1. with no extra costs, no extra staff and no extra time?
How can we improve generic palliative care knowledge, skills and attitudes in nursing homes …
with no extra costs, no extra staff and no extra time?
Kim Jones CNS Palliative Care Cheryl Durham CNS Palliative Care
Dr Dylan Harris Locum Consultant

2. 1 in 5 of all deaths take place in a care home1
The problem
An area of need
Department of Health
NICE
NCPC
GSF
Palliative Care Cymru Implementation Board
Local issues:
High volume referrals
Variable appropriateness
Often untimely
The solution
Plan A
High intensity, short term education
1 NCPC/NHS (2006) Introductory guide to end of life care in care homes.

3. Current model Little but often Focussed on generic palliative care
● 1.5 hours monthly: “clustered”
● Facilitates regular attendance
● Accommodates high turnover workforce
● ‘Formally informal’
Focussed on generic
palliative care
● Communication skills
● Recognising dying
● All Wales End of Life Care Pathway
● Basic symptom management
● Planning Ahead
Patient focussed
and reflective
● Reflection on real patients
● Communication skills role play based around actual situations
● Highlights wider training needs
Ownership by
nursing home staff
● 2 link nurses identified at each home
● Learning objectives set by NH staff
● “Resource box” maintained by NH

4. Outcomes Direct impact on: In addition: Other benefits: clinical care
confidence in core palliative care competencies
In addition:
Reduction in overall SPC workload
NHs now competently delivering generic palliative care
Referrals much more appropriate AND timely
NH staff enthusiasm and momentum
Other benefits:
Cost neutral
Time efficient

5. Future plans
Currently applying similar model to other clusters of nursing homes
Test knowledge as well as confidence “before” and “after”
Broaden learning audience to non-qualified NH staff