Theresa Richards
Betsi Cadwaladr University Health Board
Project Scope:
The six steps palliative and end of life care education programme was implemented by the Macmillan End of Life Care Plan Facilitation team in 2013 to provide end of life care training across North Wales to Nursing homes that will result in high quality care and improved outcomes and experiences for their patients and families. It is vital that residents have access to timely, skilled care and support as this can avoid unnecessary emergency admissions to hospital, and can enable more people to live and die in the place of their choice. Up to date 75 care settings and 122 champions have gone through the programme . Work continues with Flintshire county Council who we have been successfully working with throughout the programme. Key Stakeholders include BCUHB and Macmillan cancer support.
Starting Conditions:
We focused on 12 Nursing Homes in North Wales (west) that took part in the six steps programme which took place between November 2015 and July 2016. This was delivered by the Macmillan End of Life Care Plan Facilitation Team at BCUHB.
There were 20 registered nurses who attended the programme of workshops; seven half day and one full day session.
- Step 1 Discussions as the end of life approaches
- Step 2 Assessment Care Planning and Review
- Step 3 Co-ordination of Care
- Step 4 Delivery of High Quality Care in Care Homes
- Step 5 Care in the Last Days of Life
- Step 6 Care after Death
Venues were organised close to the areas where care homes were situated.Lewin’s forcefield was used to identify the drivers and resistors to change . Attended meetings with influential drivers within the organisation. Spoke to resistors within care home sector who did not understand the impact or potential of the programme. It was important to find out the values of the organisation in relation to palliative and end of life care, we used the McKinseys 7s model.
Shared Values
The All-Wales End of Life Care Delivery Plan (WG 2016). Residents in care home settings in North Wales have quality palliative and end of life care. The organisation supports care home staff to improve their knowledge and skills in palliative and end of life care to aid reductions in unscheduled admissions into secondary care.
Goals & Targets:
That all nursing and residential homes in North Wales have had opportunity to attend the six steps to success programme.
That BCUHB promote the programme in all care settings .
Key targets include:
- Unscheduled admissions into secondary care from care homes reduced.
- Residents have a choice in their care plan / advance care planning offered.
- All residents have a key worker.
- Deaths in hospital reduced.
- Out of hours admissions reduced.
- Bereavement support to other residents.
- Knowledge skills and confidence of staff improved.
Interventions and Plans:
- To continue working with Flintshire county council and discuss options with Wrexham county Council to promote the programme.
- Hold two awareness days to promote the programme.
- All Nursing homes in Wrexham North Wales to go through a six-steps programme.
- Commence a palliative and end of life care programme in secondary care across North Wales.
- To secure funding for permanent staff in the team.
- To maintain support of senior drivers within organisation.
- To continue and promote audit data.
- To cascade the programme across Wales.
- To ensure sustainability of the programme.
- To maintain quality by providing regular updates for staff who have attended the course.
- To achieve accreditation for the course.
- Develop a web resource.
Outcomes:
All goals and targets have been achieved for this project.
Pre- and post-data results of the knowledge skills and confidence of staff who took part in the programme in the west area of North Wales.
(Pre-November 2015 to post-July 2016)
| Pre (n=84) | Post (n=59) | |
| Resident identified on end
of life register? |
12% | 75% |
| Advance care plan in
place? |
37% | 66% |
| Key worker identified? | 14% | 85% |
| Preferred place of death
documented? |
68% | 78% |
| Unscheduled admissions | 15 | 7 |
| Out of hours admissions | 7 | 3 |
| Deaths in hospital | 13 | 5 |
| Bereavement support offered to other residents | 23% | 92% |
Pre- and post-data results from the west area (North Wales)
Fit with Prudent Healthcare:
- Inappropriate variation reduced due to the same evidence based training programme implemented in all care settings across North Wales.
- The six steps programme provides a cost effective and efficient method of disseminating best practice in end of life care.
- Residents have a say in their health care choices, allowing co-production and equality.
- There is a robust clinical governance system underpinning this project and this ensures quality and safety for the residents/patients and their families.
- Promotes equitable and consistent practice.
