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Innovation

A practical guide to improving end-of-life care

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Guidance from the National End of Life Care Programme shows trusts how they can give patients more choice over their place of death and the care they receive.

 Citation: Hayes A (2012) A practical guide to improving end-of-life care. Nursing Times [online]; 108: 28, 21.

Author: Anita Hayes is deputy director of the National End of Life Care Programme.

Since the Department of Health (2008) published the national end-of-life care strategy for England, several tools and guides have been produced to improve the range of elements that characterise high-quality care in this field.

The National End of Life Care Programme (2012) recently published a guidance pack. Its framework (NEoLCP, 2010) and other documents have already outlined what acute hospitals and their partners should be doing to deliver high-quality end-of-life care, and this new guide focuses attention on how to achieve this.

In line with the national strategy, the guidance should help clinicians, managers and executives in acute trusts ensure more people die in the setting of their choice, after having choice over the interventions and treatment they receive.

Key enablers

The guide identifies five key enablers that assist healthcare providers in delivering high-quality end-of-life care:

  • Advance care planning;
  • Electronic palliative care coordination systems (EPaCCS - formerly known as locality registers), which allow - with patients’ consent - members of the multiprofessional care team to access information about their end-of-life care preferences and plans for care as appropriate;
  • The AMBER care bundle (assessment, management, best practice, engagement where recovery is uncertain);
  • The rapid discharge home to die pathway;
  • The Liverpool Care Pathway.

Examples and “top tips” in the guide will be useful for clinical staff, such as ward leaders, as they discuss with their teams how their own wards and departments meet these requirements.

As end-of-life care is part of an acute trust’s core business and affects most wards, such discussions will include a focus on how teams work with other parts of the trust, as well as its partners in primary and social care and the community.

The guide includes metrics that will allow both frontline staff and the board to assess the impact of changes on care.

The document is strongly linked to the six-step end-of-life care pathway: the NEoLCP (2010) describes each step and gives examples of good practice in each. The steps are:

  • Identification and communication;
  • Assessment, care planning and review;
  • Coordination of care;
  • Delivery of high-quality care in acute hospitals;
  • Care in the last days of life;
  • Care - of the body and the bereaved - after death.

Implementation stages

The guide acknowledges that a systematic approach is needed to improve care and it is divided into sections that take readers through each of the following stages of the improvement cycle:

  • Prepare: ask why you are engaging with this project and what you hope to achieve;
  • Assess and diagnose: look at existing metrics, complaints and other key data;
  • Plan: who to involve, what needs to be done, how to measure progress;
  • Treat: the way practice can be redesigned for improvement, focusing particularly on the five key enablers outlined above;
  • Evaluate: core metrics to measure progress at ward level and for the board;
  • Sustain: making new ways of working and improved outcomes the norm.

Leadership

The guide aims to improve the care of people dying in hospital and help more to die at home or in another community setting if that is what they wish.

Achieving this will require the strategic leadership outlined in this guide. This will include regular discussion and reports at board meetings, developing a trustwide end-of-life care plan and designating a board member as an executive lead. A strategy group, including user representation, should be in place.

Communication with primary and social care should allow for effective coordination of care, including through the use of EPaCCS. These links should be built on by discharge planning, including pathways for people to be discharged to die at home or in a hospice.

The guide underlines the importance of comprehensive education and training, including communication skills.

With these elements in place, the guide says, hospitals and their partners should be able to measure an increase in the percentage of people achieving their preferred place of death and other important quality indicators.

 

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