Transcript Liverpool Care Pathway in Nursing Homes

Liverpool Care Pathway
in Nursing Homes
Pat Mowatt
Education Facilitator for Palliative Care for
the Nursing Homes
Purpose of Post
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To provide education for trained nurses
to underpin the introduction of the
Liverpool Care Pathway and / or the
Gold Standards Framework to nursing
homes in Bradford & Airedale.
Drivers
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NICE guidance Improving Supportive &
Palliative Care for Adults with Cancer 2004
B & A’s Palliative Care Education Strategy
National Minimum Standards: Care homes for
Older People 2003
Competency framework for Cancer Nursing
2004
CSCI consultation around Terminal Illness
registration March 2005
Statistics
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July 2004 69 nursing homes in Bradford &
Airedale
? number registered to take Terminally Ill
patients
July 2004 16 taking up palliative care NVQ
training
May 2005 8 more taking up NVQ training
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Total 24 now doing NVQ palliative care training
More joining project
Planning
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Registering with Liverpool
Adaptation of LCP
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Consultation with:
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local specialist palliative care services
CSCI
H M Coroner
Nursing home nurse managers
GPs & deputising service
Lead cancer nurses
Cross PCT drug group
Planning
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Adaptation of LCP
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More detailed criteria for inclusion on LCP
Included specific goal about completion of OOH
handover form
Drug guidance developed to tally with acute sector
LCPs
Included local contact numbers for specialist
palliative care advice
Planning
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Interviews with Nurse Managers
Negotiate commitment to education
programme & LCP
Registration with Liverpool
 Nomination of NH lead for project
 Base review of 20 expected deaths
 Education programme
 Audit of LCP usage
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Education Programme
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Competency documents
7x 2 hour in-house sessions built around principles of
GSF covering:
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Principles of palliative care, teamwork & specialist palliative care
services, assessing palliative care needs
Pain management
Communication issues & psychosocial & spiritual care
Symptom management
Management of the last few days of life – LCP
Bereavement & staff support
Hot topics & consolidation
Repeat sessions as needed
Introductory phase
My role
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Contact with GPs to gain co-operation
with project
NH visits to support nurses & GPs in
early days of usage of LCP
Immediate audit & feedback - both
verbal & written
Review
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Review 3 months later – use of LCP, changes
to practice, need for education, repeat of
competency document
Encourage to attend Liverpool study days
Arrangements for ongoing support
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Further education sessions
Local support group
Network & local facilitators
Results
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8 NHs signed up to LCP
4 NHs ready to use LCP
4 LCPS used so far in 2 NHs
Comments:
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It enabled us to get everything in for the
end stage
The family said they had no regrets about
transferring her here (from hospice)
Problems
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Duplication in documentation initially
Additions needed for care after death:
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Name of GP certifying death
Cause of death
Name of undertaker
Burial or cremation
Sceptics
Problems
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Not just one GP per NH
Getting new staff on board
Staff moving on
Coaxing PCTs & PHCTs to get actively
involved with education in NHs
Long term sustainability
NH staff need to commit time to audit,
analyse variances & reflect
Benefits
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Step by step approach to clinical
interventions & reduces variations in patient
care
Patient centred care with measurable
outcomes
Identifies what NH does well
Identifies areas for improvement e.g.
systems, education
Greater effectiveness, efficiency & quality of
care