Sharon Cansdale GSF Facilitator Gold Standards Framework in care homes

Key Factors with end of life care of elderly Multiple co-morbidities. Increasing memory loss/dementia. Difficulty predicting prognosis Difficulty predicting dying phase Complex social/health factors Need protection from over intervention; trolley deaths, DNAR.

Context in care homes Half a million people live in care homes-about 1% of the population. Approx 20% people die in care homes 86% all deaths over % in people over 80 For every NHS bed there are 3 care home beds The sector employs about 1.2 million people Education alone in care homes does not work – needs change management skills to embed new system plus supported learning (Froggatt et al)

Key Challenges Crises out of hours Residents being sent into hospital without a visit. 999 Drugs and equipment availability Residents/family expectation Access to education and training Clarity of what CH can offer Lack of confidence

DH End of Life Care Strategy July 08 ‘ Inadequate training of staff at all levels within care homes, sheltered housing and extra care housing sector…is considered to be the single most important factor ’ Factors leading to suboptimal care; Lack of ACP Inadequate recognition and holistic assessment Death Concerns Impact on other residents Inadequate access to NHS services Inadequate medicine reviews Training

The GSF Care Homes Training Programme Goals 1. To improve the quality of end of life care 2. To improve collaboration with primary care and palliative care specialists 3. To reduce hospitalisation - and enable more to live and die at home

What is the Gold Standards Framework? System of care that promotes one GOLD standard of care for ALL people nearing the end of their life Modified version of primary care Gold Standards Framework (GSF) 4 main aims 1.Improve quality of care for patients nearing the end of their lives 2.Improve the coordination and collaboration with GP’s and Primary Health Care Teams 3.To reduce the numbers admitted to hospital in the last stages of life 4.To share learning with key suggestions in improving end- of-life care in care homes

GSF: The 7 Key Tasks (7 Cs) C1Communication Supportive Care Register, MDT Meetings, information Advanced care planning (ACP) e.g. Preferred priorities of care (PPC) C2Co-ordination Identified co-ordinator for GSF, key worker for patient C3Control of Symptoms Assessment tools, guidelines, Specialist Palliative Care Team (SPCT) C4Continuity Handover form, Out Of Hours protocol, liaison C5Continued Learning Learning about conditions seen, audit, Significant Event Analysis, reflective practice C6Carer Support Practical, emotional, bereavement C7Care in dying phase Liverpool Care Pathway for the Dying Patient (LCP)

3 stage training programme Preparation, training, consolidation + accreditation Stage I PreparationStage II TrainingStage III Consolidation + Sustainability 3-6 monthsworkshops in 9 months9 – 12 months  Awareness Raising Meeting Local Coordinators Meetings Workshop 1 Workshop 2 Workshop 3 Workshop 4 GSFCH Accreditation      ADA After ADA Before Final Appraisal Ongoing ADA Enrolment of Care Homes

Training workshops Four Gears 1.Getting going 1.Coding, Register 2.Review Meeting, 3.Coordinator Role 2.Moving on 1.Advanced care Planning 2.Assessment of symptoms 3.Out of hours continuity 3. Gaining Speed 1.Education and reflection 2.Carers, family, residents and staff support including Bereavement 3. Care in Final days 4. Cruising 1.Sustaining 2.Embedding 3.Extending - accreditation

GSF Coding of Residents in the Care Home Years to Live Years to Live Advance Care Plan discussion initiated. Advance Care Plan discussion initiated. Holistic assessment Holistic assessment Months to Live Advance Care Plan in place. Advance Care Plan in place. Holistic assessment. Holistic assessment. Weeks to Live GSF Out of Hours Handover Form GSF Out of Hours Handover Form Family discussion Family discussion Pre emptive prescribing Pre emptive prescribing GP assessment GP assessment Days to Live Liverpool Care Pathway commenced by GP Liverpool Care Pathway commenced by GP and Nursing staff and Nursing staff Daily Daily GSF Out of Hours Handover Form A A B B C C D D

Benefits for residents and relatives Better care toward the end of life A better death in accordance with their and their families wishes Fewer crisis or hospital admission Encourages proactive care with better advanced care planning Better symptom control Attention to psychological, social and spiritual needs Earlier discussion, more information and greater support given to family Access to effective out of hours care

Benefits for Care Home Improve care for residents Improves job satisfaction, clinical skills and knowledge Greater confidence when dealing with other health professionals Fewer residents going to hospital in last stages Receive training, support and resources Improve teamwork, both in practice and across teams Raise the profile of care home for palliative care in area

20 Key standards- Accreditation checklist 1.Leadership + support 2.Team-working 3.Documentation 4.Planning meetings 5.GP Collaboration 6.Advance Care Planning 7.Symptom control 8.Reduce hospitalisation 9.DNAR +VoD policies 10.Out of hours continuity 11.Anticipatory prescribing 12.Reflective practice+ audit 13.Education + training 14.Relatives 15.Care in final days 16.Bereavement 17.Dignity 18.Dementia 19.Spiritual care 20.Sustainability

Successes using GSF 1 Attitude awareness and approach – Better quality of care perceived Greater confidence and job satisfaction Immeasurable benefits – communication, teamwork, roles respected. Focus and proactive approach. Patterns of working, structure/processes Better organisation and consistency of standards, even under stress Fewer people slipping through the net – raising the baseline Better communication within and between teams, co-working with specialists Better recording, tracking of patients and organisation of care Patient Outcomes Reduced crises/hospital admission/length of stay More residents dying in place of their choosing More recorded advanced care planning discussions

For more information on GSF National GSF centre – Walsall Judy Simkins GSF administrator. Tel Website. NHS End of Life Care Programme