‘Going for Gold’Evidence of Dignity in

CareNikki Sawkins GSF National Nurse Lead

Plan of session

• Background to GSFCH training programme

• Key Topic – Dignity

• Accreditation and the 20 standards

• Examples in practice - Dignity

• Shared experiences in practice

This is about life before death

“Our aim is that every person should be able

to live well and die well in the place and in the

manner of their choosing”

The Gold Standards Framework

A framework to deliver a

‘gold standard of care’

for all people approaching the end of their lives

A system - focussed organisational approach to optimising the care

delivered by generalists.

Background to the GSFCH Training Programme

Overview of Gold Standards Framework in Care Homes

• Based on GSF Primary Care- now used by most GP practices in UK at least at basic level 1. ‘Next stage primary care’ – embed further, training programme, new resources

• GSF in Care Homes programme developed 5 years ago in 2004, rooted and grown from experience of care homes staff

• Now used by nearly 1000 homes• Training run by GSF Centre in annual phases –commissioned/ open• Integrating experience, adaptations and learning from accredited

homes using showcased examples

• Accreditation Going for Gold - since 2008 - twice a year - 100 homes/ year

• Solid ‘gold club’ of accredited homes – supported and endorsed

• A national momentum of best practice in end of life care in care homes

GSF Care Homes Programme “The biggest palliative care initiative in care homes so far”

Aims1. To improve quality of end of life

care for all residents

2. To improve collaboration with primary care and specialists

3. To reduce hospitalisation in the last stages of life, enabling more residents to die with dignity in the care home

3 stage processPreparation, training and

consolidation + accreditation

Stage I Preparation Stage II Training Stage III Consolidation + Sustainability

3-6 months workshops in 9 months 9 – 12 months

Awareness Raising Meeting

Local Coordinators Meetings

Workshop 1

Workshop 2

Workshop 3

Workshop 4

GSFCH Accreditation

ADAAfter

ADABefore

Final Appraisal

Ongoing ADA

Enrolment of Care Homes

What are we aiming for?• A gold standard of care for residents• A gold standard of care for their families• Job satisfaction, confidence, rewards and

enjoyment for us as staff• Benefits to the owners, the GP/ primary care

teams, the PCT, the NHS and the wider community

• Best care for us if/ when we need it……

Key themes in GSF

• Pre-planning of care• Making the system work, so you can focus on

real care• You’re doing well- but you can do even better-

enabling and encouraging all • Communicating well • Aspiring to the best

Pre-planning of care

• Documenting and coding • Planning meetings - thinking what if…?• Meeting needs - use of Needs Support Matrix, • Advance Care Planning discussions with

resident + family , • Planning ahead with GPs e.g. anticipatory

prescribing, handover forms OOH• Use of LCP/ICP/min protocol

Making the system work, so you can focus on real care

• Once set up - runs smoothly

• Preventing crises

• Working smarter

• Enjoy better work

• Spend more time with people

You’re doing well- but you can do even better- Enabling and encouraging all

• Build on good practice • Improve confidence of staff• Everyone is involved - all staff aware and working

together to ensure high standard • Adapt and use tools, protocols, policies etc so that

they become part of your home• Embedding the work- so it remains if a key person

leaves

Communicating well

• Staff pre-empt issues

• Better working with GPs

• Better working with others eg hospice

• Honest discussions with residents and families

• Team spirit

• Documentation clear

Aspiring to the best

• Are you the best you could be ?

• Can we guarantee best care every time- gold care?

• What would it take to get there?

20 Key standards - Accreditation checklist

1. Leadership + support2. Team-working3. Documentation4. Planning meetings5. GP Collaboration6. Advance Care Planning7. Symptom control8. Reduce hospitalisation9. DNAR +Vo D policies10.Out of hours continuity

11.Anticipatory prescribing12.Reflective practice+

audit13.Education + training14.Relatives15.Care in final days16.Bereavement17.Dignity18.Dementia19.Spiritual care20.Sustainability

Key Topic – workshop 1 - Dignity• ‘What do you see nurse when you look at me?’ DVD

• Discussion and debate

• Re-look at Dignity related issues as a team – guidance in Good Practice Guide

• How do you engage all staff? Cultural issues?

• Key elements highlighted – Dignity Conserving Care, RCN ‘Dignity – at the heart of everything we do’

• Workshop 2 – Speed dating – sharing of experience and information, challenges and solutions

ABCD of Dignity conserving care(in Good Practice Guide)ABCD of Dignity Conserving Care

By Harvey Chochinov (in Good Practice Guide)

• A- Attitude

• B- Behaviour

• C- Compassion

• D- Dialogue

Bringing it all together…..

…..how can we

do the right thing

at the right time

for the right person

every time ?

…can we all talk the same language?

Key components of GSF & EOLC

Education

communication

Co-ordination

Team approach

Ongoing

Implementing an advanced

care plan

Identification

Assessment of need

assessment

Portfolio of evidenceHow using GSF helps improve the dignity of residents

• Dignity in good end of life care e.g. respect, autonomy, choice, humanity of each person • Breakdown in dignity when things go wrong crisis – admission, deaths in A&E, poor symptom control, not

respecting pt wishes• Improved dignity – ethos of good individualised care,

enhances choice, control, self determination, pt choice at centre

• Family discussions and information• Enhancing the skills of staff, improved confidence, improved

communication

Standard 17 Ensuring the dignity of residents is part of policies

and practices of home, particularly related to care in the dying phase, including compassionate holistic care

Evidence Evidence of policy statements and practice on

ensuring dignity Attention to detail in practice and policies, tools and

resources and individual care plans provided by all staff

What are the drivers for GSFCH?• Professional pride• Staff job satisfaction, • Staff retention and recruitment• Good reputation • Work smarter so more time for people• Fewer sent to hospital • More Money !! • Attracts more residents• Owner/ Policy/ external pressure

Don’t forget - its fun too!

Don’t forget - its fun too!

For more information on GSF

National GSF centre – Walsall

Judy Simkins - GSF Administrator judy.simkins@walsall.nhs.ukTel: 01922 604666 Nikki Sawkins – GSFCH Lead Nursenikki.sawkins@nhs.net Mobile - 07825197625

Email:• info@goldstandardsframework.co.ukNew Website Launch: 15th July• www.goldstandardsframework.nhs.uk

NHS End of Life Care Programme• www.endoflifecare.nhs.uk