P-109 Bringing new life to palliative care: The development of a dynamic and highly responsive community workforce in Wolverhampton. (19th November 2022)

• Record Type: Journal Article
• Authors: Freshwater, Sarah; Evans, Tricia; Smith, Dan
• Is Part Of: BMJ supportive & palliative care. Volume 12(2022)Supplement 3
• Page Start: A51
• Page End: A51
• Publication Date: 2022-11-19
• Subjects: Palliative treatment -- Periodicals; Terminal care -- Periodicals; 616.029
• DOI: 10.1136/spcare-2022-HUNC.126
• Languages: English
• ISSNs: 2045-435X

Abstract

Abstract : Introduction: Compton Care's refocus of strategy (2019) identified a need for a 'Rapid Response' community service to manage crises and prevent unwanted acute admissions. Goals were to make community workforce and resources more efficient, providing care for current and urgent needs. With in-patient care in demand but many wanting to be cared for at home, care needed to be available all hours of day and night, with capability to respond to changing clinical pictures. Methods: An early service commenced in 2019 providing a 7 day service, with response time 4 hours using current specialist community staff. In 2020 a dedicated Rapid Response service was formed with CNS provision to continue to support skill mix. The COVID-19 pandemic accelerated further training in clinical skills and urgent care was provided in person. In later 2020, there was a re-evaluation of the Rapid Response workforce, with recruitment of advanced practitioners, and more clinical nurse specialists, with a drive towards non-medical prescribers. Inclusion of paramedics in 2021 further drove the mind-set for responsive action. Investment in staff training increased clinical competencies in phlebotomy, catheters and syringe drivers to facilitate short notice provision in the home. The team was expanded to complete the 24 hour service provision. Day response time remained 4 hours, with night response time of 2 hours. Extremely complex patients in the final 12 months of life can now be managed at home. Results: 497 home visits made by rapid response team in the 6 month period commencing October 2020, with 747 home visits in same period 1 year later. Acute admissions reduced. Preferred place of care and death supported through use of ReSPECT process. Discussion: Through many stages over a 2-3yr period, the Rapid Response team has maximised Compton Care's impact for individuals requiring palliative care at home. Further collection of broader activity data will help to show impact in future.