Role of the Integrated Specialist Palliative Care Team Juliet Cross – Palliative Care CNS (community) Sara Smith – Nurse Practitioner- End of Life Care.

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Presentation transcript:

Role of the Integrated Specialist Palliative Care Team Juliet Cross – Palliative Care CNS (community) Sara Smith – Nurse Practitioner- End of Life Care

Definition “An approach that improves the quality of life of patients and their families facing the problem associated with life threatening illness, through the prevention and relief of suffering by a means of early identification and impeccable assessment and treatment of pain and other problems physical, psychosocial and spiritual” World Health Organisation (2006)

Role of the Specialist Palliative Care Nurse Improving the quality of life of patients and their families Identify needs, priorities and preferences Providing co-ordinated seamless services Ensuring appropriate support for carers (Day Hospice) Support integrated care pathways found to improve care and dignity at the end of life Supporting professionals involved in their care Providing a high quality service in the last days of life and after death To ascertain and respond to the educational needs of healthcare professionals To promote and develop audit and research in areas relating to palliative care Charlton (2002)

Nurse Practitioner – End of Life Care Work within the integrated palliative care team Care for patients in the last days of life Support family Support ward staff with symptom control Refer to Specialist nurse for complex needs Education Audit and monitor end of life care in the hospital Refer patients/families for bereavement/pre bereavement support Identify and support preferred place of care at end of life (St Giles/Nursing homes/own home/Hospital) Liaise with community teams to ensure smooth transition of care

Palliative Care Services Integrated Palliative Care Team – community/hospital inc. consultants, CNS’ & OT Palliative Therapies Complementary Therapies Volunteers Specialist Lymphoedema Fair Oaks Day Hospice Bereavement Service Chaplain Service Clinical Psychology

St. Giles Walsall Hospice (SGWH) St Giles Walsall Hospice is a 12 bed facility providing palliative and end of life care, alongside respite support for patients at an earlier stage of illness. Integrated Palliative Care Team work very closely with SGWH refer patients Specialist MDT

Integrated specialist team GP Hospital teams Consultants Lymphodema Information CAB Community nursing teams CNS Hospital/Co mmunity Day hospiceLTC CNS Bereavement services Hospice Diversional beds OT/Physioth erapist Complementar y therapies

Palliative care/ EOL Initiatives Transform: Transforming end of life care in hospital AMBER care bundle Advance care planning EOL care plan Electronic patient register (EPaCCs/GSF) Rapid discharge home to die DNAR: Development of a cross services policy Diversionary pathway : Access to St Giles hospice Walsall for treatment (2-3 days) Arboretum Nursing Home- diversionary beds

Any questions? Thank you for listening