Report on end-of-life care provision

Task: Think of a service/programme, which you believe could improve the quality of end-of-life care provision and write a report to management, in an attempt to persuade them to implement this service/programme. This report should include a description of the service, the rationale for its implementation and the perceived challenges. It would also be beneficial to show an awareness of any possible limitations of this service/programme and measures to minimize these.

To the management,

A way to improve the end-of-life care within our health care system would be by implementing the Gold Standards Framework. This framework was developed in 2000 by Dr Keri Thomas; a general practioner with a special interest in Palliative Care. I am writing in order to ask for the implementation of the Gold Standard Framework within our hospitals. The main purpose of this Gold Standard Framework is to provide training to us healthcare professionals and staff in order to enable “a gold standard of care for all people in the last years of life”. This is a systematic, evidence based way in optimizing patient care nearing end of life provided by healthcare professionals and healthcare workers. One must also state that according to the Department of Health’s End of life Care Strategy (2008) they state that “all organisations providing end of life care are expected to adopt a coordinated process such as the Gold Standards Framework”.

This framework also improves the coordination of care between nurses and members of the multi-disciplinary team. This framework focuses on seven key tasks mainly; communication, co-ordination, control of symptoms, continuity, continued learning, carer support and care of the dying. In order for this framework to be implemented successfully one must also evaluate current practice and identify the changes required. One must also identify the eligible patients undergoing palliative care and are at an end of life stage. Health care team meetings must also be organized within the multidisciplinary team. The Gold Standard Framework also aims at identifying and assessing symptoms at an earlier stage. This could be a possible limitation as it might not always be possible to anticipate which patients are during their last year of life. This could be easily tackled by using the prognostic screening tool provided with the Gold Standard Framework and with the help of monthly multi-disciplinary team meetings. Callaghan, Laking, Frey, Robinson & Gott (2014) identified in their cross sectional study that the prognostic tools assist in identifying patients at an early stage whom would benefit from the Gold Standard Framework . This is a result of monthly discussions that would take place within the multidisciplinary team. Early identification allows enough time for healthcare professionals to determine patient’s wishes and prepare the patient and the relatives. The healthcare workers would also have enough time to adequately refer these patients accordingly such as palliative care services when needed. In their study conducted results showed the screening guides used would be the first step in implementing and identifying means by which we address patients’ needs. The authors also add that by these prognostic tools one will be able to also identify future anticipated patients whom would benefit from these services.

Patients at an end-of-life stage have acknowledged five main goals for improved quality of care; to avoid prolonging dying, reduce the pressure on their families, to maintain relationships with relatives and loved ones and adequate pain and symptom management. Death and dying is a natural process of life but nowadays it is being seen as something to fear. Due to medical and technological advancements these have aided in prolonging life, which has urged many families to delay death and dying of their loved ones. This is a result of families wanting to spend time with their loved ones, this may also result in a far more traumatic event as false hope may be portrayed that life can be maintained. Technological advancements have made it more difficult for the persons implicated. However patient’s wishes and the caregiver’s wishes may not always be the same, therefore the implementation of the Gold Standard Framework will aide in supporting family members. Through early identification of these patients, their wishes and goals would be planned into action and communicated with caregivers. Furthermore this framework will allow patients within the community to die where they would wish. This would make the experience less traumatic for family members as they would have been prepared and reduce the risk of creating false hope.

The Gold Standard Framework provides quality improvement training and programmes to healthcare professionals in order to be able to provide gold standard care. This framework also provides tools and measures for support to healthcare professionals; the framework aims to provide on-going assessment to patients, good communication, the ability to improve quality of life and dying with dignity. It is known that a number of admissions to the acute hospital are due to dying patients, with the gold standard model this number is reduced with the help of earlier identification of these patients which would result in reduced hospital admissions. Patients would be identified at an earlier stage and the appropriate care and support would be provided to the patients and family, furthermore these patients would be followed up by community care services as part of the Gold Standard Framework.

This framework will also aim to improve the coordination of care by providing better communication and cross-boundary care. As a result of successful completion and implementation of the gold standard model one would also perceive improved skills provided by healthcare professionals and improved confidence in providing care. This would also generate a better improved patient satisfaction throughout. Furthermore the Gold Standard Framework will reduce hospitalization and therefore reduce the cost associated. The Gold Standards Framework would also enable patients to feel secure and supported by planning care ahead. Family and patients would also feel empowered through the increase in communication and through working together with the patient. Support would be provided through the process, healthcare workers would be able to refer patients accordingly to community care services such as respite care, provisions of equipment and practical assistance. Relatives would also be followed through bereavement support, one would have to plan ahead and form a protocol in dealing with relatives and helping them through the bereavement process. This is also stated by Payne (1999) where it is outlined that meeting carers’ needs would be an essential part, providing information, practical help and emotional support would result in a better patient outcome.

I believe that with the implementation of this framework one would perceive some challenges and limitations but these can be identified at an early stage. One might find resistance from healthcare professionals to attend the training and meetings required in order to attain the Gold Standard Framework but these can be eliminated as there are various pathways in which one can receive the training. This could be easily negotiated between staff members in order to find the adequate time and place for training and multi-disciplinary meetings. Challenges that might also be associated with this framework may be the increased workload associated with this framework, as a result adequate support services are to be provided. It would also be vital to divide administrative work between co-workers; as a result this would also encourage their participation in professional development activities and within the framework itself. Furthermore the framework should be adjusted to our local services and requirements; as a result improvements should be done accordingly.

The patient’s informal carers must also be included within this framework, it is vital that they as well are taught and informed. Patient’s informal carers should also be empowered and assisted at home by Hospice services and community care nurses. These carers must also be trained and educated in what they should expect when their loved ones are dying and what they can do in order to allow the patients to die with dignity.

The Gold Standard Framework also allows Advanced Care Planning which also allows the patients to inform care givers what is important to them, their spiritual needs or something they might need to do in order to allow and enable them to die with dignity. Implementing this framework will ensure the best possible care in the final days by anticipating the patient’s needs and providing the support and coping mechanisms required by the family.

As a healthcare professional, the care of a dying patient is never easy and always proves as a challenging experience to all parties involved. However, implementation of the Gold Standard Framework aims at providing the best possible care to all individuals involved within the death of a dying patient. This framework will improve the quality of end-of-life care provided within our community and aiding other services presently provided by Hospice and MMDNA. Furthermore the successful implementation of this framework will also improve outcomes for our patients.