Route to success - introduction

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Transforming end of life care in acute hospitals - introduction
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.

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

Published in: Health & Medicine
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Route to success - introduction

  1. 1. Transforming End of Life Care in Acute Hospitals Route to Success Implementation Guide The route to success Introduction
  2. 2. Introduction Foreword Some years ago I nursed and cared for my daughter who had breast cancer. Wanting and needing to provide the best possible care for her I worked hard to ensure that this would happen. However due to fear and lack of knowledge, at the very end of her journey I had to call 999 which resulted in an emergency admission. The ambulance took four hours to arrive and my daughter died in a busy accident and emergency department on a Friday evening. This had a profound and devastating effect on me, leaving me with a heavy burden of guilt even to this day. Far more recently I was able to stay beside my mother-in-law in the hospital during her last days. The palliative care which she received was wonderful. I was able to assist with some of her care and she was treated with dignity and respect. I feel that I am able to look back without any guilt about her death knowing that it was almost as good as it could have been. For the sake of the person dying and their carers, let us work towards a system of which we can all be proud, thus relieving families of unnecessary anxiety and guilt. Roberta Lovick User/carer representative – acute hospitals end of life care steering group 2
  3. 3. The route to success ‘how to’ guide Foreword Over 50% of people die in acute hospitals in England, many of whom do not currently receive optimal end of life care. For this reason the importance of improving end of life care in hospitals was highlighted in the 2008 national End of Life Care Strategy. The route to success in end of life care – achieving quality in acute hospitals published in 2010 formed the first step in a national improvement programme. It provided practical support for managers and clinicians responsible for delivering end of life care. The next step is a major initiative to launch this ‘how to’ guide, bringing together the National End of Life Care Programme and the NHS Institute for Innovation and Improvement’s Productive Ward: Releasing time to caretm series. The guide embraces the expertise of these two national programmes using service improvement methodology, including five key enablers and key metrics to implement best practice for end of life care in acute hospitals. A first wave of hospital Trusts will lead the implementation in 2012 followed by a cascade model to other hospitals across the country. It is now time for acute hospitals to embrace a positive culture in end of life care, and recognise that it is a core responsibility of every hospital and health care professional to deliver excellence for people at the end of life and their families. Professor Sir Mike Richards National Clinical Director for Cancer and End of Life Care 3
  4. 4. Introduction This guide contains individual sections that can be worked on in the order of your choosing, dependent upon your individual hospital and its current end of life care provisions. These include: 1: Prepare 3: Plan 5: Evaluate 4 6: Sustain 2: Assess and diagnose 4: Treat 7: Further resources
  5. 5. The route to success ‘how to’ guide Introduction The Department of Health’s End of Life Care Strategy (2008)1 is a blueprint for improving the care of all dying people over the next ten years, regardless of diagnosis. It emphasises that improved end of life care provision in acute hospitals is crucial given that currently more than half of all deaths take place there. As well as ensuring that those who die in hospital have a ‘good death’, the strategy called for improved discharge arrangements and better co-ordination with a range of community and social care services so that more people can die at home if that is their preferred choice. The route to success in end of life care – achieving quality in acute hospitals (2010)2 highlights best practice models developed by acute hospital Trusts and supported by the National End of Life Care Programme. It provides a comprehensive framework to enable acute hospitals to deliver high quality person centred care at the end of life. www.dh.gov.uk/en/Publicationsandstatistics/Publications/ PublicationsPolicyAndGuidance/DH_086277 2 www.endoflifecareforadults.nhs.uk/publications/route-tosuccess-acute-hospitals 3 www.institute.nhs.uk/quality_and_value/productivity_ series/productive_ward.html 1 This guide builds on that overarching framework. It draws on the valuable learning from the NHS Institute for Innovation and Improvement’s Productive Ward: Releasing time to care™ series3. The Productive Ward uses service improvement principles to offer practical and helpful tips on how to prepare your organisation for implementing The route to success in end of life care – achieving quality in acute hospitals, as well as how to maximise your ability to sustain success. This guide encourages NHS managers and clinicians and other frontline staff to use existing models and tools already identified as examples of good practice. It aims to make the links between the use of five key enablers, or their equivalent, which support and follow a person-centred pathway. These are: Advance Care Planning (ACP) Electronic Palliative Care Co-ordination Systems (EPaCCS) formerly known as end of life care locality registers AMBER Care Bundle Rapid Discharge Home to Die Pathway (RDP) Liverpool Care Pathway (LCP) for the Dying Patient. 5
  6. 6. Introduction Ensuring quality of care and putting people’s needs at the heart of the healthcare system requires a workforce that is equipped with the right knowledge, skills, competences, attitudes and behaviours. Education, training and workforce development are essential elements that require embedding as core requirements in corporate governance frameworks to enable the achievement of the aims of the The route to success. 1. Meeting the Quality, Innovation, Productivity and Prevention (QIPP) agenda4 is a challenge for all. Utilising the principles of continuous improvement within the Productive Ward will help Trusts to reshape how their staff work with each other, with the people receiving care and their families, and with community and social care partners. The Productive Ward’s six step approach may help you to achieve this: 2. Prepare 3. Assess Diagnose 6. Figure 1: six step continuous improvement diagram from The Productive Ward: Releasing time to care™ (© NHS Institute for Innovation and Improvement) 4 6 4. Evaluate Plan 5. www.dh.gov.uk/en/Healthcare/Qualityandproductivity/QIPP/index.htm Treat
  7. 7. The route to success ‘how to’ guide Acknowledgements This ‘how to’ guide has been written and developed with input from numerous individuals and organisations. These include clinicians, support staff, lay people, users of services and their carers. Special thanks go to: NHS Institute for Innovation and Improvement National End of Life Care Intelligence Network Social Care colleagues Strategic Health Authority end of life care leads Teams from the 26 Trusts participating in the transform programme The National End of Life Care Programme’s acute hospitals steering group All those who have contributed to the good practice examples and podcasts available throughout this guide. These contributions have been invaluable in making this guide a tool that can be used by a wide range of staff involved directly or indirectly in end of life care, ranging from frontline staff to educators and service commissioners. The acute hospitals initiative would not be possible without the dedicated work of Professor John Ellershaw, Anita Hayes, Chris Sutcliffe, Jackie Main, Kate Henry and the National End of Life Care Programme team. 7
  8. 8. 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

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