PAHT strategy for End of Life Care for adults 2017-2020
End of Life Care encompasses all care given to patients who are approaching the end of their life and following death, and may be delivered on any ward or within any service of a Trust. It includes aspects of essential care, specialist palliative care, bereavement support and mortuary services. ADAPTED FROM CQC (HTTPS://WWW.CQC.ORG.UK/SITES/DEFAULT/FILES/20160713_INDEPENDENT_ACUTE_CORE_SERVICE_ INSPECTION_FRAMEWORK_END_OF_LIFE_CARE.PDF) 1
What do we mean by End of Life Care? We follow the General Medical Council definition of End of Life Care (One Chance to Get it Right 2014) Patients are approaching the end of life when they are likely to die within the next 12 months. This includes patients whose death is imminent (expected within a few hours or days) and those with: a) Advanced, progressive, incurable conditions b) General frailty and co-existing conditions that mean they are expected to die within 12 months c) Existing conditions if they are at risk of dying from a sudden acute crisis in their condition ADAPTED FROM CQC d) Life threatening acute conditions caused by sudden catastrophic events 2
You matter because you are you, you matter to the last moment of your life and we will do all we can, not only to let you die peacefully, but to help you live until you die. DAME CICELY SAUNDERS 3
Purpose of the plan Our Trust serves the population of West Essex and East and North Hertfordshire. Evidence suggests that nationally up to 10% of inpatients will die during hospital admission and almost one in three will have died a year later, rising to one in two in those over 85 (National Intelligence Network 2015). This highlights that end of life care is very much a key focus of care for an acute Trust. Within our Trust there were 1,017 deaths in 2014/15 and we recognise that it is our responsibility to provide skilled and compassionate evidence based care. By setting out our objectives in this strategy we aim to improve identification of our patients within their last year of life, to have honest conversations with them to enable holistic care planning and management and to ensure a compassionate and competent workforce to improve safety and the experience of our patients and those close to them. 4
Factors considered for the plan National end of life intelligence network Ambitions for Palliative and End of Life Care, a national framework for local action 2015-2020 Leadership alliance for the care of dying people (2014) The work of the dying matters coalition NICE quality standards - care of the dying adult (2017) NICE guidelines for care of the dying adult (2015) NICE guidance on Palliative care for adult patients with cancer (2004) PAHT values, standards and behaviours Feedback from patients and families Feedback from staff 5
End of Life Care Vision To ensure all patients in their last year of life receive the best possible care Philosophy Quality First Our Time is Precious Objectives To provide an end of life service with our local health economy that is dynamic so that it meets the needs of individual patients. To have the skilled staff to support and prepare patients and families to make informed plans of care. To ensure symptom and psychological needs of patients and their families in the last year of life are met where ever they are in the health economy. To ensure that all patients, in their last days of life have the death they planned. 56
End of life care is a true quality barometer for an organisation. The trust's quality first improvement strategy encompasses all the quality improvements to deliver the end of life strategy and sits under the patient focus work stream. Patients who have palliative care needs, is approaching the end of life, is dying or bereaved will receive high quality personalised care and support. This care and support will be delivered in a compassionate and respectful way by empowered staff who take responsibility and are prepared for this role as part of a robust training and development programme. We are committed to partnership working and recognise that this is essential for efficient coordinated care to be delivered and patient choices to be addressed. Measures: The strategy is in line with the 6 ambitions for Palliative and End of Life Care: A national framework for local action 2015 to 2020 (National Palliative and End of Life Care Partnership 2015). The trust has outlined four objectives that encompass all six ambitions for end of life care. These will be measured through continuous monitoring of improvements, bench marked against the 6 ambitions. 7
Achieving the 6 ambitions 1. Each person is seen as an individual 2. Each person gets fair access to care 3. Maximising comfort and wellbeing? 4. Care is coordinated 5. All staff are prepared to care 6. Each community is prepared to help 8
1. Each person is seen as an individual I and the people important to me, have opportunities to have honest and timely conversation and to know that I might die soon. I am asked what matters most to me. These that care for me know that and work with me to do what s possible. We will: Recognise people that may be in their last year of life or whose death is imminent. Have honest and well-informed conversations about dying, death and bereavement. Offer holistic assessment and advance care planning including discussion of resuscitation (DNACPR) with the person if possible, and those identified as important to them, honestly and in a timely manner. Ensure people know what they should expect as they reach the end of their lives. Enable people who are living with terminal illness to make choices for their care. Have an individualised care plan for the anticipated last days of life that reflects the 5 Priorities for Care (LACDP 2014); Recognise, Communicate, Involve, Support and Plan and Do. To have assessment for spiritual care, hydration and nutrition review, preferred priority for care / death, medication review, clinical intervention review and bereavement support. Ensure those identified as important to the person is able to remain with the dying person day and night if needed and that they are offered support, including practical help such as refreshments and parking permits. 9
2. Each person gets fair access to care I live in a society where I get good End of Life Care, regardless of who I am, where I live or the circumstances of my life. We will: Work with the local CCGs, hospices and community services to share information efficiently and effectively. Use outcome measures to evaluate and improve person centred care. Increase identification of people in their last year of life with diseases other than cancer including dementia, respiratory conditions, neurological conditions and organ failure. Work with the community and hospices to reduce variations in aspects of End of Life Care such as access to medications and choice of care setting. Be aware of any barriers which may hamper individualised fair access to care such as: language barriers, learning disabilities, physical barriers e.g. hearing and visual problems, etc. 10
3. Maximising comfort and wellbeing My care is regularly reviewed and every effort is made for me to have the support, care and treatment that may be needed to help me be as comfortable and as free from distress as possible. We will: Provide personalised care planning by implementing the individualised care plan for the anticipated last days of life and reviewing care on a daily basis and more frequently if needed. Work together as a multi-professional team with the person and those identified as important to them to provide compassionate care. Ensure an adequately staffed specialist palliative care team, including specialised psychological support, to provide support and guidance for the person, those identified as important to them and the healthcare professionals involved in their care. Have a team of specialists who have received specific training and qualifications in palliative care or acquired substantial practical experience, to include site-specific cancer nurse specialists, cancer counsellors, cancer information nurses/other professionals, specialist allied health professionals, physicians in palliative medicine and palliative care nurse specialists. Educate and support the staff to be able to identify and respond to those people who are dying and consequently improve symptom control and provide skilled and compassionate care. Provide access to appropriate environments including private areas to discuss significant news. 11
4. Care is coordinated I get the right help at the right time from the right people. I have a team around me who know my needs and my plans and work together to help me achieve them. I can always reach someone who will listen and respond at any time of day or night. We will: Work with national initiatives, local CCG s, hospices and community services to share information efficiently and effectively. Implement a framework for providing and monitoring care for people who are not responding to treatment and whose recovery may be uncertain. (e.g. AMBER care bundle). Increase access to the specialist palliative care team face to face 7 days a week and to specialist palliative care advice 24 hours per day. Develop ward based End of Life Care champions. 12
5. All staff are prepared to care Wherever I am, health and care staff bring empathy, skills and expertise and give me competent, confident and compassionate care. We will: Promote the Trust values, standards and behaviours. Provide support to staff, promote motivation, job satisfaction through initiatives such as appraisals and other forms of continuing professional development. Demonstrate learning from complaints and sharing peoples experiences. Have an end of life steering group that has robust reporting pathways to ensure Trust Board are kept informed and involved and ensuring clear governance from ward and departments to Board level. Trust wide recognition that End of Life Care is everyones' business. Have mandatory end of life training for all new clinical staff. Collaborate with other palliative care providers to develop education programmes across all settings, promoting networking and shared learning initiatives across boundaries. Audit and provide action plans to evaluate end of life care. 13
? 6. Each community is prepared to help I live in a community where everybody recognises that we all have a role to play in supporting each other in times of crisis and loss. People are ready, willing and confident to have conversations about living and dying well and to support each other in emotional and practical ways. We will: Work with our local communities to promote public awareness of death and dying and of where support can be accessed. Work with the CCG, community services and hospices to break down boundaries and create a compassionate and resilient community. Extend the current volunteer service to support people who are dying alone (unbefriended). Work with all healthcare and social care providers to share elements of good practice and challenges e.g. yearly local palliative care conference, displaying audits and practices. 14
Our achievement of the six key ambitions will be continuously monitored and bench marked locally and nationally to identify and prioritise areas for improvement. Quality assurance dashboards and trajections will be shared to transparently identify quality achievement. 15
PAH STRATEGY FOR END OF LIFE CARE FOR ADULTS - 2016/17-2020 Implementation of the strategy will be monitored through the Trust's End of Life Care steering group. There will be quarterly reports to the quality and safety committee and yearly reports to the Trust Board. The Trust will continue to be involved in the local End of Life Care work streams in West Essex and East Hertfordshire. 16