Background Since the COVID-19 pandemic, health and care services have been under unprecedented pressure. The need to keep hospital admissions for urgent and emergency cases has never been greater. The Winter Bed Pressure Project looked at the role of specialist palliative care interventions in the community, in reducing hospital admissions and readmissions for patients with a palliative diagnosis, with particular focus on nursing homes.
Aim(s) The project aims to examine the education and support needs of nursing homes and to look at how specialist palliative care intervention may support patients to remain within their preferred place of care and death.
Methods Between January 1st and March 31st 2022, 14 Nursing Home Managers were interviewed and 49 patient reviews took place. 390 urgent unscheduled home reviews were made by the community specialist palliative care team for symptom management. 53 patients were admitted to hospital and 33 patients to the hospice in-patient unit. 140 calls were made to the hospice out of hours’ advice line.
Results Potentially avoidable admissions in the community include lack of advance care planning and ceilings of care, intravenous antibiotic administration, safeguarding concerns and carer breakdown.
The project has highlighted significant delays in obtaining medication in nursing homes. Education was lacking in communication, syringe driver and symptom management.
Conclusions Medication delays are being addressed through collaboration with the Clinical Commissioning Group to look at improving processes and wider use of Independent Nurse Prescribers involved with nursing home patients. Education needs are being addressed by the local practice development teams. A quality improvement project is being planned to look at improving access to the out of hours’ advice-line and plans for nurse-led admission to the hospice are underway.
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