with no extra costs, no extra staff and no extra time? How can we improve generic palliative care knowledge, skills and attitudes in nursing homes … with no extra costs, no extra staff and no extra time? Kim Jones CNS Palliative Care Cheryl Durham CNS Palliative Care Dr Dylan Harris Locum Consultant

1 in 5 of all deaths take place in a care home1 The problem An area of need Department of Health NICE NCPC GSF Palliative Care Cymru Implementation Board Local issues: High volume referrals Variable appropriateness Often untimely The solution Plan A High intensity, short term education 1 NCPC/NHS (2006) Introductory guide to end of life care in care homes.

Current model Little but often Focussed on generic palliative care ● 1.5 hours monthly: “clustered” ● Facilitates regular attendance ● Accommodates high turnover workforce ● ‘Formally informal’ Focussed on generic palliative care ● Communication skills ● Recognising dying ● All Wales End of Life Care Pathway ● Basic symptom management ● Planning Ahead Patient focussed and reflective ● Reflection on real patients ● Communication skills role play based around actual situations ● Highlights wider training needs Ownership by nursing home staff ● 2 link nurses identified at each home ● Learning objectives set by NH staff ● “Resource box” maintained by NH

Outcomes Direct impact on: In addition: Other benefits: clinical care confidence in core palliative care competencies In addition: Reduction in overall SPC workload NHs now competently delivering generic palliative care Referrals much more appropriate AND timely NH staff enthusiasm and momentum Other benefits: Cost neutral Time efficient

Future plans Currently applying similar model to other clusters of nursing homes Test knowledge as well as confidence “before” and “after” Broaden learning audience to non-qualified NH staff dylan.harris@wales.nhs.uk