Sharon CansdaleGSF

Facilitator

Gold Standards Framework in care homes

Key Factors with end of life care of elderly

• Multiple co-morbidities.

• Increasing memory loss/dementia.

• Difficulty predicting prognosis

• Difficulty predicting dying phase

• Complex social/health factors

• Need protection from over intervention; trolley deaths, DNAR.

Context in care homes

• Half a million people live in care homes-about 1% of the population.

• Approx 20% people die in care homes

86% all deaths over 60 - 51% in people over 80• For every NHS bed there are 3 care home beds• The sector employs about 1.2 million people• Education alone in care homes does not work –

needs change management skills to embed new system plus supported learning (Froggatt et al)

Key Challenges

• Crises out of hours• Residents being sent into hospital without

a visit. 999• Drugs and equipment availability• Residents/family expectation• Access to education and training• Clarity of what CH can offer• Lack of confidence

DH End of Life Care StrategyJuly 08

‘Inadequate training of staff at all levels within care homes, sheltered housing and extra care housing sector…is

considered to be the single most important factor’

• Factors leading to suboptimal care;• Lack of ACP• Inadequate recognition and holistic assessment• Death Concerns• Impact on other residents• Inadequate access to NHS services• Inadequate medicine reviews• Training

The GSF Care Homes Training Programme

Goals1. To improve the quality of end of life care

2. To improve collaboration with primary care and palliative care specialists

3. To reduce hospitalisation- and enable more to live and die at home

What is the Gold Standards Framework?

• System of care that promotes one GOLD standard of care for ALL people nearing the end of their life

• Modified version of primary care Gold Standards Framework (GSF)

• 4 main aims• 1. Improve quality of care for patients nearing the end of

their lives• 2. Improve the coordination and collaboration with GP’s

and Primary Health Care Teams• 3. To reduce the numbers admitted to hospital in the last

stages of life• 4. To share learning with key suggestions in improving

end- of-life care in care homes

GSF: The 7 Key Tasks (7 Cs)

C1 CommunicationSupportive Care Register, MDT Meetings, information Advanced care planning (ACP) e.g. Preferred priorities of care (PPC)

C2 Co-ordinationIdentified co-ordinator for GSF, key worker for patient

C3 Control of SymptomsAssessment tools, guidelines, Specialist Palliative Care Team (SPCT)

C4 Continuity Handover form, Out Of Hours protocol, liaison

C5 Continued LearningLearning about conditions seen, audit, Significant Event Analysis, reflective practice

C6 Carer SupportPractical, emotional, bereavement

C7 Care in dying phase

Liverpool Care Pathway for the Dying Patient (LCP)

3 stage training programmePreparation, training,

consolidation + accreditation

Stage I Preparation Stage II Training Stage III Consolidation + Sustainability

3-6 months workshops in 9 months 9 – 12 months

Awareness Raising Meeting

Local Coordinators

Meetings

Workshop 1 Workshop 2 Workshop 3 Workshop 4 GSFCH Accreditation

ADAAfter

ADABefore

Final Appraisal

Ongoing ADA

Enrolment of Care Homes

Training workshops Four Gears

1. Getting going1. Coding, Register

2. Review Meeting,

3. Coordinator Role

2. Moving on1. Advanced care

Planning

2. Assessment of symptoms

3. Out of hours continuity

3. Gaining Speed1. Education and reflection2. Carers, family, residents

and staff support including Bereavement

3. Care in Final days

4. Cruising1. Sustaining2. Embedding3. Extending - accreditation

GSF Coding of Residents in the Care HomeGSF Coding of Residents in the Care Home

Years Years to Liveto Live

• Advance Care Plan discussion initiated.Advance Care Plan discussion initiated.• Holistic assessment Holistic assessment

Months Months to Liveto Live

• Advance Care Plan in place. Advance Care Plan in place. • Holistic assessment. Holistic assessment.

Weeks Weeks to Liveto Live

• GSF Out of Hours Handover Form GSF Out of Hours Handover Form • Family discussionFamily discussion• Pre emptive prescribingPre emptive prescribing• GP assessmentGP assessment

Days to Days to LiveLive

• Liverpool Care Pathway commenced by GP Liverpool Care Pathway commenced by GP

and Nursing staff and Nursing staff • Daily Daily GSF Out of Hours Handover Form

AA

BB

CC

DD

Benefits for residents and relatives

• Better care toward the end of life• A better death in accordance with their and their families

wishes• Fewer crisis or hospital admission• Encourages proactive care with better advanced care

planning• Better symptom control• Attention to psychological, social and spiritual needs• Earlier discussion, more information and greater support

given to family• Access to effective out of hours care

Benefits for Care Home

• Improve care for residents• Improves job satisfaction, clinical skills and

knowledge• Greater confidence when dealing with other health

professionals• Fewer residents going to hospital in last stages• Receive training, support and resources• Improve teamwork, both in practice and across

teams• Raise the profile of care home for palliative care in

area

20 Key standards- Accreditation checklist

1. Leadership + support2. Team-working3. Documentation4. Planning meetings5. GP Collaboration6. Advance Care Planning7. Symptom control8. Reduce hospitalisation9. DNAR +VoD policies10. Out of hours continuity

11. Anticipatory prescribing12. Reflective practice+ audit13. Education + training14. Relatives15. Care in final days16. Bereavement17. Dignity18. Dementia19. Spiritual care20. Sustainability

Successes using GSF

• 1 Attitude awareness and approach –• Better quality of care perceived

• Greater confidence and job satisfaction

• Immeasurable benefits – communication, teamwork, roles respected.

• Focus and proactive approach.

• Patterns of working, structure/processes• Better organisation and consistency of standards, even under stress

• Fewer people slipping through the net – raising the baseline

• Better communication within and between teams, co-working with specialists

• Better recording, tracking of patients and organisation of care

• Patient Outcomes• Reduced crises/hospital admission/length of stay

• More residents dying in place of their choosing

• More recorded advanced care planning discussions

For more information on GSF

• National GSF centre – Walsall Judy Simkins GSF administrator. judysimkins@wallsall.nhs.uk Tel 01922 604666 Website. www.goldstandardsframework.nhs.uk NHS End of Life Care Programme www.endoflifecare.nhs.uk