1. Facilitator– Helen O’Neil
The North West End of Life Care Programme for Care Homes
Facilitator– Helen O’Neil

2. Introductions Helen O’Neil - Facilitator 01524 382538
Jenny Lowe – Tutor in Palliative Care

3. Induction Programme Introductions, Housekeeping and ice breaker
Session Agreements
Plan for day and objectives
End of life care drivers
The Route to Success in Care Homes
Overview of Six Steps Programme
Change management
Audit Cycle
Role of champions
Group work on what is a good death
Policy
To do list
Evaluate and close

4. Objectives Understand the key elements of the programme
Identify National, Regional and Local end of life care drivers
Begin to develop a philosophy for end of life care
Commence the audit process
Have an understanding of your role and responsibilities
Begin an End of Life Care Policy
Understand change management and the audit cycle

5. Clarification of Terms
Palliative care
• Is applicable early in the course of illness when cure is no longer an option
• Aims to improve quality of life of patients facing life-threatening illness
• Offers a support system to help patients live as actively as possible until death
• May be given for an extensive period of time
Supportive Care
• All people with chronic illness need supportive care
• Helps people & family’s cope better with their chronic debilitating illness
• Not disease or time specific, ‘less end stage’
Terminal care
• Is applicable when dying is diagnosed i.e. care in last hours and days of life
Underpinning the six steps programme is the North West End of Life Care Model which uses a whole system approach for all adults with a life limiting diseases regardless of age and settings moving from recognition of need for end of care, to care after death. Each workshop is colour matched to the north west end of life care model.

6. Definition of End of Life Care
End of Life Care encompasses the services that support those with advanced progressive incurable illness to live as well as possible until they die
People likely to die within months, weeks or days of life
These services support the end of life care needs of patients, families & carers to be identified & met throughout the last phase of life and into bereavement
It includes the management of ALL symptoms & includes ALL services in any setting, that provide an integral part of end of life care
End of life care builds on, and involves, the use of the End of Life Tools
Liverpool Care Pathway (LCP), the Gold Standards Framework (GSF), & the Preferred Priorities (place) of Care (PPC)

7. End of Life Care Strategy (July 2008)
Promoting high quality care for
all adults at the end of life
“How people die remains in the memory of those who live on”
(Dame Cicely Saunders Founder of the Modern Hospice Movement)
There are 8 workshops and 2 additional mandatory stand alone education modules which are open to all staff not just those undergoing the six steps a full day workshops,
After step 2 the first full day education module is around, communication skills, ACP, MCA, Advance decision to refuse treatment, do not attempt resuscitation orders, lasting power of attorney and Best Interest Decision making.
After step 5 the second full day mandatory course is on the LCP.
The length of time it takes to deliver the programme is flexible and dependant on each local area, for example one half day workshop per month over 8 months.

8. End of Life Care Strategy – National Driver (July 2008)
“Good Primary Care Trust’s working with local authorities will wish to commission services from care homes which:
Residents approaching the end of life are on an end of life care register
Each resident is offered a care plan, which clearly identifies their needs
and preferences for care
Staff receive the training and support they need to provide end of life care
There is appropriate access to GP, District nursing and specialist palliative
care advice”
DOH, 2008, End of Life Care Strategy p95

9. Quality Markers for Care Homes
Action plan for EoLC
• Mechanisms in place to discuss, record & communicate wishes
• Residents EoLC needs assessed & regularly reviewed
• Nominated Keyworker in place
• Use of the LCP
• Families involved in decision making
• Other residents supported
• Quality of EoLC Audits & ongoing reviews
• Identified training needs of all staff (TNAs) inc. Communication skills/ACP/Symptom control etc.…
• Review of transfer of patients…

10. Care Quality Commission CQC (2010)
End of Life Care Prompts/Guidance for Inspectors
• Care plans in place for all EoLC residents
• Do staff have knowledge & skills to deliver quality EoLC?
• Needs assessment reviewing e.g. pain, tissue viability, nutritional needs etc.
• Use of tools of assessment & use of EoLC tools e.g. LCP
• Respecting choice & recording wishes
• Systems in place for specialist referral when needed
• Information sharing & supporting dignity
• Respect for value and beliefs
• Involving & supporting families

11. Local Drivers Northwest Primary Care Trust
Proportion of Deaths in Care homes
Use of Care Pathway in Care homes
Use of PPC in Care homes
Also Primary care, Acute hospital, hospice
Unsure that care for individuals is coordinated across organisational boundaries 24/7

12. The North West End of Life Care Model
Underpinning the six steps programme is the North West End of Life Care Model which uses a whole system approach for all adults with a life limiting diseases regardless of age and settings moving from recognition of need for end of care, to care after death. Each workshop is colour matched to the north west end of life care model.

14. Six Steps to Success

15. Six Steps Step 1 Discussions as the end of life approaches
Step 2 Assessment, care planning and review (followed by a stand alone study day for the champion and ANY care home staff on Communication skills, Advance care planning, Mental Capacity Act, Advance Decision to Refuse Treatment, Do Not Attempt CPR, Lasting power of Attorney and Best Interest decisions)

16. Step 3 Co-ordination of care
Step 4 Delivery of high quality care in care homes
Step 5 Care in the last days of life
(followed by another full study day for the champion and ANY staff covering the
Liverpool Care Pathway)
Step 6 Care after death

17. Change Management Why change? Response to government initiatives
Response to audit, reflective practice, complaints, critical incidents
Diversity of patient demand and changes in population

18. Before starting organizational change, ask yourself
What do we want to achieve with this change
How will we know that the change has been achieved?
Who is affected by this change and how will they react to it?
How much of this change can we achieve ourselves
What parts of the change do we need help with?

19. Change Management There are four responses to change Bystander Victim
Critic
Navigator

20. Change management entails thoughtful planning and sensitive implementation, and above all, consultation with, and involvement of, the people affected by the changes.
Change must be realistic, achievable and measurable.

21. Poor planning
End users not
consulted
Poor follow-up
Involve team
Communicate
constantly
Plan properly
Don’t give up!

22. Group work
How has change been successfully implemented in your care home previously?
What are the potential problems with the Six Step Programme for your care home?
What can you do to make the change a success?
What help do you need?

23. 20 minute comfort break

24. What is Audit? Simply put….
“A tool to aid you in improving patient care by looking at current practices and making changes where necessary”

25. Audit Cycle

26. Why Audit? Consistency of care and treatment
Improve access, equity of healthcare
Improve quality and effectiveness of care
Improve satisfaction
Improve awareness of guidelines and
standards
Identification of training needs
Quality assurance
Risk management, reduction in
complaints / litigation

27. Roles and Responsibilities of Champion
Attend all of the Six Steps to Success workshops and mandatory study days
Take lead role, support and develop others in EOLC
Keep knowledge and skills up to date
Build resource files within the care home
Produce a portfolio to evidence the implementation of the programme that could be shared with regulatory bodies(CQC), commissioners, social services
Ensure EOLC tools promoted and used in care home
To be a link with the local End of Life Care Facilitator
Initiate change management within the home

28. To do list
Start to produce your care home’s philosophy on end of life care
Complete knowledge Skills and Confidence Audit- all champions
Complete Quality Markers Audit
Complete Post Death Information Audit
Draft the Key Principles section of policy

29. Any Questions?

30. Our next meeting will be on 8th February
1 – 5pm here in the Oak Centre
(support day 23rd Jan 1pm-3pm if needed)
Any queries please contact Helen O’Neil at the Hospice either by phone
by on:

31. Thanks for all your hard work today!