1 / 14

‘Planning for the Future’ Listening to the Patient’s Voice

‘Planning for the Future’ Listening to the Patient’s Voice. St Vincent’s Hospital Athy (SVH) HFH Community Hospitals 20 th March 2014. Aims. To develop a framework to support staff with Advance Care Planning Discussion around

treva
Télécharger la présentation

‘Planning for the Future’ Listening to the Patient’s Voice

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. ‘Planning for the Future’Listening to the Patient’s Voice St Vincent’s Hospital Athy (SVH) HFH Community Hospitals 20th March 2014

  2. Aims To develop a framework to support staff with Advance Care Planning Discussion around End of Life issues with residents/families in Le Cheile (Dementia Unit)

  3. Project Team Representatives from: • Nursing specialists/manager from the areas of Dementia and palliative Care • Medical Specialists from the area Gerontology and Palliative Care • Director of Nursing and Education Facilitator St Vincent’s Hospital Athy and St Brigid’s Hospice, The Curragh • Community services • Programme Development ManagerIFH

  4. However! While nurses report finding it easy to initiate conversation around end of life with relative there was little documented evidence in care plans that any conversation took place!

  5. Interventions • Education for staff to further develop their skills to improve confidence around end of life discussion with residents and their relatives • All staff to recognise/ identify what residents preferences and wishes are as early as possible ie. ‘special moments’ • Accept that people with dementia can express preferences and wishes and help to facilitate the discussion • Making conversations around end of life a ‘normal’ domain of care, involving residents and their families, building on information gradually • Symptom management guidelines • HFH resources

  6. Adapting Care Plans • Change from ‘Dying Domain’ to Planning for End of Life Care • Format changed to allow easier introduction of topic • Language used in care plan developed to facilitate all staff • Resident/families understand language, reduced risk of misinterpretation • End of Life topic made more ‘normal’ • Use of picture/cues as prompts

  7. Re audit of Care Plans Le Cheile • 10 residents case notes reviewed-nursing/medical • 100% entry on ‘dying domain’ in residents care plan with individualised preferences and wishes documented • End of life discussion now part of each residents regular three monthly review, discussions take place with resident and families • More awareness among families about importance of documentation expressing preferences and wishes • End of life discussion/ documentation initiated by nurses who have completed designated education programmes • No residents transferred to acute care except for treatment post falls, all returned to Le Cheile same day • Two nursing staff had not written in notes, they had not taken part in the education programmes • Inconsistencies between documentation in nursing and medical notes

  8. End of Life audit-extended • Audit of 13 care plans and medical notes from other units in hospital • 76% had no information about preferences and wishes in residents care plan • 46% no relevant information, documented ‘resident unable/not discussed’ no family invited to discuss • 30% had limited information e.g. ‘happy to stay’ here or ‘received sacrament of sick’ • 15% residents didn’t want to discuss dying • 7% Had details of burial wishes • No entries in Medical notes around Planning/Discussing End of Life Care • Average age of resident 85 years

  9. Next Phase • Dissemination of resources to all other wards on a phased basis • Address discrepancies between documentation in nursing/medical notes • Raising staff skills and knowledge • Develop audit tool to evaluate use of new end of life page • Establish End of Life Committee • Referral pathway for specialist palliative/dementia support

  10. Conclusion • End of Life can be challenging • Staff education helps to build staff confidence initiating end of life discussion • Improved tion skills, education and documentation will improve quality of care for residents at end of life • Documentation must be in medical and nursing records

  11. Remember • People with dementia can still provide invaluable insight into how end of life care is planned to meet their individual needs but the manner in which we communicate with this group needs to be sensitively adapted to allow their wishes to be heard (i.e. language, observations).

  12. Reading • End-of-life care standards for people with dementia. (2010) Dublin: Centre for Ageing Research and Development in Ireland. • Opening Conversations (2011).Developing a model for The Alzheimer Society of Ireland of best-practice palliative care interventions for people with dementia and their carers • CREATING EXCELLENCE IN DEMENTIA CARE A Research Review for Ireland’s National Dementia Strategy(2012) Suzanne Cahill, Eamon O’Shea & Maria Pierce HFH Publications

More Related