Background/context Following a retrospective analysis of urgent unplanned visits, evidence emerged that supported a new rapid response role for a clinical nurse specialist.

Main Aims

• To enable palliative care patients in the community, who have complex needs or whose condition is deteriorating, to access prompt specialist palliative care services.

• To assess whether more patients

• are enabled to exercise their preference about place of death

Approach used The service was available to new and existing patients for end of life care and support of urgent symptom control issues (N = 78). Referrals requiring urgent attention were passed onto the Rapid Response Nurse. The CNS worked flexible hours in order to support the needs of the patient. Data was collected prospectively over a six month period using survey monkey.

Outcomes Seventy Eight patients supported over 6 month period. 38% had a non - malignant diagnosis. 67% of patients were referred for terminal care with the remaining requiring symptom control. As a result of the rapid response visit 86% of patients remained in their own home. None were transferred into the acute sector. 75% of patients who died within the 6 month period achieved their preferred place of death with only 6% who wished for a home death unable to achieve this.

Application to hospice practice The service was timely, responsive and supported increasing numbers of patents to be cared for and to die in their preferred place of death. All visits responded to crisis therefore all patients had potential to be admitted to hospital. Patients in the Nursing homes were particularly vulnerable.

The service therefore prevented unnecessary admissions into the acute sector and supported Hospital Palliative Care Teams with rapid discharge home.

A Rapid Response Clinical Nurse specialist is effective – right skill, right intervention, right time.