Transcript Night Nursing Models Aim

The PAN-Care Project
Development and testing of a comprehensive care planning
service to enable patients with end stage pancreatic cancer
die at home
Department of Pain and Palliative Care
Department of Cancer Experiences
Research
Pancreatic Cancer
THE FACTS
FEASIBILITY OF THE STUDY
•189 new patients diagnosed with pancreatic cancer were admitted to 5 WCMICS hospitals
during this period, of who 103 lived in the WCMICS area
•These figures do not include patients who were treated as out patients or
Treated in a non WCMICS hospital, but living in a WCMICS area
Death Trends England Wales
Model of variations of place of death.
Gomes B , Higginson I J BMJ 2006;332:515-521
©2006 by British Medical Journal Publishing Group
Recommendations from the National End of Life Programme in the
United Kingdom
Key factors to enable individuals to die in their preferred place of death
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Strong commissioning and clinical leadership
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Clearly defined access to 24hr cover (this includes the provision of night nursing
services)
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Use of nationally recognised drivers that attract payment
Flexible budgets and care packages
Use of nationally recognised tools or their local equivalent
Use of facilitators and coordination of care across boundaries
Training to support staff delivering end of life care
http://www.endoflifecareforadults.nhs.uk
Night Nursing Models
Aim:
This programme will test the feasibility and
sustainability of a comprehensive care planning
service for patients with advanced pancreatic
cancer patients residing in the WCMICS area
3 Phases over 24 months
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Phase 1
– A retrospective case note review
– Primary Pancreatic cancer inpatients or to day oncology at the Western Hospital
(2010-11) who have since died.
– contextual data against which the study team can compare health service
utilisation, documented symptoms, social and emotional problems and patient
place of death against preferred place of death
– Review of Mercy Community Palliative Care notes where available
Phase 2
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A. Literature search and development of study resources
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B: The night nursing model
We strongly recommend the use of registered nurses as used by other
international night nursing models. The use of a registered nurse
allows for the administration of medications and completion of certain
procedures such as insertion of lines etc. that cannot be undertaken
by a nurse’s aid.
Recruitment via
• Seeking expression of interests through key organisations such as PCV /
CNSA
• From participating hospitals’ nurse bank services
• Though nursing pools in community palliative care teams and Royal District
Nursing Services.
Phase 2
- Prospective study
- Consecutive patients with primary pancreatic cancer and a carer of their
choice, presenting to or attending any WCMICS hospitals or treated by
a community palliative care team within the WCMICS catchments area
Inclusion criteria
– Patient: over 18, informed consent, English speaking / complete study
requirements with interpreter, have proxy consent provided by the next
of kin or main carer when the patient is unable to provide consent.
– Carer: over 18, informed consent; English speaking / complete study
requirements with interpreter; identified by patient as main carer or
identified in the medical record as the next of kin
– *the costs of the interpreter will be carried by usual budget
allocation and not by PANCARE .
Exclusion criteria
– Risk assessment undertaken by a community palliative care teams
suggest a risk to staff; patients who are living alone and therefore
ineligible to opt to die at home; patients who are non English speaking
and unable to meet study requirements with the help of an interpreter.
* Provision of night nursing service will be flexible based on patients
and families individual needs i.e. some patients may only require a
couple of days, others may require longer periods and some may
need to use this service on an intermittent basis)
**The budget makes provision for 6 nights of nursing ( with standard
91/2 hours shifts) but this will be flexible
***All night nurses will be provided with an emergency plan. The
night nurse may have to contact a community palliative care team,
palliative care consultant or GP if the patient develops severe pain
or difficult symptoms.
The provision of a night nurse does not preclude the admission
into hospital / hospice if appropriate for the patient care.
Phase 3: Evaluation of service model
• Patient demographic characteristics including symptom profile
• unmet supportive care needs;
• anxiety, depression and distress;
• Carer demographic data
• Carer anxiety, depression and distress.
• A validated night nursing needs assessment tool will be amended
for use in this study7.
• Carer satisfaction data with the night nursing service
• The night nurses perception of the efficacy of the service
• log of all interventions delivered to patients and carers during the night service.
• Palliative care teams’ satisfaction with the coordination service.
• The night nurses and palliative care teams to evaluate the training program
content for relevance, comprehensiveness and preferred mode of delivery.
• Service utilisation and data compared with retrospective case
note records to explore the potential of the night nursing service to
reduce health service utilisation