A nursing team in Peterborough has won the Palliative Care Award 2009 at the Nursing in Practice Awards in Birmingham. The award was sponsored by the Bereavement Advice Centre.
Bupa The Gables Nursing Home provides specialist dementia care to nursing and residential clients as well as specialist care to older people with long term psychiatric illness. Since 2005, The Gables, led by Home Manager, Dawn Harbour, played a leading role in a local multidisciplinary group called the Palliative Care Dementia Group, focusing on improving palliative/end of life care for people with dementia.
The Gables has influenced, developed and embraced key concepts within this emotive area of care. This has had a significant impact on the care given to residents at the end of their lives.
The team at The Gables have evaluated the processes used in the home and introduced new practices to enable staff to identify when a resident with dementia is at the end of life, ensuring that the persons needs are assessed and a holistic and person-centred care pathway is followed. This includes:
• The Gables Pathway for the Care of the Dying, adapted from the Liverpool Care Pathway. The pathway gives staff clear information and guidance on the resident's current care needs. It makes sure that all the vital information about a resident is held in one place with no duplication or gaps and that staff have the vital prompts they need to carry the plan forward as well as having a clear audit trail.
• Advance care planning has been introduced together with a protocol to regularly review these plans. Plans are printed on bright coloured paper so that they are easy to identify. The information they contain makes sure that staff and visiting health professionals are clear on how the residents and relatives feel about active interventions, hospitalisations etc. This ultimately means that whilst the decision to admit/treat lies with a medic, staff can at least aid that difficult decision when it has to be made.
• Staff training around dementia and end of life care.
• Staff are encouraged to talk through recent experiences where residents have passed away and to provide support to one another where this is needed. Because many of the residents have often lived at the home for quite some time, losing a resident can be very difficult for staff to come to terms with. By talking through their feelings and supporting one another, staff find that it helps them to deal with their grief.
After 18 months of using the Gables Pathway, the results speak for themselves:
• Enhanced privacy and dignity at end of life
• Forethought and consideration is given to every resident's wishes
• It promotes a peaceful and pain free death
• Highly motivated staff
• Improved partnership with NHS/social services
• Improved staff retention
• Enhanced reputation in the local community
Since the introduction of the pathway, the home has cared for more than 50 residents in the end stages of their lives. The valuable learning from each experience enables the home to refine and further develop the pathway to improve the care provided.
Other homes in the Peterborough area are now looking at the practices at The Gables and adopting similar methods. The Gables has provided training and support to these homes as well as presenting at an annual symposium. The GP who works closely with The Gables has also recommended that each home in the area has one assigned GP rather than multiple GPs as this has proven to be highly effective.
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