Achieving patient’s wishes and choice to die at home for those that do not need to be in hospital was a paramount driver in starting the project at Heart of England NHS Foundation Trust.Jennifer Brewer (Lead Palliative Care Nurse), Lucy Davies (Macmillan Therapy Team Manager) and Elette Ming-Gordon (Palliative Care CNS) formed a small working party to begin to look at how improvements could be made to the existing discharge process for patients in the last hours and days of life where a wish to die at home had been expressed, and how we could help to facilitate this discharge on the same day.
Learning from existing good practice examples, listening to the experiences of our staff, and feedback from our patients and families, led to production of a draft ‘same day discharge home to die pathway’. Widespread consultation was undertaken with staff across the trust.
"We recognised that there were many good examples of rapid discharges home, but this was not always consistent, particularly where same day discharges to die at home had been identified, and where prevention of delay is paramount".
Further Developments
- As a result of discussion during consultation, additional key contact sheets for all 3 hospital sites were produced following feedback from staff on wards to improve ease of access to all necessary information.
- A tick list for use by nursing teams to be used alongside the aide memoir is currently being trialled on 2 identified wards
- Improving ease of access to necessary equipment to support discharge in and out of hours is currently being explored by Darren MacKenzie (Macmillan Therapy Team).
Impact
The new aide memoir and key contact sheets have been laminated and distributed across the trust throughout a 2 week period to all ward areas.
Initial feedback has been positive, with ongoing feedback requested so that we can continually improve. A retrospective audit of data regarding achievement of rapid discharge home is currently being compiled, with a further audit planned in 3 months time.