Liverpool Care Pathway in Nursing Homes

1
Liverpool Care Pathwayin Nursing Homes

• Pat Mowatt
• Education Facilitator for Palliative Care for the
  Nursing Homes

2
Purpose of Post

• To provide education for trained nurses to
  underpin the introduction of the Liverpool Care
  Pathway and / or the Gold Standards Framework to
  nursing homes in Bradford Airedale.

3
Drivers

• NICE guidance Improving Supportive Palliative
  Care for Adults with Cancer 2004
• B As Palliative Care Education Strategy
• National Minimum Standards Care homes for Older
  People 2003
• Competency framework for Cancer Nursing 2004
• CSCI consultation around Terminal Illness
  registration March 2005

4
Statistics

• July 2004 69 nursing homes in Bradford Airedale
• ? number registered to take Terminally Ill
  patients
• July 2004 16 taking up palliative care NVQ
  training
• May 2005 8 more taking up NVQ training
• Total 24 now doing NVQ palliative care training
• More joining project

5
Planning

• Registering with Liverpool
• Adaptation of LCP
• Consultation with
• local specialist palliative care services
• CSCI
• H M Coroner
• Nursing home nurse managers
• GPs deputising service
• Lead cancer nurses
• Cross PCT drug group

6
Planning

• Adaptation of LCP
• More detailed criteria for inclusion on LCP
• Included specific goal about completion of OOH
  handover form
• Drug guidance developed to tally with acute
  sector LCPs
• Included local contact numbers for specialist
  palliative care advice

7
Planning

• Interviews with Nurse Managers
• Negotiate commitment to education programme
  LCP
• Registration with Liverpool
• Nomination of NH lead for project
• Base review of 20 expected deaths
• Education programme
• Audit of LCP usage

8
Education Programme

• Competency documents
• 7x 2 hour in-house sessions built around
  principles of GSF covering
• Principles of palliative care, teamwork
  specialist palliative care services, assessing
  palliative care needs
• Pain management
• Communication issues psychosocial spiritual
  care
• Symptom management
• Management of the last few days of life LCP
• Bereavement staff support
• Hot topics consolidation
• Repeat sessions as needed

9
Introductory phaseMy role

• Contact with GPs to gain co-operation with
  project
• NH visits to support nurses GPs in early days
  of usage of LCP
• Immediate audit feedback - both verbal
  written

10
Review

• Review 3 months later use of LCP, changes to
  practice, need for education, repeat of
  competency document
• Encourage to attend Liverpool study days
• Arrangements for ongoing support
• Further education sessions
• Local support group
• Network local facilitators

11
Results

• 8 NHs signed up to LCP
• 4 NHs ready to use LCP
• 4 LCPS used so far in 2 NHs
• Comments
• It enabled us to get everything in for the end
  stage
• The family said they had no regrets about
  transferring her here (from hospice)

12
Problems

• Duplication in documentation initially
• Additions needed for care after death
• Name of GP certifying death
• Cause of death
• Name of undertaker
• Burial or cremation
• Sceptics

13
Problems

• Not just one GP per NH
• Getting new staff on board
• Staff moving on
• Coaxing PCTs PHCTs to get actively involved
  with education in NHs
• Long term sustainability
• NH staff need to commit time to audit, analyse
  variances reflect

14
Benefits

• Step by step approach to clinical interventions
  reduces variations in patient care
• Patient centred care with measurable outcomes
• Identifies what NH does well
• Identifies areas for improvement e.g. systems,
  education
• Greater effectiveness, efficiency quality of
  care