our journey so far. claire nicell & sharon chadwick from the uk

“The difference that makes the difference” –

The Hospice Champion Project is funded by St James Place and is supported by Peace Hospice Care, the Hospice of St

Francis, West Hertfordshire NHS Trust and Help the Hospices

Our journey so far – promoting excellent end of life care at Watford

General Hospital, Hertfordshire

Claire Nicell, Hospice Champion Educator

Sharon Chadwick, Medical Director and Consultant in Palliative Medicine

Aims

• Give you a flavour of the journey we have been on at Watford General Hospital, Hertfordshire

• Describe some of our challenges and successes to date

• Learn from the collective experience in the room

National picture

• Around 500,000 people die in England each year

• Expected to increase to 590,000 within 20 years.

• Heart failure and stroke are the biggest killers.

• One in four people in the UK will die of cancer.

• Within 20 years, 30% of those over the age of 85 years old are likely to live with dementia

Dying Matters (2014)

• 70% of people would prefer to die at home

• 50- 60% currently die in hospital.

Place and cause of death 2012

Source: National Bereavement Survey-Voices-Office of National Statistics 2013

“The difference that makes the difference” to end of life care

This project has been funded by St James Place Foundation. It is supported by Peace Hospice Care, the Hospice of St Francis,

West Hertfordshire Hospitals NHS Trust and Help the Hospices

How often the patient was treated with dignity and respect in the last 3 months of life?

Quality of care?

Could be better…..

Locally

• Population of Hertfordshire

= approx 1.2 million

• West Hertfordshire served by West Hertfordshire NHS Trust

• Serving a population of 550,000

• 4,300 staff at WGH

• Beds = 600 AAU = 168

• In 2013:

A and E= 127,200 attendances

41,415 elective admissions

49,934 emergency admissions

Number of deaths = 1614

How was it for these patients?

• But how do we measure this?

Capturing data

Locally:

• National Care of the Dying Audit

• Complaints and compliments

• Bereavement questionnaires

• Statistics from hospital electronic systems

• Experience of the palliative care team

• Could be better……..

How can we improve this?

Nationally:

• Gold Standards Framework

• Route to success – improving quality end of life care in acute hospitals

• Quelca

• Transform programme

• Amber bundles

• Royal Alliance Bereavement and Donor Service

• ABC Education Programme

What about locally?

Challenges

• Lack of overall responsibility for end of life care within the hospital

• Poor environment

• Over-stretched palliative care team

• Poor nursing leadership within palliative care team

• Training low priority

• Changes largely driven by hospice consultants

• Palliative care has been an island until recently. Now under cancer services / medicine

• Overstretched resources within hospital

• Hospital largely operational focussed

• Change process slow

• Many overseas nurses

What are we doing?.....

• Marie Curie Nurses Discharge Co-ordinators

• Compassionate end of life care group

• Close work with resuscitation officers

• Increase specialist palliative care team – manager, more CNSs

• Hospice champion project

• Rose project • Working closely with

bereavement group • Working closely with the

local hospices • Implementing

individualised care plans

Hospice Champion Project

“To encourage and enable compassionate end of life care (including last days of life) within

Watford General Hospital (WGH) characterised by good care at the bedside and open, person-

centred communication with patients and those who are important to them.”

To work with identified hospital “hospice care

champions” on 11 wards within Watford General

Hospital

• Train and empower staff

• Train champions to train others and affect change

• Support and encourage compassionate end of life activity at WGH

• Monitor, measure and evaluate

Hospice Champion Educator

The difference that makes the difference

Challenges

• Access to staff for training!

• Focus on wards is operational rather than developmental

• Translating interest to engagement at every level

• Issues larger than nursing training

• Measuring change

The Rose Project

• Aim:

To promote dignity, respect and compassion at the end of life through the use of an end of life symbol (the rose).

The Rose Project

• Going live in December

• Being funded by League of Friends

• Staff generally receptive

Moving forward……

• How do we embed good practice?

• Suggestions for overcoming our challenges?

• Engaging with board?

• Data collection?

• Role of end of life care facilitator?

Making it as good as possible

For everyone….

“The difference that makes the difference” –

The Hospice Champion Project is funded by St James Place and is supported by Peace Hospice Care, the Hospice of St

Francis, West Hertfordshire NHS Trust and Help the Hospices

Claire Nicell

Claire.nicell@whht.nhs.org.uk

Sharon Chadwick

Sharon.chadwick@doctors.org.uk