Context Approximately 20% of people die in long term care settings. (1) National and international policies call for care homes to provide reliably good end-of-life care. Hospices are well placed to support care homes to deliver palliative care to residents who would benefit. This project builds on two previous projects aimed at better meeting the needs of care home residents.(2,3)
Aim To improve the delivery of palliative care to care home residents using a hospice-led model of care home support.
Approach used Nineteen South Edinburgh care homes were approached by two Community Palliative Care Clinical Nurse Specialists (CNS) to take part in the project. All care homes agreed. Care homes were divided into two geographically defined clusters. The intervention is currently being delivered to the first cluster.
Key components of the intervention include: support from a dedicated Community Palliative Care CNS; identification of two palliative care lead nurses in each care home; a study day and three workshops based on the Macmillan Foundations in Palliative Care programme; implementation of key processes such as multidisciplinary palliative care review meetings, and support to use tools to help identify residents who may be approaching end of life.
Outcomes The primary outcome is the proportion of residents who die in the care home. Other outcomes include the proportion of deceased residents who had an anticipatory care plan in place; DNACPR documentation in place; appropriate anticipatory prescribing and who died on the Liverpool Care Pathway. Outcome data is being collected before, during and after the intervention period.
Application to hospice practice This project will show the extent to which a hospice based model of care home support enables care home staff to improve the delivery of palliative care to their residents. This would allow hospices to greatly extend their influence to reach non-malignant patients.
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