295Compassionate End Of Life Care in Residential Care Settings - A Quality Improvement Approach

Abstract

Background: In Ireland 28,000 people live and 7,500 die each year in residential care centres (RCCs).The Irish Hospice Foundation introduced a quality improvement (QI) programme to assist RCCs to identify, reflect and implement changes to enable delivery of compassionate end of life care as part of their service, to benefit residents, families and staff.This QI programme, called Journey of Change (JOC),commenced in 2015, and over 100 residential care settings participated.An independent evaluation of the JOC programme was conducted in 2016. Method(s): The evaluation framework comprised of: outcome achievement, measuring the impact of participation, and assessment of outcomes and learning.An utilisation focused evaluation approach was taken which combined desk research and field work. A mixed methods approach was used as follows 1. Desk research, literature review and a review of the documentation relevant to the establishment of the Journey for Change Programme. 2. Field work - five case studies as well as an interview with the Director of Nursing in each location.The number of case studies selected was small, because the intention was to get an overview of how the Programme was operating across a range of settings, rather than a statistically significant sample. Result(s): The evaluation demonstrated that when all elements of the JOC programme are fully applied, it has capacity to improve end of life care. Significant changes in practice were identified in relation to end of life planning, care at the time of death and after death. Notably, staff were less likely to want to transfer patients to hospital, more aware of when to access specialist palliative care & GP services and more confident in managing pain at end of life. Key to the success of the programme is support from management, sites to agree and own their vision for end of life care, multidisciplinary participation, and availing of external support for the JOC facilitators. Conclusion(s): The evaluation found that the programme has the capacity to improve end-of-life care in participating residential care centres.The establishment of an end of life network will support the sustainability of the programme into the future, and the content of the workshops need to be condensed. The future governance of the programme must ensure that as well as addressing the culture of end of life care, the programme must also concentrate improvements in clinical care, to ensure delivery of holistic compassionate care.