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

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

Introduction of Pathway Jan 2001- piloted on 3 wards Jan 2004 – main teaching commenced By 2006 virtually all wards taught Currently now completing teaching for EMI wards

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

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)

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

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

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

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.

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

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

What now ?

Review of Variance sheets Jan – March 2008 (no. 139) Able to identify : No. of sheets returned each month (@46) 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

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

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

Thank You Any Questions?