and End Care Competency Framework Overarching Principles NICE Guidance expects that health and social care workers have the knowledge, skills and attitudes necessary to be competent to provide high quality care and support for people approaching the end of life and their families and carers. (NICE Quality Standard QS13 End Care for Adults, Statement 15 (Workforce Training) This document aims to provide guidance on these expected areas of competency. It is closely aligned with the and End Care Model. Competency to provide high quality Palliative and End of life Care is built on key foundations expected of all involved in the of Health and Social Care including: Provision of care that is safe, effective, responsive caring and well led Provision of care that is compliant with legislative requirements and best practice guidance A person centered approach to care involving the person in the decisions about their treatment and care to the extent the person wants and that follows guidance in the mental Capacity Act (2005) Open, honest and sensitive communication with patient and those important to them Care which is coordinated and delivered with kindness and compassion In order to support people in Pennine Lancashire to live well before dying with peace and dignity in the place of their choice, all individuals involved in their care need to demonstrate competency across a number of areas There are three distinct sections: Universal Competencies are aimed at all people providing some element of care to those requiring palliative or end of life care in generalist settings where life care is not core Core Competencies are aimed at all people providing significant amount of care to those requiring palliative or end of life care in settings where life is considered core Specialist Competencies are aimed at all people providing complex care to those requiring specialist palliative or end of life care in settings specialising in the of this care Core competencies build on universal competencies, specialist competencies build on both core and universal competencies; each section should not be viewed in isolation. The Framework deliberately focuses on generic competencies applicable to all groups of staff that can be further broken down and adapted into specific learning objectives to meet the requirements of different roles and individual needs. This document should be used by staff and their managers to identify areas for future development on commencement in post and at their annual Personal development Reviews. Personal Development plans should highlight what development is needed to achieve relevant competencies. Document author: and EoLC Steering Group Version: 1 Date of publication: July 2016 Review Date: July 2018 Page 1
and End Care Competency Framework The Elements of Dedicated Palliative Care model applies throughout the stages of the North West End Care Model Elements of Dedicated Palliative Care Details of education opportunities available across the area are documented in the Pennine Lancashire Palliative and End Care Training and Education Directory and can be cross referenced by the letter and number for each competency to aid selection. Level of Patient Needs Specialist Palliative Care Services Core Palliative Care Services Packages of Care Universal Palliative Care Services 1 2 3 4 5 First Days after Death Bereavement Document author: and EoLC Steering Group Version: 1 Date of publication: July 2016 Review Date: July 2018 Page 2
Universal Palliative Care Services Universal Competencies are aimed at all people providing some element of care to those requiring palliative or end of life care in generalist settings, where life care is not core U1 Define life care explaining when this care is appropriate for their client group U2 Understand the concept of Advance Care Planning including: preferred priorities of care, Advance Decisions to Refuse Treatment, Lasting Power of Attorney, DNACPR, Goals of care and support discussions about these with people affected by life limiting illness U3 Apply communication skills to open conversations that are clear, sensitive and honest with people and those important to them, including recognition of disease progression, treatment options, care options, exploration of their experiences, needs, priorities and choices U4 Demonstrate effective ongoing, regular communication with others involved in the person s care and have awareness of Electronic Palliative Care Coordination System (EPaCCS) U5 Demonstrate the ability to conduct, a holistic assessment of the person s needs, choices and priorities and to develop, review and evaluate a responsive plan of care U6 Understands the 5 priorities of care for the dying patient as identified in the One Chance to get it Right document and NICE guidance on Care of Dying Adults applying these to individualised care planning in the last days and hours of life U7 Know how to effectively manage symptoms and understand the services available in life care, referring and involving the Multi-disciplinary team as appropriate U8 Demonstrate the ability to contribute to decisions regarding nutrition and hydration at end of life U9 Demonstrate compassionate of holistic care to the person and those close to them meeting their needs, respecting their choices and addressing their priorities U10 Understand how to respond to people who are experiencing a decline in their health and wellbeing U11 Understand indicators of potentially reversible causes for deterioration U12 Explain how to arrange access to appropriate treatment for reversible causes of deterioration in line with the person s identified choices U13 Evaluate the experience of the deceased and those important to them, reflecting on what went well and what could be improved and sharing the learning with others U14 Demonstrates the ability to evaluate the quality of care provided to ensure high quality life care is being provided by all involved Document author: and EoLC Steering Group Version: 1 Date of publication: July 2016 Review Date: July 2018 Page 3
Universal Palliative Care Services Universal Competencies are aimed at all people providing some element of care to those requiring palliative or end of life care in generalist settings, where life care is not core UA15 Recognise indicators of disease progression in order to identify people entering the palliative phase of their illness UI16 Recognise indicators of increasing decline UL17 Recognise indicators that suggest a person is entering the last days of their life UL19 Demonstrate effective communication with the Multidisciplinary team and contribute to agreement that the patient is in the last days of life. Leading MDT meetings if appropriate to their role UL21 Demonstrate ability to organise support to ensure the person is cared for in their preferred place of care where possible including rapid discharge for the dying patient if preferred place of death is at home (discharge within 24 hours). UC18 Recognise indicators that death has occurred and know how to organise or conduct verification of death UC20 Understand requirements regarding certification of death knowing when and how to liaise with the coroner UC22 Know what literature is available and may be helpful to those important to the deceased person UC23 Demonstrate compassionate care of the deceased body and belongings in line with their previously expressed wishes UC24 Demonstrate effective communication with others involved in the person s care and ensure all involved are aware of the person s death UC25 Demonstrates ability to verify death as appropriate to role Document author: and EoLC Steering Group Version: 1 Date of publication: July 2016 Review Date: July 2018 Page 4
Core Palliative Care Services Core palliative care services (C) Core Competencies are aimed at people providing significant amount of care to those requiring palliative or end of life care in settings where life is considered core All the competencies outlined above plus those listed C1 Demonstrate ability to act promptly and appropriately when a person s condition deteriorates, assessing if there are any potentially reversible conditions and putting in place measures to treat reversible conditions in line with the person s identified choices C2 Understand the role of the Key Worker and demonstrate ability to carry out the role of Key worker as required through all phases of the person s illness as relevant to their role C3 Apply communication skills to open conversations about diagnosis, prognosis, treatment options, care options and Advance Care Planning, offering people an opportunity to consider their choices for future care C4 Demonstrate ability to assess if DNACPR and deactivation of internal cardiac defibrillator (ICD) is appropriate for the person, obtaining information to support decision making, recording and communication of this to the person and those important to them and others involved in their care in a timely manner. Medical Staff will lead on decision making, recording and communication C5 Demonstrate effective communication and co-ordination of care including recording the end of life care status on the Gold Standards Framework register, updating Out of Hours/North West Ambulance Service on plan of care and including use of Electronic Palliative Care Coordination System record C6 Demonstrate ability to conduct an effective, responsive and timely carer s assessment so that the needs of those identified as important are explored, respected and met as far as possible from diagnosis of a life limiting illness through into bereavement C7 Demonstrate the of care, advice, support, including non-drug interventions and prescribing, monitoring their impact to effectively manage symptoms, avert foreseeable crisis and meet the person s needs, choices and priorities, as appropriate, communicating with others involved in care as required C8 Understand how other services can support the person and those close to them, providing information, signposting and coordinating referrals as required to meet needs and choices C9 Demonstrate appropriate involvement of other services that can support the person and those close to them, providing information, signposting and coordinating referrals as required to meet needs and choices C10 Demonstrate the ability to review the package of care and equipment in place and organise for increased, additional equipment and support as required C11 Demonstrate ability to assess if DS1500 is appropriate for the person and communicate this to the person, those important to them and others involved in their care Document author: and EoLC Steering Group Version: 1 Date of publication: July 2016 Review Date: July 2018 Page 5
Core Palliative Care Services Core palliative care services (C) Core Competencies are aimed at people providing significant amount of care to those requiring palliative or end of life care in settings where life is considered core C12 Demonstrate the ability to evaluate, select and implement effective strategies to manage common symptoms, understanding the services available in life care, referring and involving the Multi-disciplinary team as appropriate C13 Demonstrate ability to provide advice and care to people with life limiting illness, those important to them and others involved in care to effectively manage symptoms C14 Demonstrate the ability to support the of formal and informal education for universal palliative care services to ensure high quality life care C15 Demonstrate the ability to evaluate the quality of care provided to provide assurance that high quality palliative and end of life care is being provided C16 Apply problem solving to situations where there are difficulties achieving high quality life care in order to ensure the best possible outcome for the person and those close to them CI17 Demonstrate ability to assess if Anticipatory Prescribing is appropriate for the person and communicate this to the person, those important to them and others involved in their care. Prescribing anticipatory drugs as relevant to your role CI18 Understand the importance of conducting regular reviews of the person s condition and increase frequency of visits to facilitate this CL19 Demonstrate ability to organise support to ensure the person is cared for in their preferred place of care where possible including rapid discharge for the dying patient if preferred place of death is at home (discharge within 24 hours) CC20 Demonstrates ability to verify death as appropriate to role Document author: and EoLC Steering Group Version: 1 Date of publication: July 2016 Review Date: July 2018 Page 6
Core Palliative Care Services Core palliative care services (C) Core Competencies are aimed at people providing significant amount of care to those requiring palliative or end of life care in settings where life is considered core CC21 Demonstrates ability to signpost bereavement follow up options for future consideration CC22 Understands grief and bereavement as a normal process and is able to demonstrate understanding of when distress indicates support from counselling services is required CC23 Understands when and how to refer people to specialist counselling services CC24 Lead on evaluation of the experience of the deceased and those important to them within own services and across others involved in care, reflecting on what went well and what could be improved and sharing the learning with others Document author: and EoLC Steering Group Version: 1 Date of publication: July 2016 Review Date: July 2018 Page 7
Specialist palliative care services (S) All the competencies outlined above plus those listed S1 Demonstrate the ability to carry out holistic assessment of complex changing needs, throughout all phases of life limiting illness and across all diagnosis Specialist Palliative Care Services Specialist Competencies are aimed at all people providing complex care to those requiring specialist palliative or end of life care in settings specialising in the of this care S2 Demonstrate ability to work collaboratively and alongside the patient s core services and key worker S3 Demonstrate ability to provide expert advice and care to people with life limiting illness, those important to them and others involved in care to effectively manage complex symptoms S4 Demonstrate the ability to evaluate, select and implement effective strategies to manage complex symptoms S5 Apply advanced communication skills to hold difficult and challenging conversations with people with life limiting illness and those close to them S6 Demonstrate ability to appropriately discharge patient s when their specialist needs have been met ensuring safe and seamless transfer of care S7 Lead on evaluation of the experience of the deceased and those important to them within own services and across others involved in care, reflecting on what went well and what could be improved and sharing the learning with others S8 Apply advanced problem solving to situations where there are difficulties achieving high quality life care in order to achieve the best possible outcome for the person and those close to them S9 Demonstrate the ability to provide formal and informal education for core and universal palliative care services to ensure high quality life care S10 Demonstrate skills in the research and development of universal, core and specialist life care services SC11 Demonstrate ability to provide bereavement support relevant to role SC12 Demonstrate ability to provide counselling relevant to role Document author: and EoLC Steering Group Version: 1 Date of publication: July 2016 Review Date: July 2018 Page 8