Introduction:

Developing and improving practice in End Of Life Care (EOLC) within a large NHS acute trust; 

How do you engage a large workforce & drive up quality in EOLC when faced with increased and competing clinical service priorities? 

This chat will focus on the role of the EOLC Champion as a means of sharing & developing initiatives around EOLC in the acute hospital. 

National context:

Over the last few years there has been a national focus on improving the quality of end of life and the choices offered to patients and families across all settings. There has been many publications to guide;

• •National Palliative and End of life Partnership (2015) Ambitions for Palliative and End of Life care. A national framework 2015 - 2020•
• The Choice in End of life care programme (2015) What’s important to me; 
• A review of choice in End of life care, Department of Health•
• CQC (2016) A different ending; Addressing inequalities in End of Life care Taking forward these new standards to enhance care is the challenge our trust has been tackling over the last 18 months.

 Local Context:

It was recognised that as a trust we have national EOLC guidelines to achieve, whilst at the same time, there are local priorities that staff identified to improve practice in EOLC in their areas; both at a divisional level or at a more specialty level. 

Introducing the EOLC Champion:

In September 2016, we embarked on introducing the role of the EOLC Champion across the trust. With the support of the Divisional Nurses across the 5 clinical divisions & specialities, nurses both registered & non registered, alongside allied health professionals have been identified as EOLC champions; staff who have an interest in EOLC, who can influence developments in EOLC that are pertinent to their clinical areas, & can further help to raise awareness and educate staff on key EOLC topics. 

The champions are provided with quarterly trust wide meetings led by the hospital palliative care team. Alongside this, each division has 2 palliative care nurse specialists from the Hospital palliative care team linked to them, to support & facilitate developments, with the lead nurse for EOLC overseeing & feeding into the trust EOLC Steering group. 

Benefits of EOL champion role:

• role model best practice
• act as a local resource for staff, patients and families 
• identify areas for development to improve practice & be supported to achieve this development•cascade training to team members 
• audit / benchmark palliative and end of life care 
• share best evidence-based practice to sustain and embed change in the clinical area 

There are now evolving developments:

• Critical care; EOLC champion structure across critical care, reviewing the care of those patients identified as EOL & who are transferred to a base ward; What needs improving?  Developing relationships with the hospital palliative care team, looking towards discharging home for EOLC 
• ED; Improvement to the relatives room, review of current use of the ‘viewing room’, improve the quality of EOLC for patients in the department – ensure they have a hospital bed, remove monitoring, commence end of life care plans provide info for relatives such as advice on car parking, providing refreshments, contacting the chaplains, how to contact the hospital etc. 
•  Allied Health professionals; local education on EOLC & their role, development of an information leaflet for families of patients at end of life: “Eating For Comfort” – eating and drinking at end of life, review of how we offer food to families of EOCL patients when in the hospital 

 So the question is - how are you facilitating developments in EOLC practice in your organisation?’