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The Bromhead Boston Care Home Support Service. Gill Garden Pilgrim Hospital [email protected]. Background. > 200 admissions from care homes to ULH during 3 week period in November 2009 January 2010: Chance meeting member of local charity workshop Discussion with Trust HQ & with PCG - PowerPoint PPT Presentation
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• > 200 admissions from care homes to ULH during 3 week period in November 2009
• January 2010: Chance meeting member of local charity workshop
• Discussion with Trust HQ & with PCG• March 2010: Business case presented to charity
• Funding for two year care home pilot secured
Background
• 8 care homes (274 places) in Boston • Staffing
– 2 WTE staff (bands 7&6)– Support from Liaison Psychiatrist (in post)
• Phased introduction:1. Identification of residents with dementia 2. Training of care home staff3. Care planning4. Outreach service:
• To assess & advise whether treatment can be instituted at home or admission required
• To advise re institution of palliative care
Care Home Liaison Service Proposed
• Agreement secured: CCG, GPs & care homes• Background information drawn up
– GPs, care home, carers’ letters– Information leaflets: delirium, feeding, end of life care– Educational programme devised
• Register of residents with dementia– Care home data– GP dementia registers
Foundations
• Stop Delirium! *
– Delirium information given to care homes– Education sessions delivered in care homes– Effectiveness measured by pre/post education surveys
• Dysphagia & comfort feeding – Teaching package developed with speech & language
therapists– Comfort feeding leaflet given to care homes
*University of Leeds 2007
Education in Care Homes
Staff confidence in recognition, prevention & management of delirium
0
10
20
30
40
50
60
70
80
90
recognition prevention management
% staff
% confident or very confident
before trainingafter training
Effect of education onunderstanding of delirium
Unable to walk without assistance and
Urinary & faecal incontinence and
No consistently meaningful conversation and
Unable to do activities of daily living and
Barthel score <3Plus any one of following
Gold Standard Framework (GSF) Prognostic Indicator Guidance
Weight loss & reduced oral intake 10% weight loss in 6/12 without other cause Albumin <25 g/l
Aspiration pneumonia Recurrent fever, pyelonephritis or UTI Severe pressure sores (grade III/IV)
Individual Resident Assessment
Presence of dementia/suspected dementia• Nutrition: MUST• ADLs: Barthel• Waterlow• Cognitive assessment
• Most frail & dependent prioritised• Mental Capacity Assessment• Advance Care planning:
– families approached by care home staff– undertaken on best interests basis– meetings involve:
• Staff, family/close friends or those with POA• History, current health, prognosis & end of life care
discussed• Liaison Psychiatrist only for residents without next of kin
(IMCA requested but declined)
Advance Care Planning
• ACP sent to care home, GP, ambulance & out of hours services
• DNACPR forms completed by care home liaison nurses & endorsed by GP
• Care homes receive frequent support & guidance in the practicalities of using the ACP
• 30 residents have died in their preferred place of care because an ACP was in place
Implementation of Advance Care Plans (ACP)
Advance Care Planning Progress
0
10
20
30
40
50
60
70
80
FRAMPTONHSE
HUNTERSCREEK
MANOR GATE MEADOWSEDGE
ST JOHNS VAUXHALLCOURT
WILLOUGHBYGRANGE
% Advance Care Plans per Care Home from March 2011
COMPLETED %
WORK IN PROGRESS %
• After completion of ACP carers asked to complete anonymous satisfaction questionnaire
• Results evaluated using Survey Monkey providing quantitative and qualitative data
• Very positive feedback: 92.6% of respondents rated the service 9/10 or 10/10
Carer Satisfaction
Carer Satisfaction
“My mum had made a living will & it was something she always talked about with her family, this process has given me the confidence to know my mum’s “voice” will be heard even though she can no longer communicate effectively. As a family we also feel we have been given the opportunity to be “heard” for the first time”
“Found the nurse to be very helpful in her explanations of all questions I asked. All was put in a very easy to understand way. I think this idea of advanced planning is very good, & allows relatives input into their family members care instead of being made to feel it is nothing to do with you”
“Excellent service”
“I met with the nurse & although I understood what an advanced care plan was I found it comforting to discuss the details with a nurse who showed so much empathy & understanding. If I have any queries in the future I wouldn’t hesitate to contact the nurse knowing that she would find time to talk to me without judging”
Place of Death
Admissions from Pilot Care Homes
05
101520253035
2010 (before service)
2010
Admissions from Pilot Care Homes
05
101520253035
2011: service introduced
20102011
Admissions from Pilot Care Homes
05
101520253035
2010/2011/2012
201020112012
Control Comparison
0
50
100
150
200
250
pilot care homes control carehomes
admissions 20102011
• Advance care planning for all inpatients (existing or future care home residents)
• Involvement of hospital staff in care planning• Expansion of inclusion criteria to include frailty• Expand geographic area & thus number of
people offered this service
• To secure permanent funding
Future Plans
THANK YOU
Any Questions?
