Welcome Gold Standard Framework Main title slide page Co-brand logo here Welcome Gold Standard Framework For End Of Life Care

Situation Welcome Herm and St Brelade’s wards have undertaken the process of accreditation to improve our practice in managing End Of Life care for patients. It had been identified that as mental health assessment wards, we had much to learn and improve on with regard to our care of the dying. Certainly within our Mental Health wards there has long been a recognised need to improve our knowledge and skills in managing care of patients in the final phase of life. Main title for slide set Optional sub title or name

Background Welcome As a ward we felt we were caring and compassionate when providing end of life care, but we wanted to introduce the Gold Standard Framework to bring our practice in line with national initiatives, such as NHS England ‘Ambitions’ and Department of Health End of Life Care Strategy. Main title for slide set Optional sub title or name

Welcome Benefits to others We anticipated that improving our care of dying patients would benefit the patients themselves the most. We underestimated the positive impact our work had on the patient’s families and friends, and our own staff. Main title for slide set Optional sub title or name

Assessment AIM PRIMARY DRIVERS SECONDARY DRIVERS Develop staff confidence in managing conversations regarding end of life care. Staff support and education Review of prescribing anticipatory medications and build relationships between medics and nurses in this area To ensure that GSF is embedded in to ward practice so that 100% of patients receive the care they want, where they want it, right up until the end of their life, providing relatives with peace of mind and staff with an increased sense of job satisfaction. This will be in place by the end of November 2018. Staff wellbeing and psychological support system to be developed. Person and family centred care Assist patient and family to establish goals and intention Preparation of family caregivers to help them cope with exacerbation and deterioration Identification of patient severity and wishes with respect to End Of Life Care Development and implementation of a shared treatment plan (all settings and patient/ family) Co-ordinated care across settings. Referral and communication pathway 24 hour access to appropriate services, such as district nurses to help with syringe drivers.

PDSA Testing Ramps for GSF implementation 1E: Embedding GSF in the practice of MHSWs Main title for slide set Optional sub title or name

We used a survey to capture staff confidence and understanding as these factors were essential in successfully implementing the GSF framework.

Measurement Welcome Main title for slide set Optional sub title or name We collected data on staff confidence before and after implementation. Audit data was submitted as part of the wider project, but due to small numbers of patients involved, we are unable to display this is a runchart.

Welcome Recommendations Main title for slide set Getting appropriate EOL anticipatory medications written up when patients were re-coded Amber on the GSF. Medics were reluctant, questioning whether nurses would use the drugs appropriately Discussion with ANPPC Jane Rickett: the specialised input and advice gave the team confidence with using the appropriate drugs at the right time, mainly by using the advised pain assessment tools to evidence our decision Involving mental health support workers in recognising and implementing EOL care within the GSF as they didn’t initially ‘buy in’ to the framework. We ran sessions on what the GSF means in terms of patient presentation. More frequently asked MHSWs for their perspective and input. Discussing the GSF with families and applying it to their loved ones. Initially it felt prescriptive of their deterioration, despite the fact that it is not a predictor of death but a guideline for the planning of the end of someone’s life. Continued practice and reflection on the use of GSF with colleagues both on and off the ward. Main title for slide set Optional sub title or name

Welcome Key improvement message learnt Main title for slide set Optional sub title or name Co-brand logo here