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
[email protected]
25th September 2012
[email protected]
1
The ABC End of Life Education Programme in
Care Homes:
• What is the programme?
• How does it link into other education out there?
[email protected]
2
[email protected]
3
What is it?
1.
A 2 year, NHS East of England funded and specifically designed
care home end of life education programme
2.
Delivered and evaluated (using the same tools) across the whole
of the East of England: 2011 -2012
•
3.
Anglia, Essex, Beds, Herts and Luton
Uses End of Life Facilitator Educators (EFE’s) 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
[email protected]
4
The process
1. 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
2. Pre and post
 Audit of care home resident notes
 Benchmark of end of life polices and procedures
 Learners confidence in end of life care
3. Managers and Learners evaluation of the programme
4. Analysis of hospital non elective admission data
5. Transferable national accreditation and certificates
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The Modules:
1.
2.
3.
4.
5.
6.
7.
Overarching principles
Assessment and care planning
Comfort and well being
Communication skills
Advance care planning
End of life tools
Follow up workshop
8.
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
‘Fabulous initiative and I know the
homes have welcomed the input –
Thank you’
‘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’
‘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’
[email protected]
‘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
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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
Educ: Peace Hospice
DN: HCHS
CNS/Educ: Isabel Hospice
Educ: Hospice of St Francis
DN: Bedford
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
West Herts
Watford General
Hospital Macmillan
Team
The Peace Hospice
The Hospice of St
Francis
Iain Rennie Grove
House
Community Macmillan
Nurses
Community Nurses
University
East and North
Herts
Isabel Hospice
Garden House Hospice
Community Macmillan
Nurses
Hospital Macmillan
Nurses
Community Nurses
University
Beds and Luton
Keech Hospice
Community Palliative
Care Team
Hospital Palliative Care
Team
Community Nurses
University
[email protected]
The Cancer
Centre
Oncology Team
Palliative Care Team
University
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Mount Vernon Cancer
Network End of Life
Education Overview 2013
Syringe Driver
sessions
LCP sessions
½ day Comm Skills in
Practice
MVCN Palliative Care
Competency Programme
Introduction, Principles of
palliative care, holistic and
carers and key worker
assessment
Policies, spirituality, sexuality,
psychological support,
depression and anxiety
½ day ACP and
DNACPR awareness
Symptom control
1 day Pain and
Symptom Control
Palliative care emergencies
1 day non malignant
end of life care day
Pain assessment and
management
1 day Holistic
assessment & mgt
End of Life strategy in
practice including LCP, GSF,
PPC.
Communication skills in
practice day
2 day MVCN ACST
programme
1 day Intro to Comm
and Significant news
MVCN Psychology
level 2
programme
MVCN DNACPR
Competency
rogramme
ABC e learning
programme
University
programmes
Oncology competency
programme
Advance care planning and
DNACPR ½ day workshop
1 day Introduction to
oncology
Introduction to palliative
care for HCA’s
End of Life E learning
East of England Care Home Programme
http://www.endoflifecarelearning.co.uk/login/index.php
eLCA
http://www.e-lfh.org.uk/projects/e-elca/index.html
Writing for
publication
MVCN CNS
Transition
programme
Teaching
and
presenting
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Local CPD
sessions
Own
organisation
sessions
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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
1. What is the experience
in Hertfordshire
2. 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 to units available
List of qualifications
Level 2 Award Awareness in End of Life Care
Level 3 Award Awareness of End of Life Care
Level 3 Certificate in Working in End of Life care
Level 5 Certificate in Leading and Managing Services to Support End of Life and Significant Life Events
List of core units within qualifications
Key
= mandatory
RITS
reference
number
EOL 201
Understand how to work in end of life
care
knowledge
2
3
A/503/8085
EOL 301
Understand how to provide support when
working in end of life care
knowledge
3
4
Y/503/8689
EOL 302
Managing symptoms in end of life care
competence
3
3
Y/503/8644
EOL 303
Understand Advance Care Planning
knowledge
3
3
A/503/8135
EOL 304
Support the spiritual well being of
individuals
competence
3
3
M/503/8133
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L5 Cert
size
L3 Cert
Credit
L3
Level
competence
Award
Knowledge /
L2
Unit title
Award
SFC Unit
ref no
= optional
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End of Life qualifications
mapping template EOL 201
Links with programme
Learning outcome
Assessment criteria
Identified Module
1. Know different
perspectives on death
and dying
2. Understand the
aims, principles and
policies of end of life
care
Links
Gaps
Comments
1.1
Outline the
factors that can affect
an individual’s views on
death and dying
1.2
Outline the
factors that can affect
own views on death
and dying
1.3
Outline how the
factors relating to
views on death and
dying can impact on
practice
1.4
Define how
attitudes of others
may influence an
individual’s choices
around death and
dying
2.1 Explain the aims
and principles of end of
life care
2.2 Explain why it is
important to support
an individual in a way
that promotes their
dignity
2.3 Describe the
importance of
maintaining comfort
and well being in end
of life care
2.4 Explain the stages
of the local end of life
care pathway
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22
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:
University of Hertfordshire
Independent evaluation
from a credible academic
and knowledgeable source
1. 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?
2. What impact does the TtT have on care home
staff’s confidence, reported knowledge, symptom
assessment and management and involvement
with NHS services when providing end of life care?
3. What are the costs?
4. What were the barriers and facilitators to the
implementation of the programme?
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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 Care
End of Life in Care Homes in Hertfordshire’
Summary
25th September 2012
0915
Coffee and registration
0930
0940
Welcome, housekeeping, CQ, outline of the day, introductions
Defining End of life care: Who, what, why when?
Sarah Russell (ABC Project lead)
0950
Commissioning end of life care: Challenges and Opportunities:
1005
Dying in a multimedia world: How does society construct death and dying?
Gordon Pownall (Commissioning Lead for End of Life and Palliative Care: Hertfordshire)
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?
1100
Coffee break
1115
1150
1215
Interactive session with education mentors and care home champions
Care home champion experiences
•What is the experience in Hertfordshire?
•Lessons learnt
Mapping the programme to Skills for Care End of Life Qualifications:
1230
Sustaining the programme through the Training the Trainer pilot
Sarah Russell
EFE’s
Care home champion and education mentor
Kathryn Chamberlain (Skills for Care Area Officer Eastern) and Sarah Russell
Sarah Russell
1245
Closing thoughts and evaluation forms
1300
Close
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Closing Thoughts:
1. What do you know
now which you did not
know before?
• Confidence
questionnaire
• Evaluation form
2. What are you going to
do next?
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‘The Hert of Care
End of Life in Care Homes in Hertfordshire’
25th 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
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The ABC End of Life Education Programme in Care Homes