1.5.1 End of life care between home, nursing homes and district hospitals: A nurse led action research project examining patient pathways from home or nursing homes via A&E wards (123)

Judith Jackson, Associate Professor Inter Professional Education, Institute of Clinical Education, Warwick Medical School, Coventry, United Kingdom Co authors: Judy Purkis, Elizabeth Burnham, Gillian Lewando-Hundt

Abstract:

Several published studies suggest that patient transfer occurring in the last few days of life, may be due to lack of intermediate care (Mohammed et al 2002), as a result of relatives requesting transfer (Williams 2003), or might be a reflection of the lack of training/support within nursing and care homes (James et al 1993). In one acute trust clinicians felt that people were being admitted for end of life care which they believed could be given elsewhere.

Aims:

Explore the reasons for referral to hospital in the last 48 hours of life, from the lay and professional perspective
Examine the quality and continuity of care following transfer
To pilot and evaluate evidence based interventions aimed at ensuring that patients and relatives experience good end of life care in an appropriate environment and of their choosing

All patient records of deaths occurring within 48 hours of admission, in the previous year were identified (n=292). Sudden unexpected deaths were excluded. Remaining records (n=151) were reviewed by consultants who identified if the admission was in the patient’s best interest, or if care and treatment could have been provided elsewhere (study sample, n=70). 20 patient relatives in the sample were interviewed at home (currently being analysed using NVIVO). 12 Key personnel involved in delivering end of life care were interviewed. Key themes will be presented at the conference.

Findings:

Quantitative findings, analysed with SPSS 12.00, will be presented under the following themes:

Place of residence prior to admission
Postcode of residence prior to admission
Medical condition and review outcome
Patient movement following admission

Suggested future pilot interventions will be reported on.

Biography:

Ann Jackson is an Associate Professor Inter Professional Education at Warwick Medical School. Ann trained as a general nurse at St Thomas’ Hospital, as a midwife at Coventry Maternity and as a Health Visitor at Leicester. Whilst working as Research Health Visitor investigating Sudden Infant Death Syndrome at Leicester, Ann obtained her DPSN and degree (De Montfort University). Continuing her work in development of circadian rhythms at Leicester, Ann obtained her PhD (Leicester University) in the Development of overnight temperature, heart rate and urinary cortisol excretion in IUGR infants. Ann’s current research interests continue to relate to infant development, patient perspectives, inter professional learning and the impact of the 4 year curriculum on graduate medical students. Ann has published around infant development, patient perspectives and Inter professional learning. She has presented papers nationally and internationally on other research interests.