Background Nationally, it is recommended that dying patients have choice in where they spend their final days nominating a preferred place of death (PPD) (Department of Health, 2008; NICE, 2015). Where patients choose hospice, they may be ineligible due to lack of complex symptoms required to meet specialist palliative care eligibility criteria. Responding to identified need, we developed a nurse-led service offering end of life care (EOLC) to dying patients with generalist palliative care needs within a hospice environment.

Aims This project aimed to widen access to hospice beds enabling patients without specialist needs to die in their PPD.

Methods

• Innovating for Improvement award from the Health Foundation enabled project pilot

• Nurse Consultant appointed as project lead

• Nurse Consultant accountable for total patient care supported by a team of nurses trained in non-medical prescribing. This innovative approach is unique in an in-patient setting.

• Steering group of local stakeholders formed to direct the project

• Operational group formed to develop and drive the project

• Four beds within existing IPU designated EOLC beds

• Outcome measures identified to enable project evaluation

• VOICES survey adapted for carer feedback.

Results To date, 115 patients have achieved their PPD and would not previously have had this option. Median length of stay is four days.

We have:

• widened access, particularly to non-cancer patients (42%) and elderly (mean age 88)

• successfully tested a safe, effective model which is now a permanent service

• received positive feedback from patients, relatives and referrers

• increased bed occupancy maximising use of hospice beds

• reduced in-hospital deaths

• developed nurses’ skills, knowledge and confidence.

Conclusions This project has enabled us to widen access for end of life care to a greater number of patients, particularly non-cancer patients and the elderly known to be disadvantaged in terms of access to hospice care (Health Select Committee, 2015). We have developed and sustained a successful and replicable model of end of life care.