Friday 15th April 2016
Mac Voice, the magazine for Macmillan professionals: Spring 2016
Theresa Richards was named Palliative Care Nurse of the Year at the International Journal of Palliative Nursing (IJPN) awards in 2015. She tells Mac Voice how her role has evolved since she took up the post in 2008.
The Macmillan End of Life Care Plan Facilitator post was created in 2008 with three years of funding from Macmillan. I was seconded into the role, which was the first of its kind in Wales, after working as a Macmillan palliative care nurse specialist.
I wrote a Mac Voice article about my role in 2010. I was really honoured to win the Macmillan in Wales Centenary Professional Innovator Award in 2012, and then to be named Palliative Care Nurse of the Year at the International Journal of Palliative Nursing awards last year.
As the role initially developed, it evolved across our health board, which covers a wide area of North Wales. Through auditing and evaluation, I was able to demonstrate the need for additional postholders. As a result, and with funding from Macmillan, my colleagues Teresa Davies and Jayne Emsley joined me in 2015 to form the Macmillan End of Life Care Plan Facilitation Team. My role is now substantive and is funded by the Betsi Cadwaladr University Health Board.
The Macmillan End of Life Care Plan Facilitation team aims to achieve the following:
- Advise and support GP practices, to help them develop multidisciplinary team meetings and identify palliative care patients in their practice population.
- Train and educate healthcare professionals in end of life care, including documenting advance care planning conversations.
- Facilitate teams and individuals to develop their skills and expertise, to improve end of life care delivery in their organisation.
- Provide palliative and end of life care training in care home and secondary care settings.
One of our key deliverables is to influence provision of care indirectly, through robust and evidence-based education programmes. We have been acknowledged by the Bevan Commission for our prudent health care initiatives.
Our goals are aligned to the Welsh Government Delivery Plan Together for Health (2013–2016). We have engaged with key stakeholders in all areas of the health board including service users, social care and third sector providers to facilitate a shared vision, clinician engagement and ownership.
We promote advance care planning through the education programmes, as a key means of improving care for individuals nearing the end of their lives. This will then lead to better planning and provision of care, helping individuals live and die in the place and manner of their choosing and involving family members as appropriate, which are aligned to seven of Macmillan’s nine outcomes.
Education programmes in nursing homes
A key development has been our implementation and evaluation of successful education programmes for nursing homes. The team has worked across North Wales to deliver the ‘six steps to success’ training programme to forty nursing and residential homes, and Flintshire adult social services has funded a project nurse, Sarah Dickinson, to support the team in the delivery of the programme. The programme aims to enable residents to stay in their place of choice for end of life care and prevent unnecessary hospital admissions.
Before our first cohort of care home education, 23% of residents’ deaths were in hospital. After the course this dropped to 11%, and at six months post-course this had dropped to 8%.
Following this evaluation, there was a significant decrease in the number of people being admitted from nursing homes dying in hospital. This has had a measurable impact on costs in the acute setting, improving efficiency in reducing the average length of bed days. As part of the criteria for accessing the educational programme, care homes agree to share their information for audit and research purposes.
Quotes from staff during training
‘Increased my awareness and skills related to end of life care, and related to my practice and residents.’
‘It will improve care of the dying.’
‘I now want to go back to practice and improve patient care in the last days of life.’
A quote from relatives after the training in a care home setting
‘The dedication and devotion in the excellent care Dad was given was the very best we could have wished for him. Your kindness and understanding shown to Dad and our family and the support we were given has been very much appreciated and will never be forgotten’.
Expanding our influence
Our future plans include developing a ‘train the trainers’ course, continuing to roll out the six steps programme, and further empowering all health professionals with the skills to deliver the highest standards of palliative and end of life care. We have had two posters accepted for the 11th Palliative Care Congress (this year held in Glasgow) and a poster accepted for the International Forum on Quality and Safety in Health Care in Sweden, both in 2016.