Worcester Acute Hospitals NHS Trust

Worcester Acute Hospitals NHS Trust - Using eLearning to improve the delivery of End of Life Care 

About the Trust

Worcester Acute Hospitals NHS Trust (WAHT) provides a wide range of services to a population of around 550,000 people in Worcestershire, as well as caring for patients from surrounding counties and further afield. The Trust employs more than 5,500 staff and has an annual turnover of more than £320 million.

Hospital-based services are provided from three main sites - the Alexandra Hospital in Redditch, Kidderminster Hospital and Treatment Centre, and Worcestershire Royal Hospital in Worcester.

Overview

The National End of Life Care Programme aims to influence the whole pathway of care as advocated by the National End of Life Care Strategy (DOH 2008). Working in conjunction with Marie Curie Cancer, they developed a tookit to identify gaps in End of Life Care and to prioritise the initiatives needed to address them. 

NHS Worcestershire launched the Marie Curie Delivering Choice Programme (MCDC) in March 2009 with the aspiration of reducing the proportion of patients who die in hospital to 33.3% by 2013/14. 

End of Life Care was also highlighted as one of the High Impact Action initiatives from the Nursing and Midwifery Council (NMC 2010) and as part of the inititive, the "Important Choices: Where to die when the time comes" document was produced with the NHS Institute for Innovation and Improvement. Following local research that showed that of the estimated 60% of patients who expressed a wish to die at home, only 20.6% actually achieved this during 2008/9 WAHT formed its own strategic End of Life High Impact Action Group & joined the Marie Curie Delivering Choice Programme as one of the county wide workstreams that includes the Helath & Care Trust, local hospices & the West Midlands Ambulance Service.

The NHS West Midlands End of Life Care for All (e-ELCA) Project for which WAHT was a pilot site provides eLearning that contributes to this agenda by enabling the rollout of End of Life care eLearning for all staff. The Trust has a strategic group based on High Impact Actions and the e-ELCA project feeds into the board as part of the governance arrangements for the project. 

One of the Quality and Safety outcomes within the Care Quality Commission (CQC)states that "Staff Treat Patients and Families with respect". Part of the criteria for meeting this outcome means that the NHS must provide training records that show that End of Life training has taken place. e-ELCA training assists Trusts in meeting these objectives and can be reported on via OLM.

The e-ELCA project raises the issue of End of Life care planning within clinical environments. The Trust undertook an End of Life care survey in 2010 to identifywhere improvements had been made and were still to be made, guiding the creation of a program of education around Advance Care Planning within the Trust.

Implementation

The Palliative Care Training Team - from left to right, Jenny Garside, Linda Morrissey and Tess Barley

Before the project was established, the IT department within WAHT worked with the NHS ESR Central Team to ensure that the ESR, PC and network settings were correct. Early IT involvement and support from the regional NHS Account Manager was key to enabling access and ensuring minimal IT disruptions for end users.The project was initially driven by the End of Life Facilitators - Jenny Garside at Worcester Royal Hospital and Tess Barley at the Alexandra Hospital in Redditch. Jenny and Tess engaged with managers and with SHA funding, were able to employ agency staff to provide cover whilst 45 Link Nurses were released to carry out essential implementation training. This training was carried out in the classroom to introduce eLearning and e-ELCA for the first time. On completion of the training the Link Nurses then cascaded the training to other nurses on the wards. Jenny and Tess also visited wards at pre-arranged times to support and encourage the use of the content after the initial launch of the project. The e- ELCA project is on-goingand to May 2012 414 sessions have been completed by staff and ELCA forms a key part of the trusts End of Life blended learning programme.

Staff are aware that there can be issues relating to limited PC access or time constraints, but there is a willingness to access eLearning from home in order to benefit their development. During face to face sessions where eLearning is introduced to learners Remote Access is setup and approved and the learner receives the Remote Access user guide created by the ESR Central team.

Over the past 12 months there has been a strong focus on embedding e-ELCA into on-going staff education with this in mind End of Life Care has been added to the mandatory training checklist for registered Nurses. 

There are future plans for e-ELCA to link to the Personal Development Review (PDR) process for ward staff and training & form one of the KPIs for Band 7 Ward Managers, both of which are monitored via OLM and Manager Self Service.

e- ELCA training is being linked to the NICE End of Life Quality Standards; these standards are audited by Clinical Governance within the Trust and are one of the standards measured by commissioning organisations. In addition the End of Life Facilitators at WAHT are using e-ELCA content as part of the roll out of the AMBERCare Bundle initially in 12 wards across the trust. AMBER aims to identify patients whose recovery is uncertain & begin to address their end of life care needs by supporting both medical & nursing staff to produce a clear plan of care and start conversations about uncertainty and the possibility of death. This gives patients and carers time to prepare and consider their wishes/preferences. The e-ELCA content focusing on communication & advance care planning is a key part of the AMBER education program. AMBER is one of the five key enablers for the National End of Life Care Programme ‘Transforming End of Life Care in Acute Hospitals’ initiative (2012).

Linda Morrissey (pictured), a Junior Ward Sister, has been very successful in introducing her team to e-ELCA. Linda’s interest in palliative and End of Life care was triggered following a period of working as a Link Nurse and rolling it out to her team has had a positive impact on their patients. For Linda, being able to complete learning at home in her own time has been a big benefit.

Benefits to date

  • The proportion of patients dying in their preferred place is 47% in 2010 and 43% in 2011 showing clear progress towards the 33% target
  • The use of the pre and post training questionnaires shows that the training has increased staff confidence in their knowledge of the common core competencies and principles.
  • The training has provided health and social care workers, who work with adults at the end of their life, with essential communication, assessment and care planning skills, together with increased knowledge of symptom management, maintaining comfort and well being and advance care planning which supports the National End of Life Care Strategy.

The e-Learning improved the quality of End of Life education within the Trust. ELCA offers a simple and easy way to access a library of the latest End of Life reference material which is constantly updated to reflect national changes.

Anticipated Outcomes

The project is ongoing and the Trust continues to analyse the results of the training, however it is expected that a saving of up to £2 million a year to 2014 will be realised across the local health economy through improved patient choices around End of Life care.

Richard Newman, Ward Manager at Worcester Royal Hospital explains: "The ELCA training has been very beneficial in increasing staff awareness about the relationship between palliative supportive and End of Life care. It has increased staff confidence and competence in questioning patients about their understanding of their disease and their biggest worries and concerns. They are more confident in conveying this information to medical staff to ensure that the patients’ wishes are fulfilled and they receive the best appropriate care. The training sessions can be linked to the PDR process and recorded in ESR which is also helpful. The fact that the sessions can also be carried at home is a bonus as the acute hospital setting is very busy and time for courses is at a premium."

One of the ultimate aims of the project is to reduce the time patients spend in hospital which will inevitably provide a direct cost saving, whilst improving people’s choices around the care they receive at the end of their life. e-ELCA training, in conjunction with classroom based training, aims to improve employee skills to ensure, through better communication skills, the right choices are made available.

Ann Carey, Head of Nursing, End of Life Care Lead adds: "e- ELCA has proven invaluable over the last 12 months enabling the End of Life Care Facilitators to deliver a blended End of Life care education programme to a range of staff groups. e- ELCA supports national initiatives such as the Transforming End of Life Care in Acute Hospitals Programme, the AMBER component of which is a CQUIN monitored strategically by the trust board.

The usefulness & quality of this free educational resource cannot be underestimated in helping to meet our End of Life workforce development programme."

Lessons Learned/Advice for other Organisations

Training relies on the individual Link Nurses to deliver and encourage training often whilst competing with other priorities on the wards. WAHT has the following advice for Trusts;

  • Cascade training works best when the individual is removed from the ward, so find a free office and allow one hour to show the individual how to log on and enrol in training;
  • Provide deadlines, such as completing the introduction to e-ELCA training within a 2 week period;
  • Ensure e-ELCA training is an agenda item at the High Impact Action group so that future rollout can be discussed and executive support provided to enable the training to be cascaded and accessed;
  • Provide information about Remote Access to enable training to be adapted to the employee’s needs, thereby improving access to learning.

Future Plans

Jenny and Tess plan to establish a core curriculum for ELCA for registered Nurses and Health Care Assistants throughout the Trust to promote best practice. Work is on-going to link e-ELCA to the NICE End of Life Standards, national competencies and embed the content into future education plans. The Ward Managers and the Education and Training department are able to monitor the completion of the sessions via ESR.

For more information

For more details about how WAHT implemented e-ELCA, please contact the End of Life Care Facilitators jennifer.garside@worcsacute.nhs.uk or teresa.barley@worcsacute.nhs.uk.