Background/Context Within the UK, there is a drive to reduce the number of hospital deaths thus potentially increasing end of life care in the community. However, there has not been a corresponding increase in the numbers of professional health care workers, so organisations such as domiciliary care agencies are providing more complex care and support for very ill patients in their own homes. This is an emerging role for these organisations so they need development, education and support to provide quality end of life care.

Aim The ‘Six Steps to Success’ programme was originally developed to enable nursing homes to implement a structured organisational change to enable the delivery of the best end of life care. The programme has been adapted for use with domiciliary care agencies, involving a multi agency approach to developing the programme.

Approach used

A pilot programme with four different organisations was pioneered, with the organisations participating both as learning organisations and evaluation partners. The pilot programme was evaluated both pre and post programme using three tools: Quality Markers, Post Death Information (PDI) and a Knowledge, Skills and Confidence audit.

Outcomes The results have established an increase in the quality of end of life care through a number of means, ranging from early identification of patients at the end of life through to improved communications with other agencies. Qualitative data has also been captured which demonstrates real life impacts and changes.

Application to Practice Supporting domiciliary agencies to care for the increasing number of patients requiring end of life care in their own homes has often been provided by hospices and their education departments. However, education alone is often not enough to make the changes required within an organisation and this programme can influence more extensive changes through a structured and systematic approach.