julie williams macmillan nurse specialist for palliative care education in nursing homes 10 th july...
TRANSCRIPT
Julie Williams Julie Williams Macmillan Nurse Specialist Macmillan Nurse Specialist
for Palliative Care Education in Nursing Homesfor Palliative Care Education in Nursing Homes1010thth July 2009 July 2009
Dignity in CareDignity in Care
INTEGRATED CARE PATHWAY FOR INTEGRATED CARE PATHWAY FOR THE ADULT DYING PATIENTTHE ADULT DYING PATIENT
IN CARE HOMESIN CARE HOMES
Dignity in CareDignity in Care
AIMS OF THIS PRESENTATIONAIMS OF THIS PRESENTATION
• To introduce the Integrated Care Pathway (ICP) for the adult dying patient
• Describe and outline how the pathway fits with the wider national agenda
• To discuss the results of the ICP Pilot Baseline Audit• To inform about the Implementation of ICP locally
Dignity in CareDignity in Care
INTEGRATED CARE PATHWAY (ICP)INTEGRATED CARE PATHWAY (ICP) A DEFINITION A DEFINITION
An integrated care pathway determines locally agreed multidisciplinary practice, based on guidelines and evidence where available, for a specific patient/client group. It forms all or part of a clinical record, documents the care given and facilitates the evaluation of outcomes for continuing quality improvement”.
(National Pathways Association 1998)
Dignity in CareDignity in Care
What is the ICP?What is the ICP?
• It was developed and initiated by the palliative care team in Liverpool. Liverpool Care Pathway (LCP)
• It has been adapted for local use (ICP)
• A map/tool/framework for the delivery of planned care to the resident during the dying phase
• It is a multi-professional document
• Provides a method of coordinating and standardising care – reducing practice variations
Dignity in CareDignity in Care
What is the ICP?What is the ICP?
• An evidence-based legal document, incorporating guidelines which reflect current good practice
• Provides a mechanism for continually monitoring and evaluating processes, practices and outcomes of care delivered
• It details tasks, sequences and timescales.
• It has been developed to transfer to all care settings.
Dignity in CareDignity in Care
The ICP is The ICP is NOTNOT
• A criticism of current practice• Totally prescriptive• Just a nursing document• Undermining of professional knowledge, skill and
competence• Complicated• WRITTEN IN STONE
Dignity in CareDignity in CareHow the ICP Relates ToHow the ICP Relates To
The National Agenda For End Of Life CareThe National Agenda For End Of Life Care
The End of Life Care Strategy (2008) States
“ Good Primary Care Trusts will want to ensure that the particular needs and wishes of all people who are dying should be identified and addressed.
The Liverpool Care Pathway provides a well established mechanism for achieving this.
Primary Care Trusts are therefore strongly recommended to ensure that the Liverpool Care Pathway is adopted and its use audited in all locations where people are likely to die.”
All national recommendations have highlighted the importance of choice and an integrated health and social care approach to end of life care
Dignity in CareDignity in CareHow the ICP Relates ToHow the ICP Relates To
The National Agenda For End Of Life The National Agenda For End Of Life CareCare
• The Cancer Plan (2000)
• National Service Framework for Coronary Heart Disease (2000)
• National Service Framework for Older People (2001)
• The Gold Standards Framework (2003)
• Cancer Services Collaborative Improvement Partnership (2003)
• National Service Framework for Renal Services (2004)
• National Service Framework for Long Term Conditions (2005)
• Our Health, Our Say (2006)
• Building on Firm Foundations- Improving end of life care in care homes (2007)
• End of Life Care Strategy (2008)
Dignity in CareDignity in CareWhy implement the ICP in Care Why implement the ICP in Care
Homes?Homes?
• People are living longer, with the percentage of deaths amongst those aged 85 and over rising
• 58% of deaths occur in hospitals (2008) • 64% of patients would prefer to die in their own homes (2004)
• 17% deaths occur in care homes collectively accounting for around 35% of all deaths (based on ONS figures for 2004)
Dignity in CareDignity in CareWhy Implement the ICP in Care Homes?Why Implement the ICP in Care Homes?
• To enable residents to die peacefully in their home
• Reduce crisis admissions to hospital in the dying phase
• To enable relatives and carers to provide care, be kept informed and have positive lasting memories if possible
• Staff involved have a sense of satisfaction that a “good death” has been achieved
Dignity in CareDignity in CareBenefits of using the ICP in Care HomesBenefits of using the ICP in Care Homes
• Promotes proactive high quality, efficient, effective and equitable care
• Enhances good communication and teamwork
• Gives permission to discontinue regimes
• Informs on symptom control
• It can save time and reduce documentation.
• It helps prevent crisis intervention
Dignity in CareDignity in CareBenefits of using the ICP in Care HomesBenefits of using the ICP in Care Homes
• Empowers and increases staff competence and confidence in caring for dying residents and their families
• Sensitive, One record Up to date - provides
evidence of quality care given to residents and families
• It can highlight and identify education, training and resource needs.
• It promotes the effective use of resources
• It can prevent repetition
• It provides data for audit and reflective practice
Dignity in CareDignity in CareConsiderations For Inclusion On The On Considerations For Inclusion On The On
The ICPThe ICP
• The resident has a known irreversible life threatening illness of any aetiology.
• Reversible causes for the resident’s current deterioration have been considered and appropriately managed.
• Intensive care and resuscitation have been discussed by the team and have been deemed inappropriate.
Dignity in CareDignity in CareCriteria For Inclusion On The ICPCriteria For Inclusion On The ICP
The Multidisciplinary Team has agreed that the resident is dying and 2 of the following apply
• The resident is bed bound • The resident is semi-comatose • The resident is only able to take sips of fluid • The resident is no longer able to take tablets
Dignity in CareDignity in CareComponents Of The ICPComponents Of The ICP
• Initial assessment
• Ongoing assessment and documentation of care on a 4 and 12 hourly basis
• Outcome Measures (Goals) for each section
• Variance recording Goal Achieved (A) Goal not achieved (“V” for Variance)
Dignity in CareDignity in CareComponents Of The ICPComponents Of The ICP
• Multidisciplinary communication/progress record sheets • Information for family and carers
• Care after death • Guidelines for staff • Symptom control Guidelines
Dignity in CareDignity in CareHow is the ICP being implemented in How is the ICP being implemented in
Local Care Homes?Local Care Homes?
• ICP document and accompanying information leaflets ratified by PCT
• Piloting in 4 GSF accredited Nursing Homes in Kirklees
• Education delivered to ALL care home staff prior to ICP implementation
• Liverpool Care Pathway National team involved in support with data analysis
Dignity in CareDignity in Care
Key Findings from Baseline ICP AuditKey Findings from Baseline ICP Audit
Documentation from 4 Nursing Homes audited
• 20 Deaths in each home (Total 80 )
• Deaths that occurred :
Men -20% Women -80%
• Age range of residents that died : 65years to 103years
Dignity in CareDignity in CareKey Findings from Baseline ICP AuditKey Findings from Baseline ICP Audit
Diagnosis of Residents that died:
- Dementia including Alzheimer’s disease - 43.75%
- Cancer - 11.25%
- Long Term Conditions - 45%
(Including Stroke, COPD, Heart Failure & Circulatory problems
Renal failure, Neurological conditions & old age )
Dignity in CareDignity in CareKey Findings from Baseline ICP AuditKey Findings from Baseline ICP Audit
• Not for CPR documented 70 - 85%
• Family/Other aware of diagnosis documented - 80 - 95%
• Family/Other aware patient dying documented - 55 - 80 %
• GP aware of Patient’s condition documented– 55 – 85 %
• Plan of Care explained to Family documented– 55- 75%
• GP practice aware of death documented– 80 -100%
Dignity in CareDignity in CareKey Findings from Baseline ICP AuditKey Findings from Baseline ICP Audit
• Anticipatory drugs were prescribed when residents referred to Specialist Palliative Care team
• Residents with cancer had anticipatory drugs prescribed
• Majority of residents with dementia and long term conditions did not have anticipatory drugs prescribed.
Dignity in CareDignity in CareWhere next with the ICP Where next with the ICP
Implementation?Implementation?
• Completed pathway data from the pilot areas will be analysed at Liverpool
• Participating Care Homes will be asked to give formal feedback to facilitators via questionnaire
• Feedback will be delivered to participating pilot areas following data analysis
Dignity in CareDignity in CareWhere next with the ICP Where next with the ICP
Implementation?Implementation?
• Pilot documentation will be reviewed and amended if appropriate
• Train the trainer ICP ( Nominated ICP Lead in each Care Home)
• Pathways will then be audited annually
• Roll out ICP to further GSF accredited homes in Kirklees and Calderdale
Dignity in CareDignity in Care
“You Matter Because you are youAnd you matter to the end of life
We will do all we can not only to help you die peacefully but also to live
until you die”
Dame Cecily Saunders ( Founder of the Modern Hospice Movement)
YOU WILL NEVER BE FORGIVEN YOU IF YOU YOU WILL NEVER BE FORGIVEN YOU IF YOU GET IT WRONGGET IT WRONG
YOU WILL NEVER BE FORGOTTEN YOU IF YOU WILL NEVER BE FORGOTTEN YOU IF YOU GET IT RIGHTYOU GET IT RIGHT
For further informationFor further information
www.lcp-mariecurie.org.uk
www.endoflifecare.nhs.uk
Dignity in Care
Thank YouAny Questions?