The aim of this initiative was to facilitate timely symptom relief at the end of life for patients in their own homes (Healy, Israel, Charles et al., 2018). By safely training family carers to administer subcutaneous medications, patients receive symptom relief without delay and family members report feeling able to support their loved one in their moment of need (Anderson & Kralik, 2008). This change not only enables effective, responsive symptom control, but also patient choice, carer involvement and preferred place of death. A registered nurse or doctor is responsible for ensuring this is carried out safely with training, reviews and monitoring (Healy, Israel, Charles, 2013).
Quality improvement methodology was used to provide a structure in which to safely roll out the initiative. During the early phases Plan Do Study Act (PDSA) cycles were used to evaluate success and identify opportunity for improvement after each new referral to the service. This included reviewing carer feedback at every stage to inform the evolution of the initiative, as part of the PDSA process.
This initiative is becoming well-embedded at Prospect Hospice and we have had fantastic feedback from those involved. We are now keen to support the roll out of this approach to the wider local Integrated Care System (ICS). Not only does it bring benefit to patients and family carers, it also releases valuable time and resource for the Hospice to direct elsewhere.
For example, thanks to this initiative one patient supported over a total of 13 days was able to remain at home, with support from her family, and died peacefully with appropriate medication administration. We calculated that the total number of community visits saved was 39, equating to approximately 3.5hrs of nursing time per day, including travel. Training was provided to the family carers when the patient was an inpatient at the Hospice, and the family had access to a 24hr helpline to use as needed. This is just one of many examples.
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