End of life care – is it an art?

Categories: Care.

The day was jointly organised by local hospices, St Wilfrid’s Hospice in Chichester and St Barnabas House in Worthing, Coastal West Sussex Clinical Commissioning Group (CWSCCG) and the local acute and community NHS trusts.

We were also very grateful for the generous support and sponsorship from Macmillan Cancer Support.  

The event, which took place on May 14, was offered free to health and social care professionals, who are involved in providing end of life care within the local area of Coastal West Sussex, and was very well attended by over 160 people from all care settings including GPs, community nurses, hospital staff, care home managers and nursing staff.

The aim of the day was to share good practice and inform staff from all care settings about the new guidance due to be released soon by the  LACDP on best practice in end of life care, once the Liverpool Care Pathway is finally phased out in July.

Chairing the day was Libby Hough, who works as the Quality Improvement Lead for South East Coast Strategic Clinical Networks at NHS England.

As our key note speaker, Dr Bee Wee, National Clinical Director for End of Life Care at NHS England, gave a fascinating introduction and overview of the work being developed by the LACDP. 

She reminded us all that there was good end of life care pre-Liverpool Care Pathway (LCP) and indeed there will continue to be post-LCP. Her talk was very thought provoking and positive and set the tone for an interesting and dynamic day.

Diagnosing dying

The programme included informative and helpful sessions on diagnosing dying and the use of prognostic indicator tools, communication and initiating important conversations.

There has been significant joint working between the providers of end of life care across the local health economy to agree guidance for the care of patients in the last days of life in all care settings. The day proved an ideal opportunity to discuss this and canvass opinion from the audience about this draft guidance.  

An excellent session, facilitated by the Interim Programme Manager for End of Life Care for the CCG and one of the palliative care consultants involved in developing our local guidance, invited all participants to put their thoughts and comments about the new guidance on to post it notes on posters around the large hall. This proved a remarkably successful user involvement exercise and ensures that the local guidance will have had far wider consultation than it may have otherwise done.   

After lunch, participants were offered the opportunity to attend two different workshops from a selection including spiritual care, hydration and nutrition at the end of life, DNACPR, end of life conversations, out-of-hour’s decision making and anticipatory medicines prescribing. 

The key learning points from the day were highlighted with a thought provoking, closing summary by Libby Hough.

Delegate feedback  

The day has been very well evaluated by attendees and there was a real sense of enthusiasm and exciting energy from all present to continue to work together and improve end of life care for all. Below is a selection of comments from various workplaces:

  • A  registered nurse working in the acute hospital trust commented: “This has been an excellent study day, very informative and answered a lot of questions and I have gained so much knowledge that I believe will help me in caring for patients at the end of their life and their loved ones.”  
  • A lecturer at a local university stated: “Excellent engagement. Good balance to programme”. 
  • A clinical manager for out of hours reflected: “Interesting that both Bee and Suzanne referred to end of life care as an ‘Art’……traditionally I guess we as clinicians are scientists, maybe there’s something to ponder on there”. 
  • Perhaps the final word should be one of optimism about the future and was said by a registered nurse working in a local care home:  “Very knowledgeable and educational day, looking forward to know what is going to be next!”

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