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What is the positive change that has emerged through new collaborations or partnerships during Covid-19 that your project is going to embed?

The partnership developed has provided a shared adoption of a proactive approach towards future planning, and commitment to respecting autonomous patient wishes. Strong connections have been created with governing body representatives from: HSCP GGC; Scottish Care CEO; Scottish Partnership for Palliative Care; Health Improvement Scotland, Scottish Primary and Community Care.

The collaboration from the homes and our relationships developed with these major governing bodies, allows for an atmosphere that aims to build a quality improvement environment. This is evidenced in quantitative data that shows how patients have received EOLC in their homes rather than hospital. With qualitative data from staff stating how they feel more confident to commence challenging conversations about anticipatory care plans. This has resulted in improving adherence to best practice from governing bodies, and builds on the skills of the staff.  This will empower them clinically and emotionally when dealing with these difficult situations.

What does your project aim to achieve?

This project aims to build on suggestions from our recently concluded quality improvement project about Anticipatory Care Plans. It is based on qualitative data from the staff who have worked through the first wave. It aims to ensure:

Provide education around previously expressed topics to increase staffs confidence and competence surrounding difficult conversations concerning anticipatory care planning (ACP)
If not done ACP planning discussions to be triggered on admission to care/nursing home where appropriate
Better quality and identification of clinical escalation information present
Better compliance with patient wishes expressed in ACP
Enable more patients to die in the care/ nursing home, if that is their wish, rather than being admitted to hospital.  This respects the patients autonomy
To reduce emotional stress on staff, from these difficult conversations, by means of educating and encourage a positive supportive environment around ACPs.  This will help build staff resilence.

How will the project be delivered?

The project will be delivered by GDPR approved video application, to a socially distanced small group setting, using a rota for each nursing/care home. It will be supervised by a Palliative Care Consultant and delivered by a Speciality Doctor to the care/nursing home staff. It will be measured by way of pre and post questionnaires on confidence/emotional stress encountered in relation to triggering ACP conversations, recognising deteriorating patients, death and dying etc.

Cost effective assessment- our previous project has showed preventing 11 admissions has projected savings of 131 bed days equating to ~£155, 000, without accounting for inflation. It is the view point of this organisation therefore, that training staff to ensure high quality ACPs are developed, and importantly followed, is of a massive cost benefit – especially given the socioeconomic deprivation of the local area.  However more importantly it respects the patient’s autonomy

How is your project going to share learning?

The aim of this project is about educating staff to help the completion of high quality ACPs, ensuring ACPs are followed, and that staff feel comfortable in initiating conversations with patients/family. These are valuable learning points in normal times; however there is the specific focus of targeted learning from hardships highlighted by COVID.

It shows Q-members a reactive approach to aiding the patients and staff affected in the community during 1st wave. We listened to their needs and have designed a project to increase clinical and emotional confidence. It highlights educational projects can enhance skill bases, improve confidence, decrease emotional stress and build resilence.  It was evidenced by savings in secondary care from reduced admissions.  This project showed by working with community staff in a positive atmosphere based on their needs can result in benefits for all.

These concepts are transferable between specialities throughout the UK/ROI

How you can contribute

  • Similar educational programmes in other deaneries in Scotland or elsewhere in the UK to pick up on different ideas, difficulties they encounter etc
  • The Collaborator - may afford opportunities to link up with similar programmes or health board workers to increase synergy and give platform to work
  • The promoter - uses social media to make people aware of supportive work, increase enthusiasm for this proactive project. We would be keen to work with others nationally to promote each others work and learn from each other. We can then bring new ideas to our deprived area which will benefit the patient, their familes and the NHS as a whole.

Plan timeline

1 Mar 2021 Advertising the Programme to local Health Board
8 Mar 2021 Scheduling first and subsequent educational sessions
15 Mar 2021 Commence educational sessionals to involved care/nursing homes
1 Sep 2021 6 month review of ACP completed
1 Sep 2021 Questionnaire to be completed by staff. Themes identified targeted education
1 Mar 2022 Completion of project and conclusions

Comments

  1. Emma Adams

    I am so grateful for your comment showing how Q members genuinely want to help help each other.  We will definitely explore your ideas.  Thanks so much

     

    Paul

  2. Hi - great to see this idea for working with care homes building on previous successful work.  I'm working with the Health Foundation to support opportunities for collaboration across Q Exchange. There are a few care home focused proposals on here that might be worth looking at for possible support and/or feedback. Specifically there's one about a virtual care home multi-disciplinary team that might be of interest to you? There are also some groups online in the Q community around digital and primary care that could give you some feedback to help develop your ideas further. Good luck with your idea, Emma

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