“one chance to get it right’ end of life care wirral university teaching hospital
TRANSCRIPT
“One Chance to get it right’
End of Life Care
Wirral University Teaching
Hospital
90% of inpatients are recognised as dying 48 hours before death and 100% of these
have a personalised care plan
This is to be achieved by by September 2015
The TeamSue Peters: Day to Day Leader
Clare Brown: End of Life Transform Lead Nurse
Claire Ashton: Quality and Safety Analyst
Heather Aitken, Liz Watkins, Denise Farrance
Janice Evans: Specialist Nursing Lead Wirral CT
Nick Mamo, Sophie Duckworth
Geraldine McCaffery: pharmacy
Anne McGinnity: Divisional Manager
Melanie Maxwell: Associate Medical Director
Cathy Lewis-Jones: Palliative Care Consultant
Alan Pugh: Administrator L+D,HROD
Jill Galvani: Director of Nursing/Executive Sponsor
Aim / Outcome
Primary Drivers Secondary Drivers
90% of inpatients are recognised as dying 48 hours before death and 100% of these have a
personalised care plan (by September 2015)
Knowledge of prognostic indicators of dying
Communication with patient, carers and family; understanding patients’ needs
and wishes
Individualised Care plan
Clinical Audit
Aide memoir prompt for Care of Dying
Education and training healthcare workers
Handover of nursing and medical staff
Priorities for Care of the Dying person
Bereavement Support
Advance Care Planning
Amber Care Bundle
Mortality audit
Critical incidents
Coding/EoL Data measurement
Methods
• Pilot wards 33/36• Assessment/Prompt Tool/Powerpoint presentation• E-learning module/Podcast• WUTH monthly Pilot meetings• E-communication• Baseline Audit completed in Pilot Ward Areas.• Communication with Ward Managers, Consultants,
trainees• Training log/Top up training
Oct 2014
Nov 2014
Dec 2014
Jan 15 2014
Feb 2015
Mar 2015 Apr 2015
May 2015
June 2015
July 2015
Aug 2015
Sept 2015
50.0% (6/12)
14.3% (1/7)
50.0% (9/18)
40.0% (6/15)
41.7% (5/12)
21.4%% (3/14)
31.3% (5/16)
22.2% (2/9)
30% (3/10)
66.7% (10/15)
33.3% (3/9)
44.4% (4/9)
Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-150%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Outcome measure: Patients recognised as entering the dy-ing phase =>48 hours prior to death.
Target 90% by Sept 2015.
Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-150%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Recognition that the patient was entering the dying phase doc-umented within the notes.
Oct 2014
Nov 2014
Dec 2014
Jan 15 2014
Feb 2015
Mar 2015
Apr 2015
May 2015
June 2015
July 2015
Aug 2015
Sept 2015
58.3%(7/12)
71.4%(5/7)
83.3% (15/18)
86.7%(13/15)
75.0%(9/12)
50.0%(7/14)
68.8% (11/16)
100% (9/9)
70.0% (7/10)
80.0% (12/15)
77.8% (7/9)
88.9% (8/9)
Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-150%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Recognition that the patent is dying communicated with the pa-tient and their relatives/carers.
Patient
Rela-tive
Oct 2014
Nov 2014
Dec 2014
Jan 15 2014
Feb 2015
Mar 2015 Apr 2015
May 2015
June 2015
July 2015
Aug 2015
Sept 2015
Patient 25.0% (1/4)
40.0% (2/5)
37.5% (3/8)
50.0% (4/8)
16.7% (1/6)
25.0% (1/4)
50.0% (2/4)
50.0% (2/4)
100% (4/4)
66.7% (2/3)
50.0% (1/2)
Relative/ carer
85.7%(6/7)
83.3% (5/6)
92.9% (13/14)
100% (12/12)
100% (9/9)
80.0% (8/10)
100% (11/11)
100% (8/8)
100% (9/9)
100% (12/12)
100% (7/7)
100% (8/8)
Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-150%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Evidence of discussion regarding treatment options with the pa-tient and their relative/carers.
Patient
Relative
Oct 2014
Nov 2014
Dec 2014
Jan 15 2014
Feb 2015
Mar 2015
Apr 2015
May 2015
June 2015
July 2015
Aug 2015
Sept 2015
Patient 55.6%(5/9)
40.0% (2/5)
36.4% (4/11)
72.7% (8/11)
55.6% (5/9)
57.1% (4/7)
55.6% (5/9)
80.0% (4/5)
100% (5/5)
88.9% (8/9)
83.3% (5/6)
100% (4/4)
Relative/ carer
83.3% (10/12)
83.3% (5/6)
93.3% (14/15)
100.0% (13/13)
80.0% (8/10)
100.0% (14/14)
92.3% (12/13)
100% (9/9)
90.0% (9/10)
100% (14/14)
88.9% (8/9)
100% (9/9)
Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-150%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%Preferred place of care documented in the notes.
Oct 2014
Nov 2014
Dec 2014
Jan 15 2014
Feb 2015
Mar 2015
Apr 2015
May 2015
June 2015
July 2015
Aug 2015
Sept 2015
25.0% (3/12)
42.9% (3/7)
27.8% (5/18)
33.3% (5/15)
16.7% (2/12)
35.7% (5/14)
25.0% (4/16)
44.4% (4/9)
80.0% (8/10)
53.3% (8/15)
30.8% (4/13)
66.7% (6/9)
Oct
-14
Nov-14
Dec-14
Jan-1
5
Feb-15
Mar-1
5
Apr-15
May-
15
Jun-1
5
Jul-1
5
Aug-15
Sep-15
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Patients preferences and wishes regarding treatment documented in the notes.
Oct 2014
Nov 2014
Dec 2014
Jan 15 2014
Feb 2015
Mar 2015
Apr 2015
May 2015
June 2015
July 2015
Aug 2015
Sept 2015
50.0% (6/12)
42.9% (3/7)
38.9% (7/18)
42.9% (6/14)
25.0% (3/12)
28.6% (4/14)
31.3% (5/16)
44.4% (4/9)
70.0% (7/10)
73.3% (11/15)
46.2% (6/13)
88.9% (6/9)
Any obstacles/challenges?
• Time constraints• Movement of Staff/ Agency Staff• Leadership on ward• Availability of stakeholders to attend
meetings and progress with project work• No designated time allocated for project
work
Key lessons?
• Collaborative working• Working within a designated time frame• Development of new skills• Networking • Staff motivated from Pilot Wards• Use of Board rounds• Communication, Care planning and
Documentation