to use LCP 4 NHs ready to use LCP 4 LCPS used so far in 2 NHs 4 LCPS used so far in 2 NHs Comments: Comments: It enabled us to get everything in for the end stage It enabled us to get everything in for the end stage The family said they had no regrets about transferring her here (from hospice) The family said they had no regrets about transferring her here (from hospice)

12. Problems Duplication in documentation initially Duplication in documentation initially Additions needed for care after death: Additions needed for care after death: Name of GP certifying death Name of GP certifying death Cause of death Cause of death Name of undertaker Name of undertaker Burial or cremation Burial or cremation Sceptics Sceptics

13. Problems Not just one GP per NH Not just one GP per NH Getting new staff on board Getting new staff on board Staff moving on Staff moving on Coaxing PCTs & PHCTs to get actively involved with education in NHs Coaxing PCTs & PHCTs to get actively involved with education in NHs Long term sustainability Long term sustainability NH staff need to commit time to audit, analyse variances & reflect NH staff need to commit time to audit, analyse variances & reflect

14. Benefits Step by step approach to clinical interventions & reduces variations in patient care Step by step approach to clinical interventions & reduces variations in patient care Patient centred care with measurable outcomes Patient centred care with measurable outcomes Identifies what NH does well Identifies what NH does well Identifies areas for improvement e.g. systems, education Identifies areas for improvement e.g. systems, education Greater effectiveness, efficiency & quality of care Greater effectiveness, efficiency & quality of care