Background Middlesbrough Redcar Cleveland has a population of approximately 300 000 with >130 registered care homes. MRC Community SPCT receives around 1300 referrals/year of which around 8% come directly from care homes. Across the locality in 2017/8 22.9% of deaths occurred in care homes. An existing single-handed CNS for care homes had identified areas for development but was unable to progress this due to limited capacity.

In 2016, funding accessed via the Better Care Fund secured an additional Specialist Palliative Care CNS within the Community SPCT to support the existing post–holder and with a remit to extend and develop training and support within the Care Home setting, with particular emphasis on verification of expected death, syringe driver training and advance care planning.

Results Between January and August 2018 an education programme delivered syringe driver updates to >100 staff, and verification of death training to >80 staff. A level 1 programme (consisting of a single broad-reaching introductory education session) for support staff has been introduced and rolled out tomore than 40 care homes. Pre and post-course analysis shows significant improvements in knowledge levels and confidence.

In 2017/18 17% of patients dying whilst on the caseload of the community SPCT died in a care home. Between April 2018 and September 2018 this had risen to 32%.

Nurse verification of death within the care homes represents a shift in work which was previously undertaken by the OOH service.

Direct advance care planning including discussion and implementation of treatment escalation and DNACPR orders, and provision of anticipatory end of life medications for symptom management has taken place in >40 individuals.

Conclusions Targeted interventions within care home settings can empower staff and improve outcomes in care at the end of life.