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Liverpool Care Pathway in Nursing Homes

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To provide education for trained nurses to underpin the ... Burial or cremation. Sceptics. Problems. Not just one GP per NH. Getting new staff on board ... – PowerPoint PPT presentation

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Title: Liverpool Care Pathway in Nursing Homes


1
Liverpool Care Pathwayin Nursing Homes
  • Pat Mowatt
  • Education Facilitator for Palliative Care for the
    Nursing Homes

2
Purpose of Post
  • To provide education for trained nurses to
    underpin the introduction of the Liverpool Care
    Pathway and / or the Gold Standards Framework to
    nursing homes in Bradford Airedale.

3
Drivers
  • NICE guidance Improving Supportive Palliative
    Care for Adults with Cancer 2004
  • B As Palliative Care Education Strategy
  • National Minimum Standards Care homes for Older
    People 2003
  • Competency framework for Cancer Nursing 2004
  • CSCI consultation around Terminal Illness
    registration March 2005

4
Statistics
  • July 2004 69 nursing homes in Bradford Airedale
  • ? number registered to take Terminally Ill
    patients
  • July 2004 16 taking up palliative care NVQ
    training
  • May 2005 8 more taking up NVQ training
  • Total 24 now doing NVQ palliative care training
  • More joining project

5
Planning
  • Registering with Liverpool
  • Adaptation of LCP
  • Consultation with
  • local specialist palliative care services
  • CSCI
  • H M Coroner
  • Nursing home nurse managers
  • GPs deputising service
  • Lead cancer nurses
  • Cross PCT drug group

6
Planning
  • Adaptation of LCP
  • More detailed criteria for inclusion on LCP
  • Included specific goal about completion of OOH
    handover form
  • Drug guidance developed to tally with acute
    sector LCPs
  • Included local contact numbers for specialist
    palliative care advice

7
Planning
  • Interviews with Nurse Managers
  • Negotiate commitment to education programme
    LCP
  • Registration with Liverpool
  • Nomination of NH lead for project
  • Base review of 20 expected deaths
  • Education programme
  • Audit of LCP usage

8
Education Programme
  • Competency documents
  • 7x 2 hour in-house sessions built around
    principles of GSF covering
  • Principles of palliative care, teamwork
    specialist palliative care services, assessing
    palliative care needs
  • Pain management
  • Communication issues psychosocial spiritual
    care
  • Symptom management
  • Management of the last few days of life LCP
  • Bereavement staff support
  • Hot topics consolidation
  • Repeat sessions as needed

9
Introductory phaseMy role
  • Contact with GPs to gain co-operation with
    project
  • NH visits to support nurses GPs in early days
    of usage of LCP
  • Immediate audit feedback - both verbal
    written

10
Review
  • Review 3 months later use of LCP, changes to
    practice, need for education, repeat of
    competency document
  • Encourage to attend Liverpool study days
  • Arrangements for ongoing support
  • Further education sessions
  • Local support group
  • Network local facilitators

11
Results
  • 8 NHs signed up to LCP
  • 4 NHs ready to use LCP
  • 4 LCPS used so far in 2 NHs
  • Comments
  • It enabled us to get everything in for the end
    stage
  • The family said they had no regrets about
    transferring her here (from hospice)

12
Problems
  • Duplication in documentation initially
  • Additions needed for care after death
  • Name of GP certifying death
  • Cause of death
  • Name of undertaker
  • Burial or cremation
  • Sceptics

13
Problems
  • Not just one GP per NH
  • Getting new staff on board
  • Staff moving on
  • Coaxing PCTs PHCTs to get actively involved
    with education in NHs
  • Long term sustainability
  • NH staff need to commit time to audit, analyse
    variances reflect

14
Benefits
  • Step by step approach to clinical interventions
    reduces variations in patient care
  • Patient centred care with measurable outcomes
  • Identifies what NH does well
  • Identifies areas for improvement e.g. systems,
    education
  • Greater effectiveness, efficiency quality of
    care
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