Implementing a quality improvement programme in palliative care in care homes: a qualitative study

Abstract

BackgroundAn increasing number of older people reach the end of life in care homes. The aim of this study is to explore the perceived benefits of, and barriers to, implementation of the Gold Standards Framework for Care Homes (GSFCH), a quality improvement programme in palliative care.MethodsNine care homes involved in the GSFCH took part. We conducted semi-structured interviews with nine care home managers, eight nurses, nine care assistants, eleven residents and seven of their family members. We used the Framework approach to qualitative analysis. The analysis was deductive based on the key tasks of the GSFCH, the 7Cs: communication, coordination, control of symptoms, continuity, continued learning, carer support, and care of the dying. This enabled us to consider benefits of, and barriers to, individual components of the programme, as well as of the programme as a whole.ResultsPerceived benefits of the GSFCH included: improved symptom control and team communication; finding helpful external support and expertise; increasing staff confidence; fostering residents' choice; and boosting the reputation of the home. Perceived barriers included: increased paperwork; lack of knowledge and understanding of end of life care; costs; and gaining the cooperation of GPs. Many of the tools and tasks in the GSFCH focus on improving communication. Participants described effective communication within the homes, and with external providers such as general practitioners and specialists in palliative care. However, many had experienced problems with general practitioners. Although staff described the benefits of supportive care registers, coding predicted stage of illness and advance care planning, which included improved communication, some felt the need for more experience of using these, and there were concerns about discussing death.ConclusionsMost of the barriers described by participants are relevant to other interventions to improve end of life care in care homes. There is a need to investigate the impact of quality improvement programmes in care homes, such as the GSFCH, on a wider range of outcomes for residents and their families, and to monitor the sustainability of any resulting improvements. It is also important to explore the impact of the different components of these complex interventions.

Improving end-of-life care in nursing homes: Implementation and evaluation of an intervention to sustain quality of care

“…8,18,23 More studies that examine the sustainability of improvements achieved during an initial programme are required. 24 Our study highlights the challenges in conducting such follow-up studies. For instance, the level of resources that was used for the initial implementation may no longer be available to provide the level of support initially received; management and staff changes mean that care homes come to the follow-up study with varying degrees of understanding and commitment to the project, and new policy developments, while helpful, can make it difficult to tease apart changes that are due to an intervention versus changes that would have occurred over time.…”

Factors promoting resident deaths at aged care facilities inJapan: a review

“…, Hall et al . ). Additionally, the number of nursing care homes registered to Liverpool Care Pathway did not reach 600 (The Royal Liverpool University Hospital St Marie Curie Cancer Care ).…”

“…Instead, co-ordination between the facility and GPs is promoted by The Gold Standards Framework or the Liverpool Care Pathway for the Dying; these are developed in the UK to improve EOL care in care homes (Ellershaw & Wilkinson 2003, Thomas & Sawkins 2008. However, nearly half of the care homes may not have completed implementation of The Gold Standards Framework because of difficulty for co-ordination with GPs (Badger et al 2009, Hall et al 2011. Additionally, the number of nursing care homes registered to Liverpool Care Pathway did not reach 600 (The Royal Liverpool University Hospital St Marie Curie Cancer Care 2009).…”

Developing, implementing and evaluating an end of life care intervention

“…The most significant initiative within the UK is the gold standard framework for care homes (GSFCH) which has now been implemented internationally (Hall et al, 2011). Evaluations of the GSFCH have demonstrated an increase in staff knowledge and confidence and improvements in communication regarding EoL (Badger et al, 2012;Hall et al, 2011;Watson et al, 2010).…”

“…The most significant initiative within the UK is the gold standard framework for care homes (GSFCH) which has now been implemented internationally (Hall et al, 2011). Evaluations of the GSFCH have demonstrated an increase in staff knowledge and confidence and improvements in communication regarding EoL (Badger et al, 2012;Hall et al, 2011;Watson et al, 2010). Implementation of the GSFCH has also been shown to reduce the number of inappropriate hospital admissions (Badger et al, 2009;Finucane et al, 2013;Hockley et al, 2010); overall the number of residents dying within their care home in England and Wales has increased while the number of people dying in an acute setting has dropped (The National Council for Palliative Care, 2014).…”