Developing Care Home Practice
Care Homes: A Good Place to Live – A Good Place to Die
30th September 2010
Jean Hannah FRCGP, Clinical Director, Nursing Homes Medical Practice
Developing Care Home Practice:
A Good Place to Live
Most nursing care home residents in Glasgow:
• can choose to register with the Nursing Homes
Medical Practice
• access wider NHSGGC Care Home Services
Those people working in the NHMP & CHS:
• have chosen to specialise in this area of care
• are an experienced, dedicated team
• prioritise the hopes, aspirations & choices of the
individual
• promote multi-disciplinary & multiagency working
Joint Development Care Home Practice
Important because:
• individuals and families have chosen a final home
and their providers of care and support
• this is the opportunity to get things right
• though some live for much less, 50% of those with
the NHMP live > than 3 years
• individuals and their aspirations and support needs
are different – and often complex
• success is dependent on establishing common goals
& joint working
Care home practice successes
Dedicated:
• Speech & Language Therapy
• Dietician
• Prescribing Support
• Care Home Liaison Nurses
• Falls Team Specialists
• Pain assessment
• Palliative care
All help enhance overall support & care
Pain assessment practice
Pain assessment documentation
(n= 80 at start of project, n=80 end of project)
80
97% 100%
100%
100%
100%
100%
No of Patients
70
60
50
46%
40
45%
47%
30
20
10
0%
0
Whole person
assessment
Start of Project
Assessment of 'total
pain'
End of Project
Continuous pain
assessment
Pain assessment
tool in use
Care plan updated
re: pain
Engagement
•
•
•
•
•
New patient registration
Tailor individual contact in response to need
Advance care planning
Families & carers - loss
Encourage thinking ahead: anticipatory
prescribing
• Because of specialism, understand care
options in care homes
Comparison of NHMP vs. NHSGGC
prevalence across nGMS QOF indicators
A good place to die: priorities
• Last Months - Identification of the last
months of life and pro-actively planning care
- taking account of patients’ and families’
wishes – and regularly monitoring needs and
care provided
• Last days - Providing the best care possible
in last days of life – for patients and families
Identification of Palliative Care Needs
Supportive and Palliative Action
Register (SPAR)
• Since July 09 – have been
piloting this approach in a
number of care homes (nursing)
• Purpose - Identify who to be
worried about – in palliative care
terms – and be proactive in
management
– Green – no or minimal
change
– Amber – moderate signs of
deterioration
– Red – rapid or major
deterioration and may be
dying
The key is - Identifying
CHANGE
SPEED OF CHANGE
FAILING RATE
(irreversible deterioration)
Be proactive - Action
– Green – no or minimal change
• continue optimum long term management – monitor monthly
– Amber – moderate signs or rate of deterioration
• Discuss with/prepare family
• DNA – CPR
• Update anticipatory/advance care plan
• Out of Hours Handover – electronic Palliative Care Summary
• Monitor weekly
– Red – rapid or major deterioration -may be dying
• Discuss with/prepare family
• DNA – CPR
• Update anticipatory/advance care plan
• Out of Hours Handover – electronic Palliative Care Summary
• Monitor daily
• Consider LCP
Best care in the last days of life
• Liverpool Care Pathway for
the Dying
– Recognising dying
– Ensuring resident
receives the care that
they need
– Being proactive
– Respect
– Preparing the family
– Working as a team
• Education and training in
relation to
– Palliative Care Principles
– Liverpool Care Pathway for
the Dying
– Supportive and Palliative
Action Register
– RN Verification of
Expected Death
– McKinley T34 syringe
pumps
– Communication skills –
sensitive conversations at
the end of life
A natural and dignified death
Challenges
•
•
•
•
•
•
•
Staff training and turnover
Inclusion
Recognition of change and failing rate
When to start the LCP
If possible, provide care in care home
Accessing medication & syringe drivers
Finding out what people think and how we
can improve
• Supporting carers in the longer term
Harness mutual desire to give the best care collaboration, co-ordination and respect
Care Home Managers and staff
Care Homes Liaison Nurses
Nursing Homes Medical Practice
Pharmacy Teams
Out of Hours Services
Marie Curie Hospice
General Practitioners
Prince and Princess
of Wales Hospice
Macmillan Primary Care GP
and Nurse Facilitators
Palliative Care Practice
Development Facilitators
Project Manager: Palliative Care
Non Malignant Conditions
Voluntary, Social Work, Care Commission and Government Agencies
Working together