Route to success - evaluate
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Route to success - evaluate

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This 'how to' guide builds upon the overarching framework set out in The route to success in end of life care - achieving quality in acute hospitals, published in 2010. The route to success ...

This 'how to' guide builds upon the overarching framework set out in The route to success in end of life care - achieving quality in acute hospitals, published in 2010. The route to success highlighted best practice models developed by acute hospital Trusts, providing a comprehensive framework to enable hospitals to deliver high quality care to people at the end of life.
This 'how to' guide aims to help clinicians, managers and directors implement The route to success more effectively, drawing on valuable learning from the NHS Institute for Innovation and Improvement's Productive Ward: Releasing time to care™ series.

This guide contains individual sections that can be worked on in any given order, dependent upon the individual hospital and its current end of life care provisions. These can be downloaded below:

Introduction
Section 1: prepare
Section 2: assess and diagnose
Section 3: plan
Section 4: treat
Section 5: evaluate
Section 6: sustain
Section 7: further resources
Cover
It places emphasis on existing 'enabling' tools and models, which support and follow a person-centred pathway. These are Advance Care Planning, Electronic Palliative Care Co-ordination Systems (EPaCCS), AMBER Care Bundle, Rapid Discharge Home to Die Pathway, and the Liverpool Care Pathway.

Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013

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Route to success - evaluate Route to success - evaluate Document Transcript

  • Section 5 The route to success Evaluate
  • Section 5 Core metrics These core metrics have been developed to inform the progress of implementation of The route to success in end of life care – achieving quality in acute hospitals and to support the model of service improvement. They have been developed following consultation with the 26 first wave hospital Trusts involved in the programme. Other locally developed metrics may also be used to inform and will contribute to overall reporting. Reports are to be collected at the beginning, middle and end of the implementation period. The core metrics are designed to inform at two levels within the organisation: 1. Reporting at ward level 2. Reporting at executive Trust Board level Reporting at ward level The core metrics developed at ward level are those that link directly with the five key enablers identified in Section 3 of this guide. These are Advance Care Planning, Electronic Palliative Care Co-ordination Systems (EPaCCS), the Rapid Discharge Home to Die Pathway, the AMBER Care Bundle and the Liverpool Care Pathway. These enablers can most inform the productive ward model of service improvement. Using the metrics in the first instance to assess your baseline will enable wards to develop a plan for service improvement according to individual starting points, priorities and agreed time scales. 2 Reporting at executive Trust Board level Metrics for the executive Trust Board level are based firstly on the ward core metrics and secondly are aligned with the hospital quality markers from the National End of Life Care Quality Assessment (ELCQuA) Tool: www.elcqua.nhs.uk How can the core metrics improve care? As a national programme to improve end of life care in acute hospitals, these core metrics can support improvement in care in two ways: 1. They can identify areas of best practice which can then be highlighted within the programme and disseminated to speed up shared learning and service improvement 2. It is anticipated that the aggregated data from the participating sites will clearly demonstrate service improvement over time. How often will the core metrics be collected? In order to keep in line with existing Trust quarterly reporting processes as far as possible, it is planned to collect metrics at ‘baseline’ (November 2011), ‘midpoint’ (June 2012) and ‘endpoint’ (November 2012). Any data that is submitted into the national programme will not be reported or published at an individual Trust level.
  • The route to success ‘how to’ guide Development of the core metrics One of the outcomes of this initiative will be to inform the development of the most relevant metrics both at ward level, and at Trust Board level. This will further inform the roll out of The route to success. Alongside the NICE end of life care for adults quality standard, it will also influence the updating of the national ELCQuA indicators for hospitals. MEDIA CONTENT To view this podcast please visit: tinyurl.com/acute-rts-howtoguide Dr Julia Verne, director of the South West Public Health Observatory, explains the importance of the local data available via the National End of Life Care Intelligence Network, and how it can be used for developing and monitoring services. MEDIA CONTENT To view this podcast please visit: tinyurl.com/acute-rts-howtoguide Andy Pring, senior analyst at the South West Public Health Observatory, provides a demonstration of how the National End of Life Care Intelligence Network’s online profiles can be used to analyse local data and trends. 3
  • Section 5 Core metrics: Trust Board Organisational baseline data: Number 1. Number of beds in Trust 2. Number of adult wards in Trust 3. Number of eligible wards (e.g. more than five deaths per year) for The route to success improvement programme 4. Number of deaths per year in the Trust 5. Number of people who die in the Trust’s catchment area per year 6. Number of people who die in their usual place of residence in Trust catchment area (QIPP KPI) 7. Number of people in the Trust discharged on the Rapid Discharge Home to Die Pathway in the last 3 months Please record or attach any end of life care CQUINS, PROMS and KPIs currently in use in your Trust Please record or attach any ‘best practice’ models of end of life care education and training initiatives in your Trust Trust Boards may also wish to consider an additional proposed QIPP key performance indicator, which is: To reduce the number of hospital admissions which end in death of eight days or more. This indicator must be based on clinical need, quality of care and individual’s preferences. 4
  • The route to success ‘how to’ guide 5
  • Section 5 Core metrics: Trust Board (continued) Please complete below the number of eligible wards (e.g. more than five deaths per year) that have implemented the five key enablers or equivalent and the number planning to implement during the next 12 months. Enablers: Baseline Midpoint Endpoint No. of wards implemented by Nov 2011 Planned no. of wards implemented by June 2012 Planned no. of wards implemented by Nov 2012 Advance Care Planning model (ACP) Integration within an Electronic Palliative Care Co-ordination Systems (EPaCCS) AMBER Care Bundle Rapid Discharge Home to Die Pathway (e.g. anticipated prognosis – hours/days) Liverpool Care Pathway (LCP) 1. The Trust has an action plan for the delivery of high quality end of life care, which encompasses people with all diagnoses, and is reviewed for impact and progress Baseline Comment on next steps 6 Plan not developed Plan partially developed Plan in place and post implementation of the strategic plan for impact and progress RED Numerical indicator: The Trust has an end of life care action plan which feeds into a locality wide strategic plan for end of life care AMBER GREEN
  • The route to success ‘how to’ guide Core metrics: Trust Board (continued) 2. Promote end of life care training opportunities and enable relevant workers to access or attend appropriate programmes dependent on their needs No curriculum evidenced Curriculum being developed against Trust Training Needs Analysis Curriculum evidenced based on Trust Training Needs Analysis RED Numerical indicator: Identification of end of life care training needs of staff and training is in place to meet this AMBER GREEN Baseline Comment on next steps 3. Monitor the quality and outputs of end of life care and submit relevant information for local and national audits Minimal audit and review Infrequent audit and review, actions not followed Regular and comprehensive audit, including participation in National Care of the Dying Audit – Hospitals (NCDAH) RED Numerical indicator: Identification of end of life care audit programme in Trust AMBER GREEN Baseline Comment on next steps 7
  • Section 5 Core metrics: Ward Baseline data: Number of people Number of admissions per year on the ward Number of deaths per year on the ward Red Level 0 Amber Level 1 Yellow Level 2 Blue Level 4 Green Level 5 1. Advance Care Planning (ACP) Indicator: Ward implementation of ACP model Midpoint Endpoint 8 The ward has plans in place to implement ACP model The ward has an education and training programme for implementing ACP model The ward is able to demonstrate implementation of ACP model The ward has embedded and sustained the use of ACP model RED Baseline The ward has not implemented ACP model AMBER YELLOW BLUE GREEN
  • The route to success ‘how to’ guide Core metrics: Ward (continued) 2. Electronic Palliative Care Co-ordination Systems (EPaCCS) Indicator: Ward implementation of EPaCCS The ward has not implemented EPaCCS The ward has plans in place to implement EPaCCS The ward has an education and training programme for implementing EPaCCS The ward is able to demonstrate implementation of EPaCCS The ward has embedded and sustained the use of EPaCCS RED AMBER YELLOW BLUE GREEN The ward has not implemented AMBER The ward has plans in place to implement AMBER The ward has an education and training programme for implementing AMBER The ward is able to demonstrate implementation of AMBER The ward has embedded and sustained the use of AMBER RED AMBER YELLOW BLUE GREEN Baseline Midpoint Endpoint 3. AMBER Care Bundle Indicator: Ward implementation of AMBER Baseline Midpoint Endpoint 9
  • Section 5 Core metrics: Ward (continued) 4. Rapid Discharge Home to Die Pathway (RDP) Indicator: Ward implementation of RDP The ward has not implemented RDP The ward has plans in place to implement RDP The ward has an education and training programme for implementing RDP RED AMBER YELLOW BLUE GREEN The ward has not implemented LCP The ward has plans in place to implement LCP The ward has an education and training programme for implementing LCP The ward is able to demonstrate implementation of LCP The ward has embedded and sustained the use of LCP RED AMBER YELLOW BLUE GREEN The ward is able to demonstrate implementation of RDP The ward has embedded and sustained the use of RDP Baseline Midpoint Endpoint 5. Liverpool Care Pathway (LCP) Indicator: Ward implementation of LCP Baseline Midpoint Endpoint 10
  • The route to success ‘how to’ guide 11
  • www.endoflifecareforadults.nhs.uk Published by the National End of Life Care Programme ISBN: 978 1 908874 04 7 Programme Ref: PB0005 A 02 12 Publication date: Feb 2012 Review date: Feb 2014 © National End of Life Care Programme (2012) All rights reserved. For full Terms of Use please visit www.endoflifecareforadults.nhs.uk/terms-of-use or email information@eolc.nhs.uk. In particular please note that you must not use this product or material for the purposes of financial or commercial gain, including, without limitation, sale of the products or materials to any person. Supported by the NHS Institute for Innovation and Improvement