1. GOLD STANDARDS FRAMEWORK
POSITIVE OUTCOMES FOR A CARE HOME

2. WHAT IS THE GOLD STANDARDS FRAMEWORK ?
TO HELP TO DELIVER A “ GOLD STANDARD OF CARE” FOR ALL PEOPLE AS THEY NEAR THE END OF THEIR LIVES
It involves working together as a team with other professionals, to help to provide the highest standard of care possible for residents and their families as they face the last stages of their lives.

3. WHAT IS THE GOLD STANDARD FRAMEWORK ?
Delivers both QUALITY IMPROVEMENT plus QUALITY ASSURANCE the programme has 3 aims
To improve the quality of care provided for all residents from admission to the home.
To improve the collaboration with GP’s primary care teams and specialists.
To reduce the number of hospital admissions in the final stages of life, enabling more people to die with dignity in the home, if that is their wish.

4. HOW CAN IT IMPROVE CARE?
Setting up a register with regular planning meetings to discuss and focus on care.
Planning for the needs of residents at varying times, using coding and a needs/support plan
Advance care planning – discussing the choices, preferences and options to best meet the needs of the resident and their families.
Reducing the need for crisis admission to hospital.

5. HOW WILL IT IMPROVE CARE?
Working closely with the family to best meet the needs of their loved one and to be aware of the choices that are available.
Even better working with GP’s, District Nurses, Palliative Care Specialists, hospitals and others
Information and communication with other services e.g. Out of Hours medical services, ambulance services.

6. HOW WILL IT IMPROVE CARE?
Use of an agreed plan for the final days of life, to enable a good death.
Ongoing reflection and education of staff according to their needs. Staff who aspire to the best, and we wish to affirm and encourage them, building confidence and ability to provide excellent care.

7. THE SEVEN C’s COMMUNICATION COORDINATION CONTROL OF SYMPTOMS
CONTINUITY
CONTINUED LEARNING
CARER SUPPORT
CARE OF THE DYING

8. COMMUNICATION
Identify residents in need of palliative care – code using for example ABCD codings
Regular team meetings
Label / colour code notes and code for handovers and GP
Use advance care plan ( preferences, DNAR, preferred place of care)
Residents, families, GP’s and Specialist practitioners are aware that the Care Home are involved in GSF

9. COORDINATION Allocated Coordinator for each home
Agreement with owner to support programme
Key worker for each resident
Ensure communication with GP, Primary Health Care Team and family
Ensure communication with specialist palliative care team e.g. local Macmillan nurses, hospital

10. CONTROL OF SYMPTOMS Use of assessment tools when relevant
Agreed management plan recorded and communicated related to protocol
Advanced care plan completed for all residents
Basic equipment available as standard and PRN medication available in advance

11. CONTINUITY
Out of hours handover form completed for all residents and kept in local out of hours office
Advanced Care Plan/ Patient held record or medication card shared with others

12. CONTINUED LEARNING Regular review, Weekly meeting
Monthly review meetings- audit of last deaths using traffic lights Significant Analysis with other professionals if possible
Programme of on going education/ training of staff, including induction of all new staff
Library resource of books, articles and web sites

13. CARER SUPPORT
Staff – staff issues and learning points and feedback after death for all staff e.g. carers, cleaners, maintenance staff
Family – written information for family and note families concerns and issues

14. CARE OF DYING Minimum protocol for the last days of life used
Liverpool Care Pathway for the Dying or Integrated Care Pathway
Agreed practice for notification of relatives, verification of death procedure and after death care
Support for the bereaved families after death
Support for all staff and other residents as needed

15. SO WHAT HAS CHANGED AT MERRYFIELD?
Everyone aware that we are participating in GSF
Coding of residents available for all staff including catering and all ancillary staff
Regular focus meetings with staff from all departments
Advanced Care Plans, preferred place of care DNAR any individual wishes

16. SO WHAT HAS CHANGED AT MERRYFIELD?
Attend GSF meetings at the GP surgery with GP’s, District Nurses and Macmillan Nurse to discuss all residents on the register. Regular speakers from local palliative care organisations
Additional assessment tools used e.g. depression scale, PACA and PEPSICOLA Distress Thermometer
We have purchased a Syringe Driver and the surgery can provide a Drug Box when needed for the Home and the District Nurses containing end stage drugs

17. SO WHAT HAS CHANGED AT MERRYFIELD?
Out of Hours handover forms are kept in the Office at Witney hospital used by Out of Hours Doctors so they have in depth knowledge of all residents when contacted by the Home.
Advanced Care plans shared on admission to Hospital and Out Patient appointments
Dignity Policies and Audit tools

18. SO WHAT HAS CHANGED AT MERRYFIELD?
Audit of deaths using Significant Analysis
Regular Reviews
On going training
Library resources
Drama therapist to work with residents who are dying and for residents who are grieving
Leaflets written by the home with information of services available in house and in the local community both relevant to before and after the death

19. SO WHAT HAS CHANGED AT MERRYFIELD?
Minimum Protocol used for the last days of life
Registered with the Liverpool Care Pathway
Policies for Notification of Relatives, Verification of Death and after death care
Support for bereaved relatives, staff and other residents available from a Personal Bereavement Service in Witney for both religious and non religious clients providing spiritual support