Marie Curie Delivering Choice Programme The Tayside Project

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Marie Curie Delivering Choice ProgrammeThe
Tayside Project

• Presentation to the
• Tayside Public Health Network
• February 7, 2007

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Marie Curie Delivering Choice Programme
A national palliative care programme with three
project sites
Together we will develop and help provide the
best possible service for palliative care
patients allowing them to be cared for in the
place of their choice
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Objectives

• Working in partnership with the NHS, social
  services, and
• the voluntary sector we aim to provide
• Patient-focused 24-hour service models that serve
  local needs and ensure
• The best possible care for palliative care
  patients
• Choice in place of care and death is available to
  all
• Improved equity of access to services
• Appropriate support services to palliative care
  patients and their carers
• Information on choice is available and known to
  all
• Improved co-ordination of care among stakeholders

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Objectives (cont)
2) Independent evaluation of the economic impact
to healthcare services of more patients receiving
palliative care at home as compared to
hospitals 3) Dissemination of findings to other
health and social care providers leading to the
replication of solutions across the UK
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Project structure

• Phase I Understanding the current state of
  services
• Phase II Designing new service models
• Phase III Implementing and monitoring service
  models

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Phase I early findings

• Communication.
• Community
• Delayed Discharge
• Identification of palliative care patients
• Transport
• Support for carers

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Phase II
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Phase II
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• The Palliative Care Electronic Patient Record
  (PCEPR)

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The illness journey
choice
choice at crisis
diagnosis
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The Palliative Care Electronic Patient Record
(PCEPR)

• Aims
• Identification of palliative care patients
• Provision of clinical information
• Provision of information on choice
• Promote communication between patients and
  healthcare professionals

Help deliver choice
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The Palliative Care Electronic Patient Record
(PCEPR)
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Improving Hospital DischargeThe Marie Curie
Discharge Liaison Nurse (MCDLN)
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Improving hospital discharge MCDLN

• Aims
• Use of PDSA model to fast-track discharge for end
  of life patients
• Improved, slicker discharge of patients to
  preferred place of care/death
• Work with current discharge models and services
  in Ninewells Hospital to ensure improvements are
  integrated into discharge practice
• Standardised discharge for palliative care
  patients across NHS Tayside
• Spread of fast-track discharge to a wider
  environment to maximise patient benefit

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Improving hospital discharge MCDLN

• Location Ninewells Hospital
• Focus initially on the respiratory oncology
  wards but will not be limited to these wards if
  patients are referred from other wards within
  Ninewells

Help fast track discharge to deliver choice
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Dedicated Palliative Care Ambulance
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Dedicated Palliative Care Ambulance

• Provide a flexible and responsive Tayside-wide
  resource
• Service responds at short notice to requests from
  discharge/transfer palliative care patients
• Provide crew trained in additional skills to
  support palliative care patients in transit
• Covers 7 days per week, 7.5 hours per day
• Provision of a control/ordering procedure which
  will result in improved ordering of vehicle and
  allocation of resources

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Dedicated Palliative Care Ambulance

• Pager system for requesting service
• Customised vehicle to maximise patient comfort
• Staff and training
• The Palliative Care Ambulance team will comprise
  of 3 x WTE up skilled Ambulance Care Assistants
  (ACAs)
• Will either drive the vehicle or support patient
• 2x ACAs per journey
• 3x WTE ACAs will be available to cover weekends
  and holiday
• Do Not Attempt Resuscitation
• Required by ACA before patient is
  transferred/discharged

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Dedicated Palliative Care Ambulance

• Key Features
• Based at Ninewells Hospital, Dundee
• Service Tayside wide
• 7 days per week, 0945hrs-1715hrs
• Requests prioritised to three categories
• Help deliver choice

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Improving Rapid Response in the Community
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Improving Rapid Response in the Community Dundee
Angus

• 1 x WTE band 7 registered nurse for Dundee
• 1x WTE band 6 registered nurse for Angus
• 6 month pilot with OOHs services to
• Explore and understand demand for service
• On completion, the nurse will develop and deliver
  a rapid response service in line with the
  findings of the pilot

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Improving Rapid Response in the Community Perth
Kinross

• 1 x WTE band 6 registered nurse per shift (total
  of 2.5 WTE required)
• Enhance OOH service 2200hrs-0800hrs, 7 nights per
  week
• Jointly funded by NHS Tayside and the Marie Curie
  Delivering Choice Programme
• Nurses to carry out general nursing care as well
  as palliative care
• Back-up support provided by Marie Curie Heath
  Care Assistants

deliver choice by helping to keep patients at
home
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Support for Patients and Carers
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Support for Patients and Carers
Marie Curie Nursing Service and Crossroads
Respite
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Support for Patients and Carers
Princess Royal Trust Support for carers

• Aims
• Identify hidden carers of palliative care
  patients
• Carry out assessment and manage support
  mechanisms for the carer

Deliver choice by keeping the carer well
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Developing the Marie Curie Nursing Service
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Developing the Marie Curie Nursing Service

• Proposal 1 Improve communication with the DN
  teams and other community professionals
• Password protected handover messaging system
• GSF Scotland meetings in primary care
• Multi disciplinary meetings in secondary care
• Resource folder

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Developing the Marie Curie Nursing Service

• Proposal 2 Education Training
• Recruit a Marie Curie Practice Educator
• 1 x WTE
• Tayside wide
• Provide education training to the Marie Curie
  Nursing Service staff staff employed through
  the Delivering Choice initiatives
• Support of other groups e.g. heart failure
  nurses, social care staff

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Possible patient pathway
Pall care pt. Has made choice to be cared for
die at home. Diagnosis of lung ca with bony mets.
Discussed with oncology consultant recorded on
PCEPR
Cared for by fragile elderly wife. Receive help
from Crossroads. DN visit x1 per day to renew
Syringe Driver. DNs note increasing fatigue of
wife and ask for social service input
Pt falls while getting out of bed at 3am. Wife
calls RRT.
Respite DNs GP OOH MacMillan MCNS Social
Services Crossroads PRT support worker
Pt. home
RRT RN notes pt. wishes recorded on PCEPR- stay
at home and DNAR- before visit
Transported home via pall care ambulance
Ward nurses co ordinate D/C. Able to fast track
using other D/C practices proven successful by
PDSA
Assessed by RRT. Pt. now distressed. Note 2
day history of weakness, loss of bladder control
and back pain. RN asks GP to assess ? SCCC. GP
recommends admission to Ninewells for further
assessment
MCDLN notes barrier to fast track discharge and
uses PDSA successfully
Pt. assessed by HPCT and recommendations for
treatment made. HPCT alert MCDLN
Admitting registrar notes entry on PCEPR.
Notifies HPCT.
Pt stable. MDT meeting. Agree on D/C date
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What next?

• Services/posts begin April/May 2007 until
  April/May 2009
• Development of telemedicine
• Extension of the Support for Patients and Carers
  workstream
• Ongoing internal external evaluation

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Marie Curie Delivering Choice ProgrammeThe
Tayside Project

• Presentation to the
• Tayside Public Health Network
• February 7, 2007