The need to provide high quality care for all people at the end-of-life was identified in the End of Life Care strategy (Department of Health, 2008). Twenty one per cent of all deaths occur in care homes in England, highlighting the need for good end-of-life care for those who live within them (Public Health England, 2014).
In order to address this a hospice in North West London funded a facilitator role to empower staff in local care homes with nursing to provide high quality generic palliative care to those residents who may benefit from it. The aims of the post are to work with the homes to adopt a framework that helps staff to ensure that patients in the last year of life are identified, assessed and have an advance care plan put in place in accordance with their wishes. Further objectives are for nursing home staff to feel more confident to diagnose dying and manage the symptoms of residents who suffer advanced incurable illness.
To achieve the aims of the initiative the nursing home facilitator regularly visits the homes and discusses with staff all residents in their care, identifying any changes in their condition. To facilitate identification of appropriate patients a Prognostic Indicator Tool is used. Once identified patients are placed on a Supportive Register, which prompts nursing home staff to undertake advance care planning discussions and take appropriate actions.
A total of 161 staff have attended short training sessions delivered in the homes and End of Life Care Champion Training Sessions at the hospice. Whilst formal evaluation of the project is planned for September 2016, early indications are of an increased number of residents dying in those care homes who are working closely with the nursing home facilitator.
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