“One Chance to get it right’ End of Life Care Wirral University Teaching Hospital

90% of inpatients are recognised as dying 48 hours before death and 100% of these have a personalised care plan This is to be achieved by by September 2015

The Team Sue Peters: Day to Day Leader Clare Brown: End of Life Transform Lead Nurse Claire Ashton: Quality and Safety Analyst Heather Aitken, Liz Watkins, Denise Farrance Janice Evans: Specialist Nursing Lead Wirral CT Nick Mamo, Sophie Duckworth Geraldine McCaffery: pharmacy Anne McGinnity: Divisional Manager Melanie Maxwell: Associate Medical Director Cathy Lewis-Jones: Palliative Care Consultant Alan Pugh: Administrator L+D,HROD Jill Galvani: Director of Nursing/Executive Sponsor

Primary Drivers Secondary Drivers Aim / Outcome   Primary Drivers Secondary Drivers Knowledge of prognostic indicators of dying Aide memoir prompt for Care of Dying 90% of inpatients are recognised as dying 48 hours before death and 100% of these have a personalised care plan (by September 2015) Education and training healthcare workers Handover of nursing and medical staff Communication with patient, carers and family; understanding patients’ needs and wishes Priorities for Care of the Dying person Bereavement Support Individualised Care plan Advance Care Planning Amber Care Bundle Clinical Audit Mortality audit Critical incidents Coding/EoL Data measurement

Methods Pilot wards 33/36 Assessment/Prompt Tool/Powerpoint presentation E-learning module/Podcast WUTH monthly Pilot meetings E-communication Baseline Audit completed in Pilot Ward Areas. Communication with Ward Managers, Consultants, trainees Training log/Top up training

Oct 2014 Nov 2014 Dec 2014 Jan 15 2014 Feb 2015 Mar 2015 Apr 2015 May 2015 June 2015 July 2015 Aug 2015 Sept 2015 50.0% (6/12) 14.3% (1/7) 50.0% (9/18) 40.0% (6/15) 41.7% (5/12) 21.4%% (3/14) 31.3% (5/16) 22.2% (2/9) 30% (3/10) 66.7% (10/15) 33.3% (3/9) 44.4% (4/9)

Oct 2014 Nov 2014 Dec 2014 Jan 15 2014 Feb 2015 Mar 2015 Apr 2015 May 2015 June 2015 July 2015 Aug 2015 Sept 2015 58.3% (7/12) 71.4% (5/7) 83.3% (15/18) 86.7% (13/15) 75.0% (9/12) 50.0% (7/14) 68.8% (11/16) 100% (9/9) 70.0% (7/10) 80.0% (12/15) 77.8% (7/9) 88.9% (8/9)

  Oct 2014 Nov 2014 Dec 2014 Jan 15 2014 Feb 2015 Mar 2015 Apr 2015 May 2015 June 2015 July 2015 Aug 2015 Sept 2015 Patient 25.0% (1/4) 40.0% (2/5) 37.5% (3/8) 50.0% (4/8) 16.7% (1/6) 50.0% (2/4) 100% (4/4) 66.7% (2/3) 50.0% (1/2) Relative/ carer 85.7% (6/7) 83.3% (5/6) 92.9% (13/14) 100% (12/12) 100% (9/9) 80.0% (8/10) 100% (11/11) 100% (8/8) 100% (7/7)

  Oct 2014 Nov 2014 Dec 2014 Jan 15 2014 Feb 2015 Mar 2015 Apr 2015 May 2015 June 2015 July 2015 Aug 2015 Sept 2015 Patient 55.6% (5/9) 40.0% (2/5) 36.4% (4/11) 72.7% (8/11) 55.6% (5/9) 57.1% (4/7) 80.0% (4/5) 100% (5/5) 88.9% (8/9) 83.3% (5/6) 100% (4/4) Relative/ carer 83.3% (10/12) 93.3% (14/15) 100.0% (13/13) 80.0% (8/10) 100.0% (14/14) 92.3% (12/13) 100% (9/9) 90.0% (9/10) 100% (14/14)

Oct 2014 Nov 2014 Dec 2014 Jan 15 2014 Feb 2015 Mar 2015 Apr 2015 May 2015 June 2015 July 2015 Aug 2015 Sept 2015 25.0% (3/12) 42.9% (3/7) 27.8% (5/18) 33.3% (5/15) 16.7% (2/12) 35.7% (5/14) 25.0% (4/16) 44.4% (4/9) 80.0% (8/10) 53.3% (8/15) 30.8% (4/13) 66.7% (6/9)

Oct 2014 Nov 2014 Dec 2014 Jan 15 2014 Feb 2015 Mar 2015 Apr 2015 May 2015 June 2015 July 2015 Aug 2015 Sept 2015 50.0% (6/12) 42.9% (3/7) 38.9% (7/18) 42.9% (6/14) 25.0% (3/12) 28.6% (4/14) 31.3% (5/16) 44.4% (4/9) 70.0% (7/10) 73.3% (11/15) 46.2% (6/13) 88.9% (6/9)

Any obstacles/challenges? Time constraints Movement of Staff/ Agency Staff Leadership on ward Availability of stakeholders to attend meetings and progress with project work No designated time allocated for project work

Key lessons? Collaborative working Working within a designated time frame Development of new skills Networking Staff motivated from Pilot Wards Use of Board rounds Communication, Care planning and Documentation