The integrated implementation of two end-of-life care tools in nursing care homes in the UK: an in-depth evaluation
- 27 July 2010
- journal article
- research article
- Published by SAGE Publications in Palliative Medicine
- Vol. 24 (8), 828-838
- https://doi.org/10.1177/0269216310373162
Abstract
In economically developed countries there is a rapidly increasing number of older people living and dying in care homes. The relative isolation of nursing care homes from the development of palliative care, the poor retention and recruitment of staff, and the lack of medical cover, hinder the provision of quality end-of-life care. End-of-life care strategies internationally highlight the benefit of using tools to help improve end-of-life care in care homes. All seven private nursing care homes within one district in Scotland undertook to implement, as a package, two end-of-life care tools, namely, the Gold Standards Framework for Care Homes (GSFCH) and an adapted Liverpool Care Pathway for Care Homes (LCP). A model of high facilitation, visiting the homes every 10—14 days with significant in-house staff training, was used to implement the 18-month programme. The notes of 228 residents who had died prior to and during the project were examined, alongside a staff audit looking at the effect that the project had on practice. A nurse researcher undertook qualitative interviews of bereaved relatives, pre-/post-implementation. This paper reports the results of an in-depth evaluation of professional practices and residents outcomes. There was a highly statistically significant increase in use of Do Not Attempt Resuscitation (DNAR) documentation, advance care planning and use of the LCP. An apparent reduction in unnecessary hospital admissions and a reduction in hospital deaths from 15% deaths pre-study to 8% deaths post-study were also found. Further work is needed to assess the optimum input required for successful implementation.This publication has 16 references indexed in Scilit:
- Improving generalist end of life care: national consultation with practitioners, commissioners, academics, and service user groupsBMJ, 2008
- Implementation and impact of the Gold Standards Framework in community palliative care: a qualitative study of three primary care trustsPalliative Medicine, 2008
- Barriers to implementing an integrated care pathway for the last days of life in nursing homesInternational Journal of Palliative Nursing, 2006
- Promoting end-of-life care in nursing homes using an ‘integrated care pathway for the last days of life’Journal of Research in Nursing, 2005
- End of Life in Care HomesPublished by Oxford University Press (OUP) ,2003
- Care for the Dying: A Pathway to ExcellencePublished by Oxford University Press (OUP) ,2003
- Obstacles to palliation and end-of-life care in a long-term care facility.The Gerontologist, 2002
- As Individual as Death Itself: A Focus Group Study of Terminal Care in Nursing HomesJournal of Palliative Medicine, 2002
- Palliative care in nursing homesPublished by Oxford University Press (OUP) ,2001
- Evaluating a palliative care education project in nursing homesInternational Journal of Palliative Nursing, 2000