I have never been one for blogging or being photographed, I never enjoy being centre of attention for that matter! However in the interest of challenging myself and trying to improve, I fancy having a… More
Dr Paul Baughan, our palliative care GP clinical lead, discusses the benefits of early palliative care, highlights a resource that we’ve developed to compare different palliative care identification tools, and looks ahead to future work on care planning and care coordination.
Having worked within General Practice for over 20 years, I have seen the transition from hospital-based care to community care for a wide variety of clinical conditions and diseases. We look after many more people who are living with complex medical diagnoses well into their 80s, 90s and beyond. It can be difficult to identify when a palliative approach to care should be considered, and as a result we sometimes find ourselves on the back-foot, reacting to events and changes in clinical condition. Often, with the benefit of hindsight, it might have been possible to anticipate and plan for these episodes before they happen.
This is one of the reasons that I have enjoyed the opportunity to work with Healthcare Improvement Scotland and five test sites across Scotland (Dundee, East Ayrshire, Fife, Glasgow, and Perth and Kinross) to explore how we might identify people who could benefit from a palliative approach to their care at a much earlier stage.
Although a variety of different electronic and paper ‘tools’ have been developed by academics to help identify those who might benefit from a palliative approach to their care, it can be confusing to know which tool to use, and in which situation. Some are electronic, some are designed for particular diseases such as cancer or dementia, or for particular settings such as care homes. Some tools are intended for health professionals and some for the general population. I have therefore enjoyed working with the team in Healthcare Improvement Scotland to design a resource which will help health and social care professionals become more familiar with the different identification tools, and most importantly, decide which one suits them best. Our five test sites have chosen different identification tools to use within their local Health and Social Care Partnerships.
However, identifying those who might benefit from a palliative approach to their care is just the first step. It is the conversations that follow, between the health and social care professionals and the person, that are important. And then of course the care planning that results from these discussions. This is our next area of focus at Healthcare Improvement Scotland. We are now working with our test sites to explore how best to plan, coordinate and deliver care to those who are living with a progressive life-limiting condition.
This is an exciting phase of our work, as each test site is considering innovative and practical ways to provide this care within existing resources, and across health and social care. We will have the opportunity to share some of the learning from across Scotland in the Autumn, with the full outcomes from our test site projects available in 2019.
Back at my own general practice, my colleagues and I will continue to see an increase in the number of people with complex progressive life-limiting conditions in the years ahead. Therefore, the outcomes from the five test sites will be very relevant to the work that we do on a daily basis. We know that a proactive, multi-professional, care planning approach is required, and eagerly await advice from the test sites regarding how best to achieve this.
On 11 May 2018 we held our latest neighbourhood care learning network event at the Care Inspectorate Offices in Hamilton. The session was well -attended by representatives from the neighbourhood care test sites, national organisations and third sector organisations. The purpose of this meeting was to discuss neighbourhood care and regulation, with a focus on questions raised by the test sites before the meeting. We also took the opportunity to discuss measurement ideas and learn what plans were already in place for local evaluation.
Sharing learning from the test sites
After introductions, staff from each test site provided an update on the neighbourhood care work in their area. There has been a lot of activity across the test sites with positives discussed on this way of working, offers of support and an eagerness from sites to arrange visits to learn from one another. Common challenges faced by the sites include those around culture and shifting perceptions, but the passion for the concept and success stories continue to drive this work forwards and motivate the teams.
Care Inspectorate – from enforcers to enablers
Catherine Agnew from the Care Inspectorate gave an informative presentation about the role of the Care Inspectorate in supporting services as enablers of innovation, rather than the traditional perception of enforcing regulation. There is acknowledgement that services for the public are evolving with the integration of health and social care. In support of this, the Care Inspectorate have developed regulatory sandboxes, where normal regulatory requirements are waived to support innovation which has the potential for public benefit.
Attendees discussed the new health and social care standards in Scotland and were pleased to note that the principles of the Buurtzorg model mirror these standards (Dignity and respect; Compassion; Be included; Responsive care and support; Wellbeing).
We facilitated a group discussion on evaluation and undertook an exercise to look at measures, how important these are and how easy they are to use. Representatives from the test sites rated examples and entered them into a prioritisation tool, which could help the teams to look at work priorities and measurements in their areas. They highlighted difficulties with measuring face-to-face contact time, although this is an important measure to show effectiveness of this model and the test site representatives acknowledged that this is a measure that is important to care givers: ‘more time with the person needing care’.
They are aware that while test sites will have different measures and there will be local variation, there is a need to have some standardisation for comparisons. Evaluation should be meaningful in a local context for individuals, their carers and staff. However, an element of evaluation will be required for national interest to look at areas such as cost saving, avoiding hospital admissions and reducing length of stays, etc.
The King’s Fund has recently published a paper on transformational change in health and care in response to the growing pressures and demands on the health and care system. The paper highlights four case studies that have been recognised as successful transformation initiatives, led by staff that directly provide care and service users. One of these successful initiatives is the Buurtzorg Nederland model.
The test site representatives agreed to try a new approach to the learning network, with an option to move to the IHI model of a breakthrough series collaborative alongside action learning sets facilitated by the Scottish Social Services Council in the future. Once logistics have been further discussed, options will be presented to the group to take forward. Members of the group were happy to share their plans for evaluation with the Living Well in Communities (LWiC) team and there are steps to visit each site. Further information will be available soon.
I’ve had a long career in generalist primary care practice management, so stepping into a new role as Fife’s palliative care improvement advisor may have seemed at first like a leap into unfamiliar, specialist territory.
But, as one doctor said to me, palliative care is the bread and butter of primary care.
Both services share a deep-rooted holistic philosophy that deals with the emotional, social, practical and spiritual aspects of health and well-being, as well as the medical management of illness.
So, for me, a move to palliative care felt like a home coming.
Our aim is to innovate and improve the identification and care coordination for people who may benefit from palliative care.
What people want is support to live well, safely and for longer in their usual place of residence. What people want is to have quick and easy access to responsive services and trusted care providers when they need them. These principals are universal to both primary and palliative care.
Some of our improvement work will focus on developing palliative care in the community, with providers that people know well. This will extend identification beyond those with cancer. Anyone living with long term conditions and growing frailty would benefit from early palliative care.
But identification is only part of the story.
As important is the coordination of responsive, person-centered services. Services that are delivered through closer, enhanced multi-disciplinary team working. Services that are nearer to people. Services that are geared towards improving continuity between people and their care providers.
You’ll hear more about my work in the coming months. I’d be delighted to learn from your community palliative care initiatives, and to hear your suggestions for improving identification and coordination of palliative care.
Please do get in touch.
The Primary Palliative Care Research Group at the University of Edinburgh have produced a series of videos for people living with declining health and the friends, family members and professionals caring for them.
Early Palliative Care: a video for health and care professionals
This short video aims to help health and care professionals to identify people who are living with progressive illnesses better, to assess their needs in a timely manner and to start discussing and planning future care with them.
Early palliative care improves life’s quality, and in some cases may even prolong life. It promotes realistic medicine, an approach which puts the person receiving health and care at the centre of decision-making.
Clinicians, patients and families can all benefit from carefully integrating early palliative care with on-going treatment, so people can both live and die well.
The information in this video is based on detailed research with patients, families, doctors, nurses and other health and care professionals about people’s experiences living with declining health and dying. ‘Palliative Care from Diagnosis to Death‘ was published in February 2017 in the BMJ.
- Identify people early and introduce early, integrated palliative care
- Consider patients’ different dimensions of need at present, and discuss what matters most to them
- Discuss what happens in the different illness trajectories so they know when they might need the most help
- Make an individual anticipatory care plan with patients and families; document, communicate and review this regularly with all involved
There are accompanying notes and suggested discussion questions available here for anyone using the video for teaching purposes.
How to Live and Die Well: a video for the public, patients and family carers
This short video is for everyone. It’s for people who are well just now, but may get a serious illness or life-threatening condition in the future. For people who currently live with progressive illness. It’s also for family members and carers of those who are ill or may become ill, and who want to learn what can happen in the future so they can plan ahead.
The full video, as well as guidance notes and useful links is available here.
There is an extended version for facilitated group viewing and discussion available here.
Strictly Come Dying
This video discusses the different illness trajectories as though each were a dance with a particular tempo and complexity. Just as knowing the dance will help someone dance well, understanding typical physical and emotional sequences of various illnesses help people live and die well.
Our research group in Edinburgh has studied the last year of life in people dying of various illnesses. We found that people dying from different diseases experience dying differently, as each disease trajectory involves different experiences, needs, ups and downs.
Further reading: Palliative Care: From Diagnosis to Death
Ask Glaswegians about palliative care and many would pay testament to the superb specialist hospices and palliative services within the city, and the care and support received at the end of a loved one’s life.
There are also a host of community staff; dedicated, experienced individuals working along-side specialist services to support the palliative and end of life needs of its population.
But palliative care is not just required at end of life. Many Glaswegians are living with long-term, life-limiting conditions which require on-going care and support within their own home.
Life expectancy in Glasgow is lower than the national average.
You are more likely to die from cancer, smoking-related diseases, heart disease or be hospitalised with COPD.
It’s vital we do all we can to identify those who would benefit from palliative care and ensure that support is available to allow them to live and die well.
My role is to support the testing of ways to improve how we do this, and help share the story of that improvement with others.
With support from Healthcare Improvement Scotland, I hope to work with colleagues and partners to evidence an improvement in identification of palliative care need and care co-ordination.
Glasgow has the largest care home population of any local authority in Scotland and some of the improvement work will focus on the residents of these homes.
The needs of this population are complex. Finding ways of listening to their preferences and supporting them to receive care in what for them is their home may be a challenge, but a worthwhile one.
I believe that improving identification of their needs and wishes, monitoring and planning for change and improving communication with the wider care team will support us to provide person-centred care in the correct setting.
Although care homes are a focus I would welcome any thoughts or ideas for improving identification or care co-ordination for any care group within the community. Please get in touch.
by Laura Dobie, Knowledge and Information Skills Specialist
In December 2017 some of our team went to Oban to learn about how partnership working and a focus on prevention and early intervention is having a positive impact on outcomes for frail older people.
The Oban multidisciplinary team
It is 20th December, and the meeting room at Lorn Medical Centre is packed with colleagues from across health, social care and the third sector. This is what it is like every Wednesday morning, except for the festive touch of the mince pies on the table. It is amazing to see the turnout for this frailty multidisciplinary team meeting, and to learn more about people’s backgrounds, and the skills and knowledge that they bring to the table.
The team meets every Wednesday morning to discuss patients with mild, moderate and severe frailty, and this work is bottom-up and clinician-led. The team is truly multidisciplinary, with representation from social care and the third sector: in addition to GPs, nurses, physiotherapists, occupational therapists, pharmacists and dietitians, a social worker, an exercise professional and the centre manager from North Argyll Carers Centre join the weekly meetings. The team are also supported by an administrative assistant and the practice manager, who runs the electronic frailty index (eFI) on the Vision system. They have also been looking at SPARRA and high health gain data.
The team reported that they get together every week to share information in this way because they find it valuable, not because they have been told to work in this way.
‘The hour spent is much more valuable time spent than the previous way of working where it could take you all week to get in touch with someone. Now you can have that face-to-face conversation and many issues are solved more quickly. It has prevented duplication of referrals and assessments.’
Derek Laidler, Physiotherapy Team Lead, gave us an overview of the Oban reablement project.
Reablement services in Oban are delivered by Healthy Options, a social enterprise. Healthy Options offer interventions for people who are pre-frail. People who are at risk are referred to Healthy Options, and the aim is to build resilience and support the person to prevent decline. The project was a response to funding constraints in primary care and the pressures of increasingly complex patients and an ageing population. It is a demand-reducing model, rather than capacity-increasing.
Healthy Options used to be very much based in Atlantis Leisure Centre. However, there are now classes in villages that people are able to attend. The support offered is both physical and social, and deals with the whole person. This collaboration with the third sector has been in place in the area for a number of years.
Staff use the eFI and the Edmonton Frail Scale to identify people with frailty and direct them towards appropriate support. 100 people have been identified through case finding, and people are referred into the project through clinician concern.
The Oban Living Well initiative is a mild frailty rehabilitation and reablement approach, and the Active and Independent Living Programme has been a driver for the programme.
Derek explained that most physiotherapy referrals are made at a crisis point, which is reactive, and that the benefits are not as long lasting as intervening at an earlier stage: if people go on an exercise programme to maintain the ability to walk 400m, they retain this ability for two and a half years, whereas the benefits of intervening at a later stage and helping people to regain the ability to transfer themselves from the toilet only last six to eight weeks.
The project staff consider that we should be intervening before people are on the Lifecurve, and have produced a list of activities above the Lifecurve, where people should be targeted with early interventions.
Healthy Options would intervene when people are struggling to run half a mile, or run to catch a bus, and physios would intervene when people are having difficulties climbing stairs and getting up from the floor. There is still a role for Healthy Options with very frail patients, but it is limited. However, they can make people who are mildly frail better.
Derek presented some case studies, which demonstrated how exercise programmes delivered by Healthy Options are reversing people’s frailty scores and improving their health and wellbeing. One older gentleman has regained the ability to take the bus independently and engage in social activities again, while an older lady who was afraid of falling now has increased confidence and improved gait and posture after completing a 12-week exercise programme and attending strength and balance classes.
Lianne McInally from the team visited a lady who had been though the programme recently. The lady had a one-to-one assessment by a specialist physiotherapist and support from an exercise instructor to complete a home exercise programme based on OTAGO. The lady reported that she had made improvements in her strength and balance and noted a difference getting in and out of her chair. She also reported increased confidence walking further distances, and has agreed to attend the local leisure exercise class now that she was more confident to go outdoors. A buddy system exists, whereby the individual is paired with someone else from the class. Motivation to attend classes can be poor, particularly when a person is not comfortable initiating conversation, and the buddy system appears to make a difference, encouraging people to attend.
Moderate frailty project
Pauline Jespersen, Advanced GP Nurse, described the moderate/severe frailty project, which is running from October 2017 to March 2018. It is being delivered by four GPs (three qualified GP trainers). The project lead is a district nurse, and a physio, OT and pharmacist are also involved in the project. So far they have scanned 80 patients.
Their referral pathway takes a whole-system approach:
- Edmonton frail scale score 0-5 – Healthy Options
- Edmonton 6-7 vulnerable, 8-9 mild frailty – physio, Lorn and Islands Hospital reablement team
- Edmonton 10-11 moderate frailty – Lorn Medical Centre.
The team are aware of all the options in the third sector and can pass on a referral, where appropriate. Their assessment form records people’s conditions, social circumstances and medication, and they are also using the DeJong Gierveld Loneliness Scale as part of the assessment process.
They have a meeting at 9am on a Wednesday, where they discuss the patients that were identified the week before. The frailty team then have a huddle to allocate work. The team double up to mentor staff and support them with enhanced assessment. Visits for enhanced assessment are an hour minimum.
In the afternoon they have a feedback huddle. In some cases they may need to do de-prescribing, and pharmacy assistants help to manage the change and take away old medication. They have been carrying out evaluation with patients and staff. There have been clinical and MDT tutorials, and nurses are doing formal educational modules. Oban has lost a lot of advanced nurses in recent years, so upskilling staff has been an important part of the project.
The process is as follows:
- Advanced clinical assessment
- Edmonton frail scale
- Polypharmacy review
- Loneliness questionnaire
- Checking ACP and DNACPR are in place
- MDT discussion of findings
Although the team have seen 80 patients so far, they reported that there have been a lot more than 80 contacts. The initial assessment that is conducted is accepted by everyone – they do not have different groups of professionals coming in and conducting their own assessments. Secondary care is involved in the management of moderate and severe frailty, and advanced nurses work across primary and secondary care. There is an emphasis on home care and avoiding hospital admission.
We then went on to visit Healthy Options to learn more about their work. This social enterprise clearly demonstrates how a community-owned resource can meet public health needs. In addition to supporting the reablement programme, they also support other initiatives within the community.
Roy Clunie, one of the directors, observed that there is a growing number of people with chronic conditions, and many of these people’s conditions could be managed or improved through a change to a healthy lifestyle.
Healthy Options was established by the community, and staff are drawn from the health, business, fitness and community sectors. A public health dietitian, Jacqualin Barron is seconded to them one day a week. Healthy Options, Atlantis Leisure Centre and health professionals all work in partnership. The Healthy Options staff are highly qualified, and are entitled to attend NHS training courses.
We went on a short walk from the Healthy Options offices to Atlantis Leisure Centre, where we were able to see some of their staff working with clients. One older gentleman was working on the treadmill and cross trainer in the gym, under the instruction of trainer Kirsty, while two ladies were doing a seated exercise class in the dance studio. All of them were very enthusiastic about the support that they were receiving, and the beneficial impact that it has had on their health.
Healthy Options have worked with Atlantis Leisure Centre to make the gym more welcoming for people who are not typical gym goers. The centre manager removed some of the exercise bikes from the gym to create more space and make it easier for people with a high BMI to use the facilities. The consultation process is co-produced, and people can choose the activities that interest them, whether this is swimming, classes or going on the rowing machine. They offer supervised gym sessions and a healthy living outreach programme at the MS Centre.
In addition to delivering a reablement programme and self-management support, Healthy Options is also working with vulnerable social housing tenants, and they have a part-time health liaison officer. They are also working with partners on a healthy village pilot in Taynuilt, with falls prevention, Healthy Options exercise and classes, tai chi and a self-management class.
An example to develop in other areas?
It is clear that the Oban frailty project’s prevention and early intervention approach is having a positive impact on people with frailty, helping them to maintain their independence and keep up with all the activities that they enjoy, from singing in the choir to walking football. By working together across the whole system in a genuine partnership, and involving a third sector partner that is able to offer tailored support for people in the early stages of frailty, Oban is meeting the challenges of population ageing head on, improving the health of its inhabitants, and supporting people to live as well as they can at home, for as long as they can.
I’ve been a registered nurse for 28 years, starting my career in Northern Ireland. I moved to community nursing in 1996. It was during this time I worked with Marie Curie Nursing Service in Northern Ireland.
I developed a passion for palliative care and worked mainly night-duty, caring for people in their homes and supporting their family.
This work prepared me for the expected loss when my mother died. As many people do, I helped care for her in her own home, where she died with her family around her in March 1999.
I saw first hand the support needed by different members of a grieving family, and what her death meant to them.
In 2001 we moved, with a young family, to South West Scotland and settled in a lovely farm over-looking the sea. I joined NHS Ayrshire & Arran and since then I’ve been supported to work and study caring for people with cancer and palliative care to degree and masters level.
Shortly after our move, my father died suddenly and unexpectedly. This opened up a different perspective on death, which I wasn’t as prepared for.
His death made me realise that there are different reactions to the ways in which people die, and the support needed in the weeks and months after is often different.
These experiences, and what I learned from them, remain with me.
I moved from clinical nursing to work on several palliative care projects improving palliative care in the community, including Gold Standards Framework in 2004 and more recently Macmillan Education Programme for upskilling generalists in palliative care in 2011.
A recent thesis study explored the knowledge and skills required by family members to look after someone who was palliative at home. This was another window into the support needed by families to use equipment, move people and general knowledge for managing medicines.
My interest remains in caring for the individual and their family during this distressing time, when people are often at their most vulnerable.
My aim is that the person can die peacefully in a place of their choosing, and their family will feel supported and cared for while caring for their loved one.
I’ll update you soon on the work I’ve been involved in around palliative beds in care homes.
“Let’s see what I can do to get it.”
Sadie, a resident at Thomson Court Care Home in Bute, is playing hoopla, and is determined to score. Sitting on either side of her are some children from the local nursery, cheering her on: “Go Sadie!”
This is just a normal Wednesday afternoon at Thomson Court, where the residents have regular visits from the children at nearby Apple Tree Nursery.
Inspired by the example of a care home in Canada that had co-located a staff nursery to increase resident contact with children, Unit Manager Sheila Scott wondered if there was the potential to do something similar at Thomson Court. Sheila had noticed that many residents in the home were not seeing their great-grandchildren on the mainland, and Appletree Nursery, where her daughter Stephanie works, is very proactive in working with the community.
Getting the ball rolling
The children first visited the care home in summer 2015, when they helped to paint the fence and planted sunflower and lettuce seeds. ‘Cameron’s Auntie Nan and her friend Sadie made sure that we painted it all,’ reads one of the quotations from the day. The initiative was such a success that it has led to a regular programme of indoor and outdoor activities between the care home residents and the children.
The nursery staff have compiled a floor plan with photographs and feedback from all their sessions, which map activities to health and wellbeing outcomes to demonstrate their beneficial impact. The care home also keeps its own activity records, although they are increasingly using the nursery’s Facebook page to share photographs from the sessions with families.
Looking back over the past couple of years, it is inspiring to see the breadth and variety of activities that have taken place in the care home: ‘dooking’ for apples at Halloween, music and movement sessions, baking and biscuit decorating, puppets and nursery rhymes, and a raspberry tea, to name but a few. At Christmas the children made gifts for the residents and table mats for their Christmas dinner, and Santa came to visit them all. The children have also made cards for the residents for Valentine’s Day and Mother’s Day, and there are plans for the residents to attend a concert at the nursery this Christmas.
The nursery has also helped to raise money to pay for resources that support the residents’ wellbeing. They held a bake sale, which raised enough money to pay for a therapy doll for a resident who has dementia, and the children helped to choose the doll that was purchased. They also raised funds for a material cat and a pram, which are calming for residents.
Benefits for young and old alike
The nursery and care home staff have observed that the intergenerational activities are having a positive impact on both the residents and the nursery children. Sheila comments that the regular Wednesday sessions provide a good break for residents in the afternoon. The residents choose whether or not to attend, and one resident who initially was not interested in joining in the activities because he has a lot of family of his own living locally started to come along when he saw how much fun everyone was having! The daughter of one of the residents has commented that the children ‘generally light the place up’, and that both the residents and the children love it.
Lesley-Anne Lee, the nursery manager, observes that ‘our weekly visit to our Thomson friends has given children new experiences and emotions’ and they appreciate that the residents are teaching the children ‘maybe without them realising’. She also comments that ‘the bond between the vast age differences is a joy to see.’
The nursery children have forged close friendships with the residents, and one of the nursery pupils, Maisie, who has now moved up to primary school, formed a particularly close bond with Barbara, and enjoyed painting her fingernails. ‘Barbara is my friend, she’s my best girl,’ she said, and her father observed that ‘Maisie loves Thomson Court.’
Learning about life
The regular visits have made the children more aware of disabilities, and helped them to learn about the whole of life, including its end. The children visited one of the residents’ rooms to look at old photographs and learn about what her life was like when she was younger, and they have also started a memory garden at the nursery to commemorate residents who have passed away.
Sheila comments that most of the residents have dementia, which affects their ability to communicate, and that the children help to bring them out of their shell. One resident, who previously did not talk very much, became very animated when the children visited.
After an hour packed with games, and a break for cake and juice, it is time for the children to head back to the nursery school. ‘I want to stay at Thomson Court because it’s so much fun,’ pipes up one of the children. Thanks to the hard work and commitment of the staff at both the nursery and the care home, it is easy to understand why they do not want to leave.
To find out more about the intergenerational work at Thomson Court, contact Sheila Scott, Unit Manager: Sheila.firstname.lastname@example.org
by Ian Mountford, Communications Executive, Energy Saving Trust
The ihub Frailty and Falls Assessment and Intervention tool highlights a fuel poverty check as a key consideration when determining if someone is in a safe and suitable environment. Individuals experiencing fuel poverty often find it difficult to heat their home, and are worried about their fuel bills.
If you have identified an individual who needs support, a good place to start is by speaking to Home Energy Scotland. Funded by the Scottish Government and delivered by the Energy Saving Trust, their network provides free, impartial advice to help older people with frailty to:
- save energy;
- reduce heating costs;
- access nationwide or local energy efficiency schemes;
- maximise their income; and
- identify and access any support available from their energy supplier.
Some households have saved £1,000 a year, and others have qualified for free heating and insulation.
Home Energy Scotland welcome referrals and partner with a number of organisations that make use of their easy-to-use online referral portal, where clients can be securely referred and useful feedback can be obtained on referral outcomes. More information on the referral portal can be found in this short video.
Their trained advisors are located in five centres across Scotland, and give advice over the phone or in person. In addition, their community liaison teams support partner organisations with a range of advice and resources.
HES Homecare Pilot
Householders in the Moray East and Annandale and Eskdale health and social care partnership areas can benefit from extra help through a pilot project called HES Homecare. HES Homecare Energycarers visit people whose health makes them vulnerable to cold-related illness, and work with Care and Repair and Warmworks to make those homes easier – and cheaper – to heat. Contact HESHomecare@est.org.uk for more information.
To find out more about how Home Energy Scotland can support older people experiencing fuel poverty, you can visit their website, contact Mark Macleod, Stakeholder Relations Officer, on 0131 555 9151 or email HES_Partnerships@est.org.uk.
First of all I would like to say thank you to all the people who have got in touch with me in this new role as nursing national clinical lead for palliative care at Healthcare Improvement Scotland. Having conversations with like-minded colleagues is just great and, to me, the first step in working towards change and improvement. I am hoping that by engaging with as many teams as possible, I can learn about any particular issues and share best practice – please tell me about any good work going on, too! In providing palliative and end of life care we all have a common goal of getting it right for patients and those important to them at what can be a most difficult time, and we only get one chance to get it right.
In addition to working with six test sites in an advisory capacity, teams I have met to date include leads in NHS 24, Scottish Ambulance Service (SAS), Children’s Nurses, and Care Opinion, as well as teams within HIS and Scottish Government. All these conversations are about how we can ensure dignity at the end of life every time, such as through reducing the risk of inappropriate resuscitation attempts. Not surprisingly, it always comes back to the need for sensitive conversations earlier on in someone’s journey! It is essential that we support staff and teams to be able to have these conversations, which can be highly complex.
In July I attended a session at University College London Hospital recently on Talking DNACPR, and it was excellent. One thing I learned was the 5Ps model for sharing difficult information, based on work in St Christopher’s Hospice. Below is my adapted version:
P Purpose what is the purpose of this interaction?
P People who should be there? The patient/family? Should I take a colleague?
P Preparation what do I need to know?
P Process how will I construct the conversation – should I use a model, e.g. SPIKES?
P Product what is the outcome I expect? E.g. a completed Anticipatory Care Plan or DNACPR form?
I think this could be used as a simple approach when teaching staff.
Spotlight on the Four Principles
I mentioned the four principles from Caring for People in the Last Days and Hours of Life in my last blog post, and HIS have very kindly produced small cards that staff have can have in their pockets or use for teaching students, etc.
Please see below:
If you would like some, please contact: email@example.com.
Compliance with these principles will also ensure excellent delivery of the fundamentals of nursing as advocated in the Nursing and Midwifery Council Code.