The west London challenge

1
The west London challenge

• Managing end of life care within the renal
  setting.
• Jacquie Fraser Senior renal counsellor
• Jo Burke Head nurse Hand-field Jones ward

2
Background

• October 2005 Merger of Hammersmith, Charing Cross
  and St .Marys Hospital renal and transplant
  services on the Hammersmith Hospital site.
• Amalgamation of patients, nursing medical
  skills.
• NSF for renal part two Chronic kidney disease,
  acute renal failure and End of life care (DH,
  2005)
• DH(2003p44)Building on the Best Choice,
  responsiveness and equity in the NHS-12 million
  over 3 years invested to improve EOL care based
  on a hospice type model.
• Improving Supportive and Palliative Care for
  Adults with Cancer (Nice 2004)
• Our health, Our care, Our say a new direction
  for community services (DH 2006)
• National care of the dying audit (Marie Curie
  Cancer care,2006)

3
End of Life Initiative

• Approach made by Jan Holden NW London Project
  Lead co-ordinator of local initiatives
• Kara Blackwell Palliative Care Clinical Nurse
  Specialist Lead keen to introduce Liverpool Care
  Pathway as increase of renal referrals to the
  Palliative care team (4 per month).

4
West London response

• End of life lead for renal agreed-Wendy Brown,
  Consultant nurse.
• Working group set up September 2006 (ward
  nurses, renal counsellor, education team ,CAPD,
  discharge team, satellite dialysis nurse, and
  pharmacist)
• Group has met on five occasions.
• Valuable experience for team as many members had
  not met or worked with one another before.
• Concerns from group about the whole package of
  care on wards - that patients and relatives
  were getting the service they deserved
• It was agreed that where the patient was dying
  the care was good although documentation was not
  as good!
• Evidence from group meetings of good practice on
  wards, involving nursing/ medical teamwork with
  involvement where appropriate of Palliative and
  Pain team.

5
Next steps

• The audit demonstrates that we are identifying
  this group of patients however, the LCP would
  assist us in managing them more effectively.
• Implement LCP as patient need arises with
  assistance from palliative care team.
• Get medical team to support the use of the LCP.
• The group to carry on meeting to ensure continued
  support of new practises on the wards.
• Possible annual review with patients GSF.
• To develop relative information folders on dining
  facilities, car parking , overnight facilities,
  visiting and use of phone and other appropriate
  leaflets.
• To continue with staff involvement on how we
  manage care of dying in order to enhance staff
  skills competence and confidence.
• Access to study days.
• Development of link nurse role.