Background The Intercollegiate Stroke Working Party (2016) outlined that services providing acute and long-term care for people with stroke should provide high quality end-of-life care. Difficulties occur in recognising dying when the trajectory of the disease is not easily predicted.
Method A project was developed which involved a band 7 CNS in Palliative care having 15 hours a week designated to the 4 stroke wards for a year. The model was of in-reach work. Data was collected prospectively for patients referred to the CNS using a pro forma. Information was also obtained by identifying patients who were diagnosed with a stroke who had a palliative care code. A survey was also developed to assess the impact of the project on ward staff.
Results 113 patients were seen by the project CNS over a 12 month period. The average Karnofsky Performance Score (KPS) of patients seen was 20. 80% of patients lacked capacity.
38% referrals were related to managing patients in their last few days of their life.
66% patients died in hospital but over a third were discharged with CNS support. 73% required symptom management. 66% involved supporting the stroke team with decision making and 42% involved facilitating family discussions.16% patients were referred with artificial nutrition, but only 1% patients died with nutrition in situ. Satisfaction with palliative care input increased from 43% to 92%
Conclusions Regular palliative input to the stroke wards supported complex decision making for patients who often lacked capacity. Key roles included supporting staff to recognise dying and stopping artificial nutrition. Initiating discharge planning was also an important aspect and has led to the development of a discharge coordinator specifically for palliative care patients. The in-reach model was valued by staff.
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