Livewell Southwest is a social enterprise delivering integrated care in South West England. They've developed an end of life care for adults policy.
Informed by recommendations from our guidance on end of life care for adults, the Livewell Southwest policy provides advice on delegating clinical tasks to third parties - such as informal carers and relatives - and delivering appropriate care to patients at the end of life during the COVID-19 pandemic.
Livewell and St Luke’s Hospice Plymouth, jointly implemented 3rd party delegation following a pilot in Cornwall funded by the Burdett Nursing Trust. This demonstrated informal support networks were able to undertake delegated nursing tasks, with support. We jointly trained our staff who now successfully work in partnership with informal networks.
palliative and end of life organisation lead for Livewell Southwest
What was done and why
A fundamental part of end of life care is making sure patients are comfortable and receive timely and effective symptom control and pain relief. As Devon is a geographically large and largely rural county, access to swift, timely healthcare can sometimes be challenging.
The team, assisted by the end of life care lead, worked together to develop the policy through a medicines optimisation group with medical and pharmacy input. The policy gives clarity on the roles and responsibilities of staff when care is delegated to informal carers. It also gives assurance that tasks are undertaken correctly, and patients receive safe and effective care.
During the COVID-19 pandemic, when the most vulnerable have been shielding, it has been possible to avoid unnecessary visits. This was achieved by delegating care tasks to families and carers where appropriate. The publication of our rapid guideline provided an opportunity to ensure the development of the policy was aligned with our recommendations.
Outcomes and impact
The greatest benefits were seen in supporting relatives and informal carers to administer wound care and change dressings. This reduced home and care home visits by staff, which helped to prevent the spread of COVID-19.
This also helped to reduce the number of caseloads, which enabled more patients to be seen when needed and helped when staff were off sick or isolating due to COVID-19.
Care home residents still needed to receive the same standard of care supported at a distance while reducing the footfall.
This has been achieved by the district nursing service using:
- telephone contact
- email support
- technology to effectively review wounds from a distance.
What was learnt
The local hospice involved in the project was keen for this policy to be implemented as they could see the benefit to patients. Both organisations had evidence of where this could benefit patients and reduce anxiety for families.
They found that listening to the concerns of families and acting, where possible, helps with the therapeutic relationship. In some instances, families asked to undertake a task that the nurse was not confident they were competent to undertake.
Competence is not only about the practical ability but could relate to someone’s mental and emotional ability. However, this was overcome through communication, extra support, and by explaining the rationale for decisions.
Informal carers and families needed to know that they had support 24 hours per day and that they could contact a professional whenever they need to.