- A project by St Gemma’s Hospice in Leeds, in partnership with Leeds Teaching Hospital NHS Trust, Leeds University, Leeds Community Health Care Trust, Leeds South and East Clinical Commissioning Group, and endorsed by Hospice UK.
- Aimed to enable patients to die in the place of their choosing and improve the quality of end-of-life care.
- Involved reassigning four hospice beds as nurse-led; designated for patients with a limited prognosis but without complex symptoms.
Many end-of-life patients may prefer to die in a hospice but are unable to because they do not have specialist palliative care needs and do not meet the admission criteria. Others are unable to access a hospice bed due to limited medical capacity to admit them.
This project involved developing and piloting a nurse-led service that offers end-of-life care to dying patients with generalist palliative care needs within a hospice environment.
St Gemma’s Hospice is a 32-bed specialist palliative care unit. All inpatient beds were previously medical consultant led. Under this initiative, four beds have been assigned as nurse-led and designated to the care of people with days or weeks to live, but without complex symptoms that require medical input. While there are examples of nurse-led rehabilitation and respite services within hospices, nurse-led end-of-life care is a novel approach.
Hospice nurses trained and registered as 'non-medical prescribers' admit, assess and prescribe medication for end-of-life patients, and an individualised care plan is devised. There is access to the multi-disciplinary team and bereavement support as required. Doctors are available for cover and advice, and patients needing active treatment rather than end-of-life care are transferred to medical beds.
The pilot has enabled 50 patients to die in the place of their choosing who would not have had this option prior to the project. It has improved the quality of end-of-life care received by patients and their families, and successfully widened access to hospice beds. It has also reduced in-hospital deaths, saved 132 hospital days, maximised the use of hospice beds, reduced hospice waiting times, and developed nursing skills and knowledge.
Positive feedback has been received from patients, relatives and referrers.
A challenge for the project team was the shortage of registered nursing staff, which led to some delays, but was resolved through a successful recruitment campaign. Balancing competition for beds between specialist palliative care and end-of-life care patients represents an ongoing challenge.
This Innovating for Improvement project ran from the beginning of May 2015 until the end of July 2016.
- An end-of-life care beds film that explores the impact of the project from the perspectives of different stakeholders and service users.
For more information about this project, please contact Catherine Malia, Advanced Nurse Practitioner, St Gemma’s Hospice.