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P16 Planning your week: a new model for rural working
  1. Derek Hart,
  2. Cathy Martin and
  3. Maggie Draper
  1. St Luke’s Hospice Plymouth, Plymouth, United Kingdom


An examination of caseload management is currently being undertaken by 2 community palliative care nurses who cover a large area, encompassing the environs of city to remote moor land. The remote areas have no mobile telephone access and poor infrastructure.

The caseload was analysed and divided into 7 geographical areas (zones). Visits were to be arranged to these zones on specific days to optimise efficiency, taking into account mdt commitments.

The aims were:

  • To increase efficacy of visits, reduction of interruptions

  • Reduce travelling time and mileage

  • Improve response time from referral to first visit,

  • Improve reliability and therefore develop stronger integrated working.

  • Improve wellbeing and support of the CNS.

  • Move from reactive “fire fighting” to proactive care where crises were predicted where possible.

The approach used was:

  • A time table of areas and days was created.

  • Two nurses covered the caseload of approx 60 patients.

  • The timetable took into account mentorship needs of the new CNS. It promoted men- tee and mentor working in neighbouring zones. Meeting places in the field (literally!) were highlighted should support be required.

  • 1 nurse per day was allocated to triage calls and trouble shoot.

  • The administrative team were involved in planning and were aware of who to call.

Outcomes – to be measured / reviewed September 2013

  • Supportive mentorship of new CNS in rural environment

  • Reduced Mileage

  • Reduced interruption from mobile phone calls.

  • Reduced sickness

  • Improved record keeping. The two nurses were reliant on each others records to provide continuity of care.

  • A more efficient use of laptops reducing the need to return to base.

  • Development of professional relationship between nurses encouraging peer review.

  • Improved relationships with GPs and community nursing teams

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