In 2011 Karen Breese & I, both End of Life Care Facilitators in Shropshire at the time had this work published in an End of Life Care journal, I thought it was worth sharing again as it made a real difference in helping people to achieve their dying wishes in Shropshire.
A widespread training programme combined with close partnership working and rapid response to people’s equipment needs was ensuring that four out of five people living in Shropshire were achieving their preferences at the end of life.
In March 2009 the End of Life Care Team ran a two-year pilot to improve Preferred Priorities for Care (PPC) uptake after a review of unscheduled admissions to Shrewsbury and Telford Hospitals showed only 5 out of 46 had PPC’s.
As a result of the pilot which ran from March 2009 to March 2011, a total of 446 staff were trained in the delivery of the PPC. The training covered a wide range of organisations including hospices, acute trust, care homes, community teams and mental health and learning disability teams. The PPC included a two-part audit – the first of which was to be completed shortly after the PPC was drawn up while the second was filled in after death to establish whether the persons wishes had been met.
PPC training continued after the pilot finished with a total of 524 staff trained and 268 PPC’s were initiated. They included 119 cancer patients, 59 with dementia or frailty, 23 with renal problems, 30 with heart failure, 40 with COPD and 51 with more than one condition.
Ninety six patients with a PPC died in that time with 80% achieving their wishes about where they were cared for and died.
The PPC’s were well received not only by patients and their carers but by professionals. As one commented “it informs us what patients really want and not just what we thought they wanted”.
A number of challenges exist to achieving people’s end of life care wishes. This includes patients deteriorating over the weekend, waiting for equipment and availability of care and funding agreements. In Shropshire this has gone some way to being resolved through using end of life care tools, fast tracking care provision, funding agreements and ensuring equipment needed in the home is provided within a matter of hours.
Now in 2016 – I am currently working with the renal unit staff at the Shrewsbury and Telford Hospital in Shropshire to introduce a similar document they have produced ‘My kidney wishes’.
I will be encouraging & supporting the renal unit staff to share this work when fully implemented and they have the evidence to show what a difference it is making.
I also plan to relaunch the PPC document in all areas within the Trust training sessions to be planned for later this year.
We have one chance to get it right, for every person, every time. The PPC document is patient owned about ‘what matters to you’ it can make a real difference. However, there is little evidence of its use in 2016 it plays such an important part in starting conversations about end of life care whilst allowing people to express their wishes.
Jules Lewis End of Life Care Facilitator Shrewsbury and Telford Hospital NHS Trust Twitter @juleslewis6