Taking an innovative approach to delivering community palliative care at St Richard’s Hospice is helping us to provide compassionate care to more patients and their families in need of specialist end of life care.
The changes made to our community nursing services have saved the team 1,674 hours a year, almost equivalent to another full-time nurse. This time is now being redirected to those patients and families with greatest need, supporting patients to remain at home if this is their wish, improving patient and carer satisfaction and reducing patients’ demands on GP and hospital services.
Like all hospices, we are experiencing increasing demand for specialist end of life care. Hospice care, which traditionally cares for patients with cancer, has over recent years been extended to cover other life-limiting illnesses. More people are living longer with more complex needs and changing preferences for end of life care means that the community nursing teams are looking after more patients who wish to be cared for and die in their own home. Additionally, hospice services have felt the impacts of increased pressure within acute hospitals which means that patients with complex needs are being discharged home earlier with a referral for hospice care, exacerbated by pressure within GP surgeries which means that GPs are less able to visit people at home.
Hospice nurses have traditionally been viewed as willing to ‘go the extra mile’ for patients, and patient feedback frequently tells us that people really appreciate this dedication, compassion and support. However, hospice nurses, like other nursing teams, are vulnerable to high stress levels and can be at risk of illness and burnout.
The impacts of wider social and health services changes have been felt within the St Richard’s community nursing team, with increasing stress levels and resulting illness as dedicated nurses went ‘the extra mile’ to provide the compassionate holistic care that the hospice is renowned for. As managers, we knew that changes needed to be made to protect individuals from the impacts of high levels of stress and to ensure that patients receive the right care at the right time.
So, the community nurse specialist team have restructured the services they offer to work within current budgetary constraints, to ensure that they could sustainably provide a high quality service which was responsive and sensitive to the needs of both patients and families and which protected the wellbeing of the team.
Three interventions were introduced which aimed to address increasing demands upon a team of specialist nurses by enabling them to focus their interventions on those patients with the most complex needs. Internally, interventions were also designed to reduce stress levels, sickness levels and overtime.
The hospice extended its existing telephone triage service to include assessment of all new referrals by highly qualified specialist nurses, offering a helpline for patient, carers and health professionals, thus preventing unnecessary home visits by nursing team.
- Changes to the community nursing on-call process included involving highly skilled nurses based in the In-patient Unit overnight, enabling a 24/7 service.
- To tackle increasingly unmanageable caseloads, the team implemented a process of proactive caseload management, whereby geographical teams work together to provide flexibility, together with the introduction of a waiting list. To manage stress levels and maintain quality, each community nurse’s daily caseload was capped.
The results so far indicate that 1,674 hours of specialist nursing time have been released over the last year, equating to an additional 44.64 weeks per year.
Data on admission prevention suggests that the new way of working, providing timely specialist support, could potentially produce an annual NHS saving of £32,760. For patients and families, the results indicate that we are able to respond to their needs in a more timely manner.
The results demonstrate clear practical benefits for our community nursing service, patients, GPs and the local acute hospital, and work will continue to enhance team resilience, which is of particular importance as our efforts are now focused upon patients with the most complex needs.
Community Nursing Services Manager
The project is featured on the RCN Building Nursing Capacity in Economic Assessment portal, which includes a video of the breakfast event, Demonstrating the value of nurse-led innovations in End of Life Care, which took place on 27 April 2016. Find out more on the RCN website.