Importance of end of life education for all Rachel Burden

Brief Recap The 2008 10 year End of Life Care Strategy Recognised that in the NHS 60 years cradle to grave service there was a lack of attention to End of Life Care. Education and training lie at the heart of tackling issues to ensure people can experience a good death. Lord Darzi report and Neuberger review (LCP) also highlighted this.

3 Specific Areas Poor communication between services, patients and professionals. Lack of effective care planning including advance care planning. Difficulties identifying those approaching end of life.

More recently…. In 2013 at the halfway point of strategy the NHS refreshed and required new ambitions and actions for end of life care to be linked to other national priorities i.e. people with Dementia and vulnerable older people!

What is a good death ? Being treated as an individual, with dignity and respect; Being without pain and other symptoms; Being in familiar surroundings; and being in the company of close family and/or friends. Good specific, co-ordinated end of life care must be standardised for everyone

How can we deliver a good death? The key is education and training Enabling staff to improve their skills, behaviour and knowledge about caring for people who require palliative and end of life care. In Medway Developed a competency framework for community nurses so raising the standards. Provided palliative training for community nurses and healthcare assistants in hospice. This had input from all community services. Input from specialist palliative consultant at GP monthly meetings.

All care homes offered end of life care training by facilitators, including syringe driver training. Specialist nurses given training in advanced communication skills to enable them to discuss with and complete for patients needing DNACPR’s. Introduction and training for the ‘My Wishes’ register accessible to all relevant services including the ambulance service. Introduction of Advance Care Planning/ Priorities of Care Document in care homes and training given in this.

Specialist nurses providing support and advice to GP’s and ensuring they are kept updated on their patients condition. CHS rolled out to all services. (central health information system) better information sharing between services Roll out and training of new end of life care plan in Medway Hospital.

Challenges Backfilling of staff both in community and in care homes to attend training. New systems and ways of documentation, going paperless. Recognising the dying patient. Difficult conversations. Implementing advance care planning earlier i.e. at diagnosis.

Benefits Reducing inappropriate admissions to acute services from care homes. Supporting people’s wishes to die in their preferred place of care. Care home staff increased confidence and knowledge.

Reduced requests for GP visits Faster response for anticipatory medication Improved quality of care in care homes for all, irrelevant of condition. More collaborative care as communication improved

Quick wins Palliative Care Bi-monthly meetings Care home family/ residents meetings to discuss advance care planning / DNACPR’s.

Rachel Burden Facilitator for End of Life Care in Homes Medway Community Healthcare rachelburden@nhs.net kssahsn.net