Corbis
Opinion
Difficult decisions Achieving the Gold Standards Framework for end of life care requires a huge culture change, but the results are worth it, says Alison Scott UNIVERSITY HOSPITALS of Morecambe Bay NHS Foundation Trust is one of only two acute trusts to gain national Gold Standards Framework (GSF) accreditation for its end of life care on a stroke ward. The trust covers a large geographical area which encompasses the Furness peninsula, the city of Lancaster and the Lake District, providing hospital services to a population of 350,000 people across five sites: Furness General Hospital, Royal Lancaster Infirmary, Westmorland General Hospital, Ulverston Community Health Centre and Queen Victoria Hospital. The GSF was introduced at the trust in 2013 as part of a three-year End of Life Care CQUIN (Commissioning for Quality and Innovation), which has also included improvement in bereavement care and development of an electronic palliative care co-ordinating system. The GSF has provided the structure to enable staff to improve the care of patients with life-limiting conditions and their carers, especially as they approach end of life. Ward 23, a 24-bed medical ward specialising in the care of stroke patients at the Royal Lancaster Infirmary, is the first ward in the trust to gain GSF accreditation. To achieve this, staff have had to show that they have identified patients whose potential life expectancy has been affected by their condition. This is communicated to patients and their carers and they are provided with information relating to their future treatment and care, which includes the opportunity to consider advance care planning. A GSF patient information leaflet has also been developed. NURSING OLDER PEOPLE
This information is shared with the patient’s GP on discharge and patients are encouraged to continue advance care planning with their primary care provider. A wide range of training methods have been implemented across the trust, including a basic overview which all trust employees completed as part of their mandatory training in 2013-14 and lectures and ward-based training applicable to an individual’s role have been made available for nurses, allied health professionals, doctors and administrative staff. These sessions have included an overview of end of life care models and strategies, such as the 2008 National End of Life Strategy, advance care planning, discharge planning, improving bereavement care and communication skills training. In addition to staff training, Dying Matters events and public seminars have been held to raise awareness. The right conversations Identifying patients early has enabled staff to know when and how to have the right conversations about, for example, resuscitation status, carer needs, benefits entitlement and ‘just in case’ drugs. Asking the right questions about the immediate and future care an individual may want, and acting accordingly, has empowered patients and improved staff satisfaction. Stroke care encompasses a holistic approach to recovery involving many members of the multidisciplinary team (MDT) and external agencies, such as stroke and carer associations, for additional support on discharge.
GSF is now part of the ward’s routine assessment of patients, from admission to discharge. This is supported by changes to ward documentation, weekly MDT discussions, recording appropriate end of life information on the hospital IT system and written, verbal and electronic communication across care boundaries. The whole team has embraced the GSF as staff recognised it would enhance the care they deliver to patients, relatives and carers. The greatest challenge to achieving GSF accreditation has been cultural, from a patient and staff perspective. Entering into a discussion about preferences for care when someone is dying, in terms of location and clinical interventions, does not come easy for many healthcare professionals or patients but it is a topic that many of us must consider at some time in our lives. Not to offer patients the chance to have these conversations while they have the capacity to make informed decisions has the potential to deny them the care they would prefer. As consultant Pradeep Kumar says: ‘The biggest change has been the culture change. It’s about getting patients and their families to take ownership of their care. GSF is the framework that allows us to make that happen. The best bit is making sure patients receive the care they want, where they want it, when and how they want it and the satisfaction they, and we, get from that.’ Alison Scott is end of life care lead nurse at University Hospitals of Morecambe Bay NHS Foundation Trust June 2015 | Volume 27 | Number 5 11
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Opinion
Difficult decisions Achieving the Gold Standards Framework for end of life care requires a huge culture change, but the results are worth it, says Alison Scott UNIVERSITY HOSPITALS of Morecambe Bay NHS Foundation Trust is one of only two acute trusts to gain national Gold Standards Framework (GSF) accreditation for its end of life care on a stroke ward. The trust covers a large geographical area which encompasses the Furness peninsula, the city of Lancaster and the Lake District, providing hospital services to a population of 350,000 people across five sites: Furness General Hospital, Royal Lancaster Infirmary, Westmorland General Hospital, Ulverston Community Health Centre and Queen Victoria Hospital. The GSF was introduced at the trust in 2013 as part of a three-year End of Life Care CQUIN (Commissioning for Quality and Innovation), which has also included improvement in bereavement care and development of an electronic palliative care co-ordinating system. The GSF has provided the structure to enable staff to improve the care of patients with life-limiting conditions and their carers, especially as they approach end of life. Ward 23, a 24-bed medical ward specialising in the care of stroke patients at the Royal Lancaster Infirmary, is the first ward in the trust to gain GSF accreditation. To achieve this, staff have had to show that they have identified patients whose potential life expectancy has been affected by their condition. This is communicated to patients and their carers and they are provided with information relating to their future treatment and care, which includes the opportunity to consider advance care planning. A GSF patient information leaflet has also been developed. NURSING OLDER PEOPLE
This information is shared with the patient’s GP on discharge and patients are encouraged to continue advance care planning with their primary care provider. A wide range of training methods have been implemented across the trust, including a basic overview which all trust employees completed as part of their mandatory training in 2013-14 and lectures and ward-based training applicable to an individual’s role have been made available for nurses, allied health professionals, doctors and administrative staff. These sessions have included an overview of end of life care models and strategies, such as the 2008 National End of Life Strategy, advance care planning, discharge planning, improving bereavement care and communication skills training. In addition to staff training, Dying Matters events and public seminars have been held to raise awareness. The right conversations Identifying patients early has enabled staff to know when and how to have the right conversations about, for example, resuscitation status, carer needs, benefits entitlement and ‘just in case’ drugs. Asking the right questions about the immediate and future care an individual may want, and acting accordingly, has empowered patients and improved staff satisfaction. Stroke care encompasses a holistic approach to recovery involving many members of the multidisciplinary team (MDT) and external agencies, such as stroke and carer associations, for additional support on discharge.
GSF is now part of the ward’s routine assessment of patients, from admission to discharge. This is supported by changes to ward documentation, weekly MDT discussions, recording appropriate end of life information on the hospital IT system and written, verbal and electronic communication across care boundaries. The whole team has embraced the GSF as staff recognised it would enhance the care they deliver to patients, relatives and carers. The greatest challenge to achieving GSF accreditation has been cultural, from a patient and staff perspective. Entering into a discussion about preferences for care when someone is dying, in terms of location and clinical interventions, does not come easy for many healthcare professionals or patients but it is a topic that many of us must consider at some time in our lives. Not to offer patients the chance to have these conversations while they have the capacity to make informed decisions has the potential to deny them the care they would prefer. As consultant Pradeep Kumar says: ‘The biggest change has been the culture change. It’s about getting patients and their families to take ownership of their care. GSF is the framework that allows us to make that happen. The best bit is making sure patients receive the care they want, where they want it, when and how they want it and the satisfaction they, and we, get from that.’ Alison Scott is end of life care lead nurse at University Hospitals of Morecambe Bay NHS Foundation Trust June 2015 | Volume 27 | Number 5 11
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