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Plan of care for the last days of life

Plan of care for the last days of life

The last days of life in hospital can be traumatic for dying patients and their loved ones.

At our hospital, the needs and wishes of the dying person and those close to them are paramount  - and we must ensure that they receive high quality focussed care in their last few days and hours of life.

To help us achieve this, we have developed an End of Life Care Strategy, based on national best practice – and our own ambition to ensure that patients reaching the end of their life, and their loved ones, are listened to and cared for in a compassionate, supportive way.

The strategy is based on the foundations of the ‘six ambitions’ for end of life care, developed by the National Palliative and End of Life Care Partnership.

The strategy was driven by our commitment to continuous improvement.

In 2015, the Care Quality Commission (CQC) inspected the hospital and gave the Trust an overall rating of “good”.

Usefully, the inspection report highlighted several areas where inspectors felt we could improve the service we offer our patients.

These included the roll out of an ‘end of life’ care plan across the hospital.

This has been done – and wards across the hospital are now using our Plan of Care for the Last Days of Life to ensure that all care delivery decisions are recorded as well as the outcome of conversations with patients and their families so that their needs are taken into account

What 'Plan of Care for the Last Days of Life' means for you and your family

We want to provide the best possible healthcare for everyone who attends our hospital – from the new born baby just starting on life’s journey to the patient reaching the end of their life.

For patients who are in their final days, we provide an individual care plan which not only meets their needs and ensures their comfort but also, where possible, accommodates all their final wishes. For example, this may include making arrangements so that a patient can leave hospital to be with their families in the last days of life, in the familiar surroundings of their own home.

To help us do this, we have introduced the “Plan of Care for the Last Days of Life”, which guides and supports how our staff will work with patients and their families

Khristina Bartlett, a senior nurse with more than 20 years’ experience, is our Nursing Lead for end of life care and has provided some answers to key questions around the subject:

  • Every patient reaching the end of their life in our hospital will have their own individual Plan of Care. The plan itself is a comprehensive document which not only records care delivery and decisions taken but also notes conversations with patients and their families so that their needs are taken into account. Each and every plan is based on five key principles, including commitments to:

    • communicate sensitively with patients and those identified as important to them.
    • involve the patients, and those identified as import to them, in decisions about treatment and care.
    • support, by ensuring that the needs of families and others identified as important to the patient are actively explored, respected and met as far as possible.
    • plan and do, by implementing an individual plan of care which includes food and drink, symptom control and psychological, social and spiritual support. The plan must be agreed, co-ordinated and delivered with compassion.

    Each plan is a paper document which is kept where it needs to be – at the end of a patient’s bed, so that all involved in support and care have easy and immediate access to it.

  • Essentially, it acts as a communication tool which ensures that every contact with a patient is recorded in one place. This can include decisions about treatment, information about spiritual or religious needs or sensitive conversations about a patient’s wishes for how they wish to spend their final days. At the same time, it helps guide and prompt staff to ensure that no element of care and support is missed. While it is primarily a record for hospital staff and other health and social care professionals, it is also available to both the patient and their family should they wish to be satisfied that everything is being carried out according to plan and in line with the patient’s wishes.

  • Because it helps build a partnership of trust and understanding between patients and those responsible for their healthcare, acknowledging that this is a highly emotive and sensitive time as a patient approaches the end of their life. Understandably, this can be an extremely anxious and stressful time for patients and their loved ones: the aim of the plan is to reduce this stress as much as possible. We want to create an atmosphere where patients feel they are given the time to express their wishes and feel confident that we will do all we can to act upon those wishes. It’s about listening, being supportive and acknowledging what matters to the patient and those that care for them.

  • We are always looking at ways in which we can improve – and following an inspection from the Care Quality Commission, for which we received an overall rating of ‘good,’ inspectors recommended that we introduce a new plan across the hospital to further improve our service in this area. We were also asked to appoint a Non Executive Director for End of Life Care, who is David Ellis. I am the Nursing Lead and my colleague Sarah Downey is the Medical Lead. 

  • We recognise that not all staff feel confident having these conversations. So, for those that need help, training and support is available-both in the classroom setting and face to face if needed.

  • Yes. We have a Care at End of Life group, chaired by the Director of Nursing, which meets regularly to check that the care plan is being implemented appropriately. . This group also ensures that our End of Life Care Strategy is being implemented and reviews any new national guidance and best practice as it becomes available.

  • Yes. We are committed to continuous improvement  we encourage feedback to enable us to where necessary learn and make changes, to enable patients and their families receive the best care possible. . If anyone has any suggestions, they can submit them via our Patient and Liaison Service or contact me directly at Khristina.bartlett@jpaget.nhs.uk

Khristina Bartlett, Nurse Lead for end of life care

Khristina Bartlett