Introduction The Hospice undertook a project with 10 local care homes which had the highest rate of admissions to an acute hospital where the patient had died. The inital results in 2012 led to a further 12 months of funding with 10 more homes.
Reduce inappropriate hospital admissions from care homes for end of life patients
Promote the use of end of life care
Methods Registered Nurse led project with multi-disciplinary steering group
After death analysis (ADA) – last 5 deaths prior to project commencement
Care home training needs analysis (TNA)
Training programme based on TNA delivered and evaluated
Collation of ADA information
Reviewed whether new skills and knowledge embedded.
Results Year 1 – 19% of nursing home patients and 57% of residential home patients died in an acute setting. Uptake of EOLC tools rose dramatically. 140 staff received EOLC training.
Year 2 – Post-training, 19% of patients died in an acute setting and the ADAs suggested only 5% might have been avoided if end of life needs had been correctly identified. Uptake of EOLC tools increased with 90% of those who died having some form of ACP and nearly 80% having a valid DNACPR form. 157 staff received EOLC training
Discussion The uptake of EOLC tools was the most obvious achievement and qualitative data indicated increased staff confidence as a major factor. The ability to measure a reduction in inappropriate hospital admissions was more difficult due to interventions from other in-reach projects. The importance of good engagement with GP practices was identified early on, but was outside the scope of this project.
Conclusion This project demonstrated the value of EOLC training, tailored to care home staff needs. Hospices can increase opportunities for good end of life care in the community, without the need for specific patient intervention from specialist palliative care providers.
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