Ashmore, Russell

Brown, Hayley

Harrop, Deborah

Healey, Joan

Painter, Jon

Turner, James

English

Sheffield Hallam University Research Archive

Service Evaluation of End of Life care arrangements of a Hospice to Care Home initiativeTURNER, James <http://orcid.org/0000-0002-8360-1420>, PAINTER, Jon <http://orcid.org/0000-0003-1589-4054>, ASHMORE, Russell <http://orcid.org/0000-0002-9456-7926>, HEALEY, Joan, HARROP, Deborah <http://orcid.org/0000-0002-6528-4310> and BROWN, HayleyAvailable from Sheffield Hallam University Research Archive (SHURA) at:http://shura.shu.ac.uk/26213/This document is the author deposited version.  You are advised to consult the publisher's version if you wish to cite from it.Published versionTURNER, James, PAINTER, Jon, ASHMORE, Russell, HEALEY, Joan, HARROP, Deborah and BROWN, Hayley (2019). Service Evaluation of End of Life care arrangements of a Hospice to Care Home initiative. In: RCN International Nursing Research Conference and Exhibition 2019, Sheffield, UK, 03-05 Sep 2019. (Unpublished) Copyright and re-use policySee http://shura.shu.ac.uk/information.htmlSheffield Hallam University Research Archivehttp://shura.shu.ac.ukBetween October 2017 and September 2018 a total of 388 admissions and 119 GP visits were avoided through the team's input to care homes.  Despite the evidence regarding preference of place of death, it is estimated that 16% of care home residents are admitted to hospital during the last week of their life and die in this location. These 'advice calls' included an average of 41.1 (range 5-99) per month to care homes. Calls to the advice line also resulted in an average of approximately 300 patient visits by a qualified hospice nurse.  Of these, an average of 30.5 (range 1-68) visits per month were to care home patients. Precise costing estimates were difficult to obtain, however, the crude financial impact of these outcomes was calculated by using the figures from Georghiou and Bardsley (2014) for each admission (£4,580).  Over the 12-month period (October 2017- September 2018) this equated to a saving of £1,777,040.  Similarly, using a cost estimate of £147 per GP visit, the team also saved £17,493 A study from Bukki et al. (2016) with a range of nursing home staff found they were willing to care for dying residents, but expressed concerns which included issues such as workload, and a lack of training, knowledge and skills.  Internationally the World Health Organization (2011) has endorsed the integration of palliative care into care homes, but despite this integration is not standard practice (Johnston et al, 2016). 100% of respondents (n=245) said they would recommend the hospice's training course they attended to a care home colleague  Mitchell et al. (2016) situated in Northern Ireland, similarly explored care home managers knowledge of palliative care and found that some managers need to improve their knowledge and competence in this area.  The research literature finds that many people wish to die where they live (DoH, 2012; Higginson et al., 2013; Brogaard et al., 2012) or at home (Neuberger, 2004) Chen et al. (2017) highlights the need for research into hospice provision in long term care facilities such as care homes Evaluating Rotherham Hospice's Care Home Initiative for End of Life Care. Dr James Turner, Dr Joan Healey Dr Jon Painter, Dr Russell Ashmore Deborah Harrop, Hayley Brown All the care home staff talked about an improvement the hospice support had made to their practice and ultimately to the end of life experiences of the residents. Hospice staff reported that, as more and more nursing homes became aware of the project they had noticed an increase in the number of people being referred to the services.   There was a consensus that both the education strands had improved the confidence of care home staff in their everyday practise and in using the hospice's services directly  The outputs to be measured were: Patient and care home activity data, Planned and bespoke education access data, Calls to the advice line. The Hospice at Home team supported people to stay in their care home, bringing appropriate hospice support to them.  The hospice continued to visit responsively day and night to support staff and residents with palliative care needs during their illness •A critical analysis of the data available to support both activity and individual patient, care home and borough-wide outcomes was undertaken Care home staff had direct access to Hospice services 24 hours a day, 7 days a week The care home pilot aimed to work with all care homes in Rotherham (n=45) and provide a multi-stepped service to them A critical analysis of the type, structure and content of the education provided was undertaken via semi-structured focus group interviews with a cohort of Care Home Staff, The aims of this evaluation project were to:  • Evaluate if and how the introduction of the pilot has provided a responsive service •Explore how the planned education packages influenced decision-making •Explore how the bespoke education packages influenced decision-making  •Inform NHS Rotherham of the cost benefit and qualitative evaluation to enable further decisions to be made.  The Hospice worked with care home staff to provide education and support staff with decision making which prevented unnecessary hospital admissions. The team spent an average of 65.9 hrs of face-to-face time with these care home patients per month, equating to an average of 110 minutes per patient. It was not possible to identify any statistically significant associations between the team's activity metrics and avoided GP contacts or early discharges. Care home residents determined to be in the last phase of life can be expected to experience multiple symptoms and to have physical, psychological and spiritual needs (Brinkman-Stoppelenburg et al., 2015).  Staff commented that they experienced increased knowledge and awareness of end of life care 'I thought as soon as you said Palliative Care I’d say you’ve only got X amount of time to live and she said no you could be on Palliative Care for years.  Participants appreciated the level of training and support that the hospice staff bought, considering some of their knowledge transfer as 'little nuggets of gold…oh I’ll remember that’ (Grp2). Staff felt the training enabled then to adopt a more person centred perspective, to 'give people the view of that person as a whole, complete with the families to get it' (Grp2). They appreciated the training being tailored to meet the needs of the care home staff A perceived increase and confidence in knowledge around the context of dying also enabled staff to be more confident when talking to families about end of life care. 'I think it’s made people think, I think it’s opened people’s eyes so I think people are feeling more comfortable about having those conversations' (Grp1).  Participants appreciated the improved level of coordination that came from the pilot service in that they experienced better continuity of care as well as how proactive support was. They felt this was because of the training as it had led them to have better relationships with the hospice as well as the hospice being 'closer' to the care home. In relation to advanced care planning there were no direct observations by the participants regarding their increase in use but there was a sense of a change in practice. For example in Group 1 comments indicated change was 'Massive, it opens your eyes up to so many things The participants discussed how much more efficient it was to liaise with the hospice staff than GPs '...With most other professionals, with Doctors and that, you have to go through the scenario all over again. Tell them about the patient, about this, about that, but no, they’ve already got that information. Even if they’ve already seen them, if it’s somebody new they’ve got that information, it’s already there so you’re not having to go through it' (Grp2).  For some places bespoke, in-house training had been more useful and others preferred to be able to plan and rota staff to attend the hospice based training. '.. sometimes people do prefer training in house rather than having to travel somewhere to do training? ..if it’s in-house, you do sometimes find more people will come.(Grp2) Four care home staff focus groups were undertaken comprising 26 attendees in 4 locations across Rotherham and one Hospice staff focus group. The focus groups consisted of staff who had received the training, or used the telephone helpline, or the bespoke support, or a combination of all three.  Hospice at home staff have been visible and present when care home staff needed their support.    Additionally, the care staff's knowledge and confidence in managing palliative and end of life care has been shown to have improved, and subsequently the experience of the patients and families involved  Data suggests that the increased knowledge and confidence brought about by the training package, timely advice and bespoke support has led to an increase in positive decision making.   Between October 2017 and September 2018 a total of 388 admissions and 119 GP visits were reportedly avoided through the team's input to care homes.  

Service Evaluation of End of Life care arrangements of a Hospice to Care Home initiative

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Service Evaluation of End of Life care arrangements of a Hospice to Care Home initiative

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