sections become ‘boring’. Also three mentioned difficulties with gaining their passwords to access the e learning. When asked to comment on the whole programme participants identified the whole course as important to their professional development. They valued the e-learning materials, the workshops provided by the facilitators, meeting people from other care homes and the group work. Individual’s comments: Most useful “Being made to think of own actions, not to make judgements” (Participant care home M) ‘Helping me to reflect on work practice, see things a bit differently’. (Participant care home C) ‘The whole thing just because I learnt more about end of life and how to deal with end of life’. (Participant care home J) “The internet” (Participant care home N) “Video's on computer” (Participant care home A) Least useful ‘Password was very hard to get. The sound on the videos didn't work.’ (Participant care home Q) ‘E-learning was very repetitive, lost interest easily.’ (Participant care home J) Suggestions of support ‘Occasional drop in sessions to discuss how it has affected our practice’. (Participant care home J) ‘To come into the home and check end of life care plans’. (Participant care home K) ‘Continue to deliver the course in the future as staff turnover is high in care homes’. (Participant care home A) ‘It would be great if GP and district nurses know about all this’. (Participant care home E) ‘Keep updated with changes’. (Participant care home P) Suggestions to improve the experience ‘Ensure people want to do this course’ (Participant care home P) ‘E-learning needs to be varied, different voices for narrating’ (Participant care home J) ‘1/2 day course would probably give initiative to get on with course work giving incentive’ (Participant care home C) ‘Making the password situation more easier is needed’ (Participant care home A) Audit findings from resident care records To ascertain the impact of the programme on care, an audit of patents notes was undertaken, using the audit tool at Appendix 2. Patients notes were audited both pre and post education. A paired samples
C5 Acknowledges, recognises and responds with sensitivity and compassion to the needs of patients and informal carers irrespective of their backgrounds C6 Provides general information confidentially to patients and carers but reports more complex information needs ( e.g.; details of patients condition or prognosis to staff member in charge) C7 Records care delivered including significant interactions with patients and families according to local policy and procedure C8 Effectively communicates information verbally to other members of the team using available handover opportunities C9 Contributes to the presentation of the patient’s condition and emotional health of the patient and informal carer in a multi-disciplinary team environment C10 Communicates effectively by telephone and electronic methods C11 Demonstrates compassion, respect and a non judgemental approach towards patients and their informal carers C12 Processes own reactions and remains respectful of patients and informal carers in stressful situations Advance Care Planning and End of Life Tools Pre Course Post Course 1 – Not at all confident, 2 – A little confident, 3 – Quite confident, 4 – Very confident ACP1 Identifies when patients may want to discussion advance care planning to include preferred place care and death, involving the appropriate professional. ACP2 Uses documentation, whether paper or electronic, appropriately to access inform and record end of life care planning and delivery succinctly and legibly as per NMC Guidance (NMC 2008) ACP3 Is involved in advance care planning as an on-going process,
6 Is there evidence in the notes that a holistic assessment of the patient / resident has taken place? 61% 78% 17% 7 Is there evidence in the notes that an advance care planning discussion was offered to the patient / resident? 26% 51% 24% 8 Is there evidence in the notes of an advance care planning discussion? 33% 55% 22% 9 Is there evidence in the notes of a preferred place of care? 21% 28% 17% 10 Is there evidence in the notes of a preferred place of death? 16% 36% 20% 11 Is there evidence in the notes of a statement of preferences and wishes? 16% 20% 4% 12 Is there evidence in the notes of an Advance Decision to Refuse Treatment in place? 4% 8% 4% 13 Did the patient / resident die in their recorded preferred place of death? 12% 24% 12% NB 14 was free text entry Anticipatory Panning 15 Is there evidence in the notes of a symptom control assessment tool for this patient / resident? 6% 6% 0% 16 Is there evidence in the notes of anticipatory drugs prescribed for this patient / resident in the dying phase? 7% 16% 9% 17 Is there evidence in the notes of a syringe driver prescribed for the patient / resident? 9% 10% 1% 18 Is there evidence in the notes that a syringe driver was dispensed for this patient/resident? 4% 10% 6% 19 Is there evidence in the notes of a signed Do Not Attempt Resuscitation for this patient / resident? 15% 36% 21% 20 Is there evidence in the notes of discussion with family / next of kin re deterioration of patient / resident? 35% 64% 29% 21 Is there evidence in the notes the patient / resident commenced on the Liverpool Care Pathway or similar? 5% 26% 21% Communication and Coordination Pre course score Post course score % 22 Is there evidence in the notes bereavement support and follow up was offered to the patient / resident’s family or next of kin? 3% 14% 11% 23 Is there evidence that other services were involved with this patient / resident? 66% 82% 14% 24 Is there evidence in the notes that other services involved were informed of the death? 28% 20% -8%
Appendix 5 Statistical analysis table – staff confidence results Please note that that audit scoring tool is based on 1= Yes – 2=No. Therefore a lower score denotes a positive change. {Assuming non-equal variance} Q. No. Advance Care Planning Measurement Mean Standard Deviation Sig of Difference (2-tailed) Confidence limits for difference 4 Is there evidence in the notes that the palliative care needs of the patient / resident were discussed in a ward round/ care home / GSF or MDT meeting? Pre-education programme 12 9.16 .83 .012 Lower .787 Upper 5.39 Post-education programme 13 6.07 3.75 5 Is there evidence in the notes that the patient was placed on a palliative care register or similar? Pre-education programme 12 9.75 .86 .465 -2.85 5.89 Post-education programme 13 8.23 7.20 6 Is there evidence in the notes that a holistic assessment of the patient / resident has taken place? Pre-education programme 12 7.16 2.58 .006 .98 5.19 Post-education programme 13 4.07 2.49 7 Is there evidence in the notes that an advance care planning discussion was offered to the patient / resident? Pre-education programme 12 8.41 1.72 .027 .35 5.09 Post-education programme 13 5.70 3.63
Q. No. Advance Care Planning Measurement N Mean Standard Deviation Sig of Difference (2-tailed) Confidence limits for difference 8 Is there evidence in the notes of an advance care planning discussion? Pre-education programme 12 8.41 2.02 .009 .88 5.33 Post-education programme 13 5.30 3.22 9 Is there evidence in the notes of a preferred place of care? Pre-education programme 12 8.75 1.60 .013 .726 5.38 Post-education programme 13 5.69 3.61 10 Is there evidence in the notes of a preferred place of death? Pre-education programme 12 9.00 1.34 .006 1.05 5.40 Post-education programme 13 5.76 3.41 11 Is there evidence in the notes of a statement of preferences and wishes? Pre-education programme 12 9.25 .96 .022 4.58 5.11 Post-education programme 13 6.46 3.77
12 Is there evidence in the notes of an Advance Decision to Refuse Treatment in place? Pre-education programme 12 9.66 .77 .016 .59 4.89 Post-education programme 13 6.92 3.49 Q. No. Advance Care Planning Measurement N Mean Standard Deviation Sig of Difference (2-tailed) Confidence limits for difference 13 Did the patient / resident die in their recorded preferred place of death? Pre-education programme 12 12.16 3.27 .020 .76 8.02 Post-education programme 13 7.76 5.27 14 If ‘no’ to the above question – what were the reasons for not achieving preferred place of death? FREE TEXT RESPONSES Pre-education programme Auditors noted that where the patient/resident did not die in their preferred place of death a key reason was because no record of choice existed. Not applicable Not applicable Not applicable Post-education programme Post programme audits revealed that where a record was kept then this was more frequently a note of a verbal request in the care record.
Q. No Anticipatory Planning Measurement N Mean Standard Deviation Significance of the Difference (2 tailed) Confidence limits for difference 15 Is there evidence in the notes of a symptom control assessment tool for this patient / resident? Pre-education programme 12 9.33 1.82 .061 -.114 4.78 Post-education programme 13 7.00 3.74 16 Is there evidence in the notes of anticipatory drugs prescribed for this patient / resident in the dying phase? Pre-education programme 12 9.58 1.08 .011 .800 5.13 Post-education programme 13 6.61 3.47 17 Is there evidence in the notes of a syringe driver prescribed for the patient / resident? Pre-education programme 12 9.58 1.08 .014 .683 5.09 Post-education programme 13 6.69 3.54 18 Is there evidence in the notes that a syringe driver was dispensed for this patient/resident? Pre-education programme 12 9.58 1.08 .017 .582 5.04 Post-education programme 13 6.76 3.58 Q. No Anticipatory Planning Measurement N Mean Standard Deviation Significance of the Difference (2 tailed) Confidence limits for difference 19 Is there evidence in the notes of a signed Do Not Attempt Resuscitation for this patient / resident? Pre-education programme 12 9.00 1.65 .005 1.06 5.24 Post-education programme 13 5.84 3.15 20 Is there evidence in the notes of discussion with family / next of kin re deterioration of patient / resident? Pre-education programme 12 8.33 1.96 .003 1.26 5.55 Post-education programme 13 4.92 3.09 21 Is there evidence in the notes the patient / resident commenced on the Liverpool Care Pathway or similar? Pre-education programme 12 9.75 .866 .055 -.068 5.10 Post-education programme 13 7.23 4.22 Q. No Communication and Coordination Measurement N Mean Standard Deviation Significance of the Difference (2 tailed) Confidence limits for difference 22 Is there evidence in the notes bereavement support and follow up was offered to the patient / resident’s family or next of kin? Pre-education programme 12 9.50 .90 .055 -.073 5.53 Post-education programme 13 6.77 4.58
23 Is there evidence that other services were involved with this patient / resident? Pre-education programme 12 6.33 2.01 .002 1.06 4.21 Post-education programme 13 3.70 1.75 24 Is there evidence in the notes that other services involved were informed of the death? Pre-education programme 12 8.91 8.91 .100 -.520 5.43 Post-education programme 13 4.47 6.46 Table 3 – results of patient notes audit pre and post educational activity.