The East of England ABC End of Life Education Programme in Care Homes

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The East of England ABC End of Life Education
Programme in Care Homes

• Sarah Russell
• Mount Vernon Cancer Network ABC Project Lead
• On behalf of the team
• Seconded from The Hospice of St Francis,
  Berkhamsted
• sarah.russell_at_stfrancis.org.uk
• 25th September 2012

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• The ABC End of Life Education Programme in Care
  Homes
• What is the programme?
• How does it link into other education out there?

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What is it?

• A 2 year, NHS East of England funded and
  specifically designed care home end of life
  education programme
• Delivered and evaluated (using the same tools)
  across the whole of the East of England 2011
  -2012
• Anglia, Essex, Beds, Herts and Luton
• Uses End of Life Facilitator Educators (EFEs)
  providing a blended learning package in the care
  home setting
• 4 WTE in Hertfordshire
• 1 WTE Bedfordshire, 1 WTE Luton
• They are also simultaneously delivering a
  community and hospital end of life education
  programme

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The process

• 6 core end of life modules plus follow up
  workshop
• Learners and Managers evaluation and action plan
• Identification of 3 care home champion roles
• End of Life,Learning, Quality
• Care home end of life standards
• Pre and post
• Audit of care home resident notes
• Benchmark of end of life polices and procedures
• Learners confidence in end of life care
• Managers and Learners evaluation of the programme
• Analysis of hospital non elective admission data
• Transferable national accreditation and
  certificates

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• The Modules
• Overarching principles
• Assessment and care planning
• Comfort and well being
• Communication skills
• Advance care planning
• End of life tools
• Follow up workshop
• Due this year Caring in the last
  days....................

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Title
Diagnosing dying (weeks, days, hours)
Patient choices
Signs of dying
Physical care
Physical comfort
Last offices
Emotional care
Involving the family
Communication
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Overview of structure
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NHS East of England Care Home Education Programme
in Mount Vernon Cancer Network
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In our area also includes

• Champion follow up workshops
• Care Home Standards
• Advance Care Plan Check List
• Ongoing support
• Linking into other education

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NHS East of England Care Home Education Programme
in Mount Vernon Cancer Network
Has completely changed staff attitudes toward
death, and end of life care. The importance of
treating our residents as individuals and putting
their needs and wishes in front of all others
Care Home Manager
Preferred Priorities for Care document has acted
as a catalyst for initiating and embracing
conversations that no-one wants to start. Care
Home Learner
All care staff need to be equipped to deal with
all of the situations in the programme. It was
more than an education programme, it results in a
change in thinking, attitude and priorities
End of life care has improved dramatically in
the home. We now have more and more good
deaths
Following the E-learning we now realise how
important care of the residents family is. We
have cleared a room which relatives can receive
support and privacy in. Feed back from relatives
from this have been very positive. Care Home
Learner
Valuable course and I want all my staff to
complete this in the future. I would definitely
recommend care home staff to attend this
programme
Fabulous initiative and I know the homes have
welcomed the input Thank you
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End of Life Scrutiny May 2012

• Recommendations for Health Community Services
• Health Community Services accreditation
  criteria of care and nursing homes recognises end
  of life training and provides financial
  assistance in partnership with health colleagues
  to enable continuation of the training programme
• The training, whether based in a care home
  setting or through educators leading sessions for
  health centre staff, enables staff involved in
  end of life to develop the confidence to raise
  sensitive issues and initiate difficult
  conversations.

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1. The East of England End of Life Education
   Programme is proving to be effective
2. Member visits to care and residential homes
   highlighted to members the good practice in the
   county.
3. It is clear that end of life training increases
   staff confidence and the ability to support
   people to die in their preferred setting.
4. The result is fewer transfers (to hospital,
   hospice etc) and this included a care home for
   clients with profound dementia.
5. Members heard that not all care home had received
   end of life training, therefore there was
   inconsistent practice across the county.
6. The group would like all homes providing care on
   behalf of Hertfordshire County Council (HCC) to
   undertake both the end of life training and to
   adopt the strategy.
7. Accreditation should be a factor in selecting the
   provider.

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IPU Keech Hospice
DN HCHS
Educ Hospice of St Francis
DN Bedford
Educ Peace Hospice
CNS/Educ Isabel Hospice
Peace Hospice, Hospice of St Francis, NHS EOE
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How does it link into other education?
End of Life and Cancer Education Steering Group
East and North Herts
The Cancer Centre
West Herts
Beds and Luton
Watford General Hospital Macmillan Team The Peace
Hospice The Hospice of St Francis Iain Rennie
Grove House Community Macmillan Nurses Community
Nurses University
Isabel Hospice Garden House Hospice Community
Macmillan Nurses Hospital Macmillan
Nurses Community Nurses University
Keech Hospice Community Palliative Care
Team Hospital Palliative Care Team Community
Nurses University
Oncology Team Palliative Care Team University

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Why do the ABC programme?

1. It makes a difference to care and to you
2. It increases individuals dying in their care home
3. It is accessible and flexible
4. It comes with a mentor and they are stars!
5. It comes with an ongoing relationship
6. It provides a nationally recognised course

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After Coffee Interactive session

1. Look at the programme
2. Look at the resources
3. Discuss and reflect together

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• Care home champion experiences
• What is the experience in Hertfordshire
• Lessons learnt

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Mapping the programme to Skills for Care End of
Life Qualifications
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End of Life qualifications mapping template EOL
201
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Sustaining the programme through the Training
the Trainer pilot
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End of Life Champion Purpose to maintain the
passion and focus on end of life care in your
setting through the encouragement and support of
your staff as well as working with the manager to
ensure relevant policies, documentation and
procedures are in place. Learning
Champion Purpose To facilitate new and current
staff in end of life learning either though
participation in the End of Life education
programme delivered by yourself or by your
educator mentor. Encourage and source
opportunities of extra learning available
locally. Quality Champion Purpose To enable the
accurate measuring and reporting of good end of
life care through regular audit , surveys and
systematic reporting. This enables you to be able
to demonstrate for inspections (e.g. Care Quality
Commission, Commissioners), residents and clients
about the quality of the care you provide. It
also enables you as a care home to be able to
share good practice or learn different ways of
doing things
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Sustaining the programme through the Training the
Trainer pilot

• 18 homes
• 6 in Herts
• 6 in Essex
• 6 in Anglia
• Oct 2012 March 2013
• Aim is to enable the
• learning champions to
• deliver the training in
• their own settings

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Formal Evaluation

• What evidence is there that TtT increases
  residents (and where appropriate family members)
  care home and NHS staff, engagement with advance
  care planning and ongoing conversations about end
  of life care?
• What impact does the TtT have on care home
  staffs confidence, reported knowledge, symptom
  assessment and management and involvement with
  NHS services when providing end of life care?
• What are the costs?
• What were the barriers and facilitators to the
  implementation of the programme?

• University of Hertfordshire
• Independent evaluation
• from a credible academic
• and knowledgeable source

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Mixed Method

• Observation
• Questionnaires
• Audio Diaries
• Interviews plus 3 focus groups
• After death analysis and review of care and
  resources used

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The Hert of CareEnd of Life in Care Homes in
Hertfordshire25th September 2012
Summary

• 0915 Coffee and registration
• 0930 Welcome, housekeeping, CQ, outline of the
  day, introductions
• 0940 Defining End of life care Who, what, why
  when?
• Sarah Russell (ABC Project lead)
• 0950 Commissioning end of life care Challenges
  and Opportunities
• Gordon Pownall (Commissioning Lead for End of
  Life and Palliative Care Hertfordshire)
• 1005 Dying in a multimedia world How does
  society construct death and dying?
• Dr Ros Taylor (Clinical Trustee, Help the
  Hospices, Hospice Director Hospice of St
  Francis, Berkhamsted, DL Hertfordshire)
• 1035 The ABC End of Life Education Programme in
  Care Homes
• What is the programme?
• How does it link into other education out there?
  
  
  
  Sarah Russell
• 1100 Coffee break
• 1115 Interactive session with education mentors
  and care home champions
  
  EFEs
• 1150 Care home champion experiences
• What is the experience in Hertfordshire?
• Lessons learnt
  
  
  Care
  home champion and education mentor

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Closing Thoughts

1. What do you know now which you did not know
   before?
2. What are you going to do next?

• Confidence questionnaire
• Evaluation form

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The Hert of CareEnd of Life in Care Homes in
Hertfordshire25th September 2012
The journey to where?I don't know where life
will take me. I don't know how the river bends
or where the rapids may be. Radiotherapy
completed my treatment, but my journey isn't
finished. My cancer seems to be gone, but who
can be sure? There are no certainties, and from
time to time a new pain has panicked myself and
my loved ones. My body may be healed now but
adjusting to the changes in my life and the
recovery of my emotions, my soul, and my spirit
takes longer