GOLD STANDARDS
FRAMEWORK
POSITIVE OUTCOMES FOR A
CARE HOME
WHAT IS THE GOLD STANDARDS
FRAMEWORK ?
• TO HELP TO DELIVER A “ GOLD
STANDARD OF CARE” FOR ALL
PEOPLE AS THEY NEAR THE END OF
THEIR LIVES
• It involves working together as a team with
other professionals, to help to provide the
highest standard of care possible for
residents and their families as they face
the last stages of their lives.
WHAT IS THE GOLD STANDARD
FRAMEWORK ?
• Delivers both QUALITY IMPROVEMENT plus
QUALITY ASSURANCE the programme has 3
aims
• To improve the quality of care provided for all
residents from admission to the home.
• To improve the collaboration with GP’s primary
care teams and specialists.
• To reduce the number of hospital admissions in
the final stages of life, enabling more people to
die with dignity in the home, if that is their wish.
HOW CAN IT IMPROVE CARE?
• Setting up a register with regular planning
meetings to discuss and focus on care.
• Planning for the needs of residents at varying
times, using coding and a needs/support plan
• Advance care planning – discussing the choices,
preferences and options to best meet the needs
of the resident and their families.
• Reducing the need for crisis admission to
hospital.
HOW WILL IT IMPROVE CARE?
• Working closely with the family to best
meet the needs of their loved one and to
be aware of the choices that are available.
• Even better working with GP’s, District
Nurses, Palliative Care Specialists,
hospitals and others
• Information and communication with other
services e.g. Out of Hours medical
services, ambulance services.
HOW WILL IT IMPROVE CARE?
• Use of an agreed plan for the final days of
life, to enable a good death.
• Ongoing reflection and education of staff
according to their needs. Staff who aspire
to the best, and we wish to affirm and
encourage them, building confidence and
ability to provide excellent care.
THE SEVEN C’s
•
•
•
•
•
•
•
COMMUNICATION
COORDINATION
CONTROL OF SYMPTOMS
CONTINUITY
CONTINUED LEARNING
CARER SUPPORT
CARE OF THE DYING
COMMUNICATION
• Identify residents in need of palliative care –
code using for example ABCD codings
• Regular team meetings
• Label / colour code notes and code for
handovers and GP
• Use advance care plan ( preferences, DNAR,
preferred place of care)
• Residents, families, GP’s and Specialist
practitioners are aware that the Care Home are
involved in GSF
COORDINATION
• Allocated Coordinator for each home
• Agreement with owner to support
programme
• Key worker for each resident
• Ensure communication with GP, Primary
Health Care Team and family
• Ensure communication with specialist
palliative care team e.g. local Macmillan
nurses, hospital
CONTROL OF SYMPTOMS
• Use of assessment tools when relevant
• Agreed management plan recorded and
communicated related to protocol
• Advanced care plan completed for all
residents
• Basic equipment available as standard
and PRN medication available in advance
CONTINUITY
• Out of hours handover form completed for
all residents and kept in local out of hours
office
• Advanced Care Plan/ Patient held record
or medication card shared with others
CONTINUED LEARNING
• Regular review, Weekly meeting
• Monthly review meetings- audit of last
deaths using traffic lights Significant
Analysis with other professionals if
possible
• Programme of on going education/ training
of staff, including induction of all new staff
• Library resource of books, articles and
web sites
CARER SUPPORT
• Staff – staff issues and learning points and
feedback after death for all staff e.g.
carers, cleaners, maintenance staff
• Family – written information for family and
note families concerns and issues
CARE OF DYING
• Minimum protocol for the last days of life used
• Liverpool Care Pathway for the Dying or
Integrated Care Pathway
• Agreed practice for notification of relatives,
verification of death procedure and after death
care
• Support for the bereaved families after death
• Support for all staff and other residents as
needed
SO WHAT HAS CHANGED AT
MERRYFIELD?
• Everyone aware that we are participating
in GSF
• Coding of residents available for all staff
including catering and all ancillary staff
• Regular focus meetings with staff from all
departments
• Advanced Care Plans, preferred place of
care DNAR any individual wishes
SO WHAT HAS CHANGED AT
MERRYFIELD?
• Attend GSF meetings at the GP surgery with
GP’s, District Nurses and Macmillan Nurse to
discuss all residents on the register. Regular
speakers from local palliative care organisations
• Additional assessment tools used e.g.
depression scale, PACA and PEPSICOLA
Distress Thermometer
• We have purchased a Syringe Driver and the
surgery can provide a Drug Box when needed
for the Home and the District Nurses containing
end stage drugs
SO WHAT HAS CHANGED AT
MERRYFIELD?
• Out of Hours handover forms are kept in
the Office at Witney hospital used by Out
of Hours Doctors so they have in depth
knowledge of all residents when contacted
by the Home.
• Advanced Care plans shared on
admission to Hospital and Out Patient
appointments
• Dignity Policies and Audit tools
SO WHAT HAS CHANGED AT
MERRYFIELD?
•
•
•
•
•
Audit of deaths using Significant Analysis
Regular Reviews
On going training
Library resources
Drama therapist to work with residents who are
dying and for residents who are grieving
• Leaflets written by the home with information of
services available in house and in the local
community both relevant to before and after the
death
SO WHAT HAS CHANGED AT
MERRYFIELD?
• Minimum Protocol used for the last days of life
• Registered with the Liverpool Care Pathway
• Policies for Notification of Relatives, Verification
of Death and after death care
• Support for bereaved relatives, staff and other
residents available from a Personal
Bereavement Service in Witney for both religious
and non religious clients providing spiritual
support