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Guidance in brief

Going for Gold: how a training programme is supporting nurses to improve end of life care

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Going for Gold, the Next Stage Gold Standards Framework quality improvement training scheme, will enable nurses to provide the end of life care patients want

Keywords Training, Gold Standards Framework, End of life

Background

The Gold Standards Framework enables nurses and other professionals to help patients to receive the care they want where they want it, reducing inappropriate hospital admissions and deaths in hospitals.

In 2008-9, the National GSF Centre undertook a systematic review of the use of GSF in primary care. The process included wide consultation with many groups including nurses, and concluded that while GSF works well in many cases and had made significant improvements in end of life care, it required further work and resources to be fully implemented. 

The main areas were:

  • Improving levels of consistency of care for all people nearing the end of life;
  • Improving effectiveness of GSF use;
  • Improving equity for non-cancer patients;
  • Ensuring the quality of care provided.     

Next stage GSF and levels of adoption

To meet these demands, GSF in Primary Care was re-launched as “Next Stage GSF”, with updated resources, tools and a new programme of training - “Going for Gold” GSF Primary Care Training Programme.  Importantly, levels of adoption were changed. The new levels are:

GSF foundation level

Basic GSF. A practice that has a palliative care register and holds meetings to review those patients on the register – following C1 and C2 (communication and coordination) of GSF - equating to the QOF palliative care points claimed by most GP practices.

GSF intermediate level

A practice is classed as intermediate if it is following C1-C7: communication, coordination, control of symptoms, continuity of care, continued learning, carer support, and care of the dying pathway.

Advanced Level

To attain advanced level, a practice needs to implement C1-C7 and demonstrate evidence of effectiveness, equity and consistency. This includes elements of better identification, use of Needs Base Coding, Needs Support Matrices, Advance Care Planning for patients on the register, measures towards improving cross boundary care and reducing hospital admissions and use of audit.

The GSF quality recognition/accreditation process

This will be introduced in 2011, requires practices to meet the key 20 standards outlined in the Good Practice Guide supplied to practice teams.

How it works

The new training programme follows a non-judgmental learning model in which, after an introductory session, participants take part in four one hour sessions at multi-disciplinary team meetings over six months, followed by a review meeting at which they create and review action plans. The emphasis is on team working. Each session contains three learning outcomes and raises four key questions, as well as the development of a personalised practice protocol. Each practice receives a DVD, practice workbook, GSF Good Practice Guide and a range of other resources including symptom management guidance books.

The 7Cs are still at the heart of GSF, but equal attention is given to the three major bottleneck areas common in general practice with the “Identify, Assess, Plan” three step process at its heart. The sessions are designed to support teams to build on their existing good practice thereby providing patients with effective, consistent care.

Session 1 focuses on identifying the right patients to go on the register and the stage they are at, using needs based coding. The second session centres on assessment of the patient’s clinical and personal needs using Advance Care Planning. This session also covers assessment of carers’ needs.

Planning care across boundaries forms the basis of session 3. This includes continuity of care out of hours, avoiding crises and inappropriate hospital admissions as well as care in care homes and other settings.

Session 4 concentrates on planning the final days, including anticipatory medicine and the adoption of a care pathway such as the Liverpool Care Pathway.

The nurse’s role

Nurses have always been at the heart of GSF and, to reflect their enormously important role in end of life care, the national GSF team, in partnership with the RCN and Queen’s Nursing Institute, has produced a “Focus on Nurses Pack”.  This is an essential guide for nurses, containing the core elements of the programme and a simple step by step implementation guide. It also outlines the available tools and resources to help nurses embed the programme.

GSF recognises that nurses are often best placed to identify appropriate patients, support them and work with them to develop a suitable care plan. The straightforward GSF colour coding system is an easy to use tool for nurses planning and assessing patients’ care.

GSF makes nurses feel more confident about their role in end of life care and, allied with greater job satisfaction and better communication with fellow professionals, has empowered them to kick start associated local improvements and develop other local initiatives.

Conclusion

Nurses are at the forefront of end of life care. By enabling more organised care, fostering job satisfaction and encouraging improved communication, the GSF Primary Care Training Programme is enabling nurses to deliver the type of quality end of life care patients want, where they want it.

For more information visit the GSF website click here

AUTHOR Helen Corner, Community Health Studies, EN, RGN, is clinical associate at the National Gold Standards Framework Centre and End Of Life Care facilitator, North Hampshire Palliative Care Service, Basingstoke and North Hampshire NHS Foundation Trust

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