The Royal Wolverhampton NHS Trust Trust Board Report Meeting Date: 20 th February 2015 Title: Executive Summary: Position statement for Trust Bereavement Services The Trust offers a good bereavement service and an end of life service which requires a framework previously offered by the use of the Liverpool Care Pathway (LCP). Whilst there are examples of good practice there is always room for improvement and this report outlines the start of that improvement journey. From June 2014 five new Priorities for Care replaced the Liverpool Care Pathway (LCP) as the new basis for caring for someone at the end of their life. The new priorities have been created by a coalition of 21 organisations known as the Leadership Alliance for the Care of Dying People (LACPD), of which CQC is part. The ethos of the Alliance s five priorities for care is mirrored in CQC s new inspection approach to make sure that people receive safe, effective and compassionate care at the end of their life. End of life care is one of the eight core services looked at during hospital inspections This report outlines service improvements to create an integrated approach to end of life and bereavement care, ensuring compliance to the 5 priorities and improving bereavement care Trust wide Action Requested: Endorsement Report of: Author: Contact Details: Cheryl Etches, Chief Nurse Lynne Fieldhouse, Deputy Chief Nurse Resource Implications: Public or Private: (with reasons if private) Public References: (eg from/to other committees) Appendices/ References/ Background Reading http://www.nice.org.uk/guidance/qs13 One chance to get it right Improving people s experience of care in the last few days and hours of life (June 2014) Leadership Alliance for the care of dying people. Quality Standard for end of life care for adults (NICE,
2011). Gold Standards Framework. National Council for Palliative Care. National End of Life Programme, 2011. NHS Constitution: (How it impacts on any decision-making) In determining this matter, the Board should have regard to the Core principles contained in the Constitution of: Equality of treatment and access to services High standards of excellence and professionalism Service user preferences Cross community working Best Value Accountability through local influence and scrutiny
1. Background Details Caring for a person at the end of their life, and after death, is enormously important and a privilege. How people die remains in the memory of those who live on. The Trust offers a functional bereavement service and an end of life service which requires a framework previously offered by the use of the Liverpool Care Pathway (LCP). Whilst there are examples of good practice there is always room for improvement and this report outlines the start of that improvement journey. Drivers for change. There is only one chance to get it right and it is not at all easy to coordinate everything that needs to happen. This strategic direction will help with that, putting the patients, the deceased and their carers as the focus of care, whilst balancing the needs of the legal and coronial system and the health and safety of staff. In October 2013 Following the independent review of the use of the Liverpool Care Pathway (LCP) for the Dying Patient there has been the phasing out of the LCP. From June 2014 five new Priorities for Care replaced the Liverpool Care Pathway (LCP) as the new basis for caring for someone at the end of their life. The new priorities have been created by a coalition of 21 organisations known as the Leadership Alliance for the Care of Dying People (LACPD), of which CQC is part. The ethos of the Alliance s five priorities for care is mirrored in CQC s new inspection approach to make sure that people receive safe, effective and compassionate care at the end of their life. End of life care is one of the eight core services looked at during hospital inspections. The new Priorities for Care mean that: The possibility that a person may die within the coming days and hours is recognised and communicated clearly, decisions about care are made in accordance with the person s needs and wishes, and these are reviewed and revised regularly by doctors and nurses. Sensitive communication takes place between staff and the person who is dying and those important to them. The dying person, and those identified as important to them, are involved in decisions about treatment and care. The people important to the dying person are listened to and their needs are respected. Care is tailored to the individual and delivered with compassion with an individual care plan in place. Trust response Improving end of life pathways is a Trust objective with an Executive Director sponsor- Chief Operating Officer. Improving the quality of bereavement care is within the quality agenda of the Chief Nursing Officer. Ensuring compliance to the 5 priorities and improving bereavement care trust wide is being managed within the Trust s service improvement framework of Creating Best Practice and form a work stream within that framework. Getting it right is everyone s responsibility Work is underway to improve the viewing facility in the mortuary Proposed service improvements To create an integrated approach to end of life and bereavement care which will be symbolised
by the Swan logo This imagery will be synonymous with end of life and bereavement and used on relevant documentation, trigger signage on wards to ensure a calm and respectful environment, on memory bags used to transport the personal effects of deceased patients currently use a generic polythene carrier bag) and used on literature given out from the bereavement office. The rationale for use of this imagery is for it to trigger a compassionate response from any staff member, it is also envisaged, in tandem with awareness raising and education, it will allow us to challenge the paradigm that staff should avoid disturbing those who may be dying or grieving but re-personalise the process of death and give staff permission to offer help or support. This symbol will be used in a wide variety of situations from direct care givers knowing the patient is end of life, to alert staff to the presence of deceased patients, to trigger kind communication, respectful care of visitors through to seeing members of the public, for example, on Trust sites with the memory bags and being empathetic and supportive To adopt some of the award winning practices showcased by the Salford Royal NHS Foundation Trust including: offering the families of end of life patients keepsakes such as photographs( of hands) and handprints(similar to the hands and footprints we currently offer bereaved parents) locks of hair( taken discreetly from behind the ear and presented in an organza bag not as present in a brown envelope) Currently piloted in Mortuary returning jewellery in a ring/small box rather than a brown envelope having a book of remembrance available in the bereavement office within the considerations of infection prevention and control offer the bereaved, or patient as appropriate the choice of their care after death being clothed in nightwear or day wear rather than a disposable paper shroud. Currently being offered on ward C25 consideration of sending a condolence card, Work streams exploring designs introduction of bereavement boxes in inpatient areas with all relevant equipment available, these would be combined with the current chaplaincy boxes Adoption of the revised documentation and patient/career leaflets produced by the End of Life work stream Palliative team intranet page is being updated and will have links to what will be the Swan page, the intranet page will also have guidance for staff regarding the completion of the care in the last days of life document Refreshing the Trust bereavement booklet currently being undertaken as part of work stream Renaming the Mortuary the Swan Suite for discrete communication in public areas of within earshot of the public Strengthening clinical practices for care after death to provide a more compassionate experience for the bereaved and dignified practice for the deceased Physical care given by healthcare staff following death in care settings has traditionally been known as last offices this will now be referred to as care after death a term more befitting our
multi-cultural society, and moving away from the link with the military and religious origins of nursing and the association with last rites (a Christian sacrament and prayer administered to the dying), and because last offices traditionally only applied to the physical preparation of the body. To develop Swan Champions across the Trust workforce Facilitating waiving car parking charges to bereaved families visiting the sites to collect death certificates, view the deceased or having had an emergency call into hospital. Facilitating a family member staying overnight with dying relative Provision of training and awareness opportunities using existing induction, communication forums and current and bespoke educational programmes Development of website both intranet and internet The progress of the developments will be reported through the Creating Best Practice Steering Group