Liverpool Care PathwayLiverpool Care Pathwayin Nursing Homesin Nursing Homes

Pat MowattPat MowattEducation Facilitator for Palliative Care Education Facilitator for Palliative Care

for the Nursing Homesfor the Nursing Homes

Purpose of PostPurpose of Post

To provide education for trained To provide education for trained nurses to underpin the introduction nurses to underpin the introduction of the Liverpool Care Pathway and / of the Liverpool Care Pathway and / or the Gold Standards Framework to or the Gold Standards Framework to nursing homes in Bradford & nursing homes in Bradford & Airedale.Airedale.

DriversDrivers

NICE guidance Improving Supportive & NICE guidance Improving Supportive & Palliative Care for Adults with Cancer 2004Palliative Care for Adults with Cancer 2004

B & A’s Palliative Care Education StrategyB & A’s Palliative Care Education Strategy National Minimum Standards: Care homes National Minimum Standards: Care homes

for Older People 2003 for Older People 2003 Competency framework for Cancer Competency framework for Cancer

Nursing 2004 Nursing 2004 CSCI consultation around Terminal Illness CSCI consultation around Terminal Illness

registration March 2005registration March 2005

StatisticsStatistics

JulyJuly 2004 69 nursing homes in Bradford & 2004 69 nursing homes in Bradford & AiredaleAiredale

? number registered to take Terminally Ill ? number registered to take Terminally Ill patients patients

July 2004 16 taking up palliative care NVQ July 2004 16 taking up palliative care NVQ trainingtraining

May 2005 8 more taking up NVQ trainingMay 2005 8 more taking up NVQ training Total 24 now doing NVQ palliative care trainingTotal 24 now doing NVQ palliative care training More joining projectMore joining project

PlanningPlanning

Registering with Liverpool Registering with Liverpool Adaptation of LCPAdaptation of LCP

Consultation with:Consultation with: local specialist palliative care serviceslocal specialist palliative care services CSCICSCI H M CoronerH M Coroner Nursing home nurse managersNursing home nurse managers GPs & deputising serviceGPs & deputising service Lead cancer nursesLead cancer nurses Cross PCT drug groupCross PCT drug group

PlanningPlanning

Adaptation of LCPAdaptation of LCP More detailed criteria for inclusion on LCP More detailed criteria for inclusion on LCP Included specific goal about completion of OOH Included specific goal about completion of OOH

handover formhandover form Drug guidance developed to tally with acute Drug guidance developed to tally with acute

sector LCPssector LCPs Included local contact numbers for specialist Included local contact numbers for specialist

palliative care advicepalliative care advice

PlanningPlanning

Interviews with Nurse ManagersInterviews with Nurse Managers Negotiate commitment to education Negotiate commitment to education

programme & LCPprogramme & LCP Registration with LiverpoolRegistration with Liverpool Nomination of NH lead for projectNomination of NH lead for project Base review of 20 expected deathsBase review of 20 expected deaths Education programmeEducation programme Audit of LCP usageAudit of LCP usage

Education ProgrammeEducation Programme

Competency documentsCompetency documents 7x 2 hour in-house sessions built around 7x 2 hour in-house sessions built around

principles of GSF covering:principles of GSF covering: Principles of palliative care, teamwork & specialist palliative Principles of palliative care, teamwork & specialist palliative

care services, assessing palliative care needscare services, assessing palliative care needs Pain managementPain management Communication issues & psychosocial & spiritual careCommunication issues & psychosocial & spiritual care Symptom managementSymptom management Management of the last few days of life – LCPManagement of the last few days of life – LCP Bereavement & staff supportBereavement & staff support Hot topics & consolidation Hot topics & consolidation

Repeat sessions as neededRepeat sessions as needed

Introductory phaseIntroductory phaseMy roleMy role

Contact with GPs to gain co-Contact with GPs to gain co-operation with projectoperation with project

NH visits to support nurses & GPs in NH visits to support nurses & GPs in early days of usage of LCP early days of usage of LCP

Immediate audit & feedback - both Immediate audit & feedback - both verbal & writtenverbal & written

ReviewReview

Review 3 months later – use of LCP, Review 3 months later – use of LCP, changes to practice, need for education, changes to practice, need for education, repeat of competency documentrepeat of competency document

Encourage to attend Liverpool study daysEncourage to attend Liverpool study days Arrangements for ongoing supportArrangements for ongoing support

Further education sessionsFurther education sessions Local support groupLocal support group Network & local facilitatorsNetwork & local facilitators

ResultsResults

8 NHs signed up to LCP8 NHs signed up to LCP 4 NHs ready to use LCP4 NHs ready to use LCP 4 LCPS used so far in 2 NHs4 LCPS used so far in 2 NHs Comments:Comments:

It enabled us to get everything in for the It enabled us to get everything in for the end stageend stage

The family said they had no regrets about The family said they had no regrets about transferring her here (from hospice)transferring her here (from hospice)

ProblemsProblems

Duplication in documentation initiallyDuplication in documentation initially Additions needed for care after death:Additions needed for care after death:

Name of GP certifying deathName of GP certifying death Cause of deathCause of death Name of undertakerName of undertaker Burial or cremationBurial or cremation

Sceptics Sceptics

Problems Problems

Not just one GP per NHNot just one GP per NH Getting new staff on boardGetting new staff on board Staff moving on Staff moving on Coaxing PCTs & PHCTs to get actively Coaxing PCTs & PHCTs to get actively

involved with education in NHsinvolved with education in NHs Long term sustainabilityLong term sustainability NH staff need to commit time to NH staff need to commit time to

audit, analyse variances & reflect audit, analyse variances & reflect

BenefitsBenefits

Step by step approach to clinical Step by step approach to clinical interventions & reduces variations in interventions & reduces variations in patient care patient care

Patient centred care with measurable Patient centred care with measurable outcomesoutcomes

Identifies what NH does wellIdentifies what NH does well Identifies areas for improvement e.g. Identifies areas for improvement e.g.

systems, education systems, education Greater effectiveness, efficiency & quality Greater effectiveness, efficiency & quality

of careof care