As part of its commitment to coordinating and improving the quality of care within North East Essex, St Helena Hospice has developed an educational programme for local residential and nursing homes.
It is recognised that with an increasingly elderly population and admission to residential care taking place later in life often as a result of a complex range of needs, the staff within homes are managing palliative and end of life care on a day-to-day basis.
In a desire to work in a more collaborative way with our local residential care homes and to improve the quality of end of life care for their residents, we have developed a half-day educational session which focuses on the importance of advance care planning, recognising the key features of the dying process and having an awareness of key communication skills.
It also aims to give staff an understanding of their value in the wider health and social care economy, particularly in relation to the ‘My Care Choices Register’, a locality-wide register hosted by the hospice which records patients’ choices about their care, not just at the end of life in the last few weeks, but also in the last months or years of life.
We also promote the advice, care and support available from our SinglePoint service which is accessible 24 hours a day, in the hope that this will encourage staff to seek advice early to help avoid inappropriate admission to hospital. In the last year we have demonstrated that an average of 85% of patients with their choices recorded on the register died in their preferred place of care.
The session contains some formal learning from the delivery of presentations by senior clinicians working for the hospice, but the emphasis is mainly on providing staff with an opportunity to reflect on informal advance care planning discussions with their own residents, how to make these meaningful and where they can be recorded in order to assist the resident’s GP to enter data onto the register.
We also aim to discuss with them the potential impact of loss and bereavement experienced by staff after the death of a resident and what coping strategies they can use to manage this, for example, setting up a regular open team forum for reflection.
A resource pack is left with the homes after the session and we will bring together senior staff from the homes at a later date to explore how they have been able to move forward with the recognition of residents who might be appropriate for advance care planning discussions and for inclusion on the register and to give them an opportunity to learn from each other.
A pre-education audit is done which records the number of deaths over the preceding year that took place in the home with advance care planning in place, and this is followed by an on-going audit to measure any potential outcome of the session and continued support.
The first session of the new programme was delivered on 7 October at Milton Lodge Residential Home in Colchester and was attended by nine members of staff.
Initial feedback has been encouraging and the carers on the day reported improved confidence in dealing with difficult questions and how to use the Red, Amber, Green (RAG system) for identifying when it is appropriate to start having advance care planning conversations with residents.
Lee Welland, community nurse specialist at St Helena, said of the first educational session: “It was good to meet the staff of Milton Lodge residential home. They seemed keen to engage with the benefits of advanced planning and I feel we were able to share our experiences. I hope this education opportunity will enable them to use our services more and feel supported by us.”
This piece of work is part of a wider hospice-led initiative to better support local care homes. This includes a job shadowing project with a local nursing home, with staff from our in-patient unit swapping place with those from the home for a 12 week period.
We are also introducing some of our volunteers to local homes to build relationships with residents who are coming to the end of life and who do not have local family or friends to support them. A tablet with Skype facility which gives staff and residents the opportunity to have face-time consultations with the community team is also currently being piloted.
Find out more about the programme on the St Helena Hospice website.