This 'how to' guide builds upon the overarching framework set out in The route to success in end of life care - achieving quality in acute hospitals, published in 2010. The route to success highlighted best practice models developed by acute hospital Trusts, providing a comprehensive framework to enable hospitals to deliver high quality care to people at the end of life. This 'how to' guide aims to help clinicians, managers and directors implement The route to success more effectively, drawing on valuable learning from the NHS Institute for Innovation and Improvement's Productive Ward: Releasing time to care™ series. This guide contains individual sections that can be worked on in any given order, dependent upon the individual hospital and its current end of life care provisions. These can be downloaded below: Introduction Section 1: prepare Section 2: assess and diagnose Section 3: plan Section 4: treat Section 5: evaluate Section 6: sustain Section 7: further resources Cover It places emphasis on existing 'enabling' tools and models, which support and follow a person-centred pathway. These are Advance Care Planning, Electronic Palliative Care Co-ordination Systems (EPaCCS), AMBER Care Bundle, Rapid Discharge Home to Die Pathway, and the Liverpool Care Pathway. Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013

1. Section 2 The route to success
Assess and
diagnose

2. Section 2
Assess and diagnose
There are numerous sources of information
available to help you benchmark your current
position, for example:
Your Trust’s existing key performance indicators
relating to QIPP, PROMs and CQUINs for end of life
care
The benchmark developed from the collated
Strategic Health Authority returns indicating what
is collected by Trusts currently against PROMs,
CQUINs and QIPP could provide a useful marker
Jargon
,
y, Innovation
QIPP – Qualit
d Prevention
Productivity an
programme
utcome
nt Reported O
ROMs – Patie
P
Measures
r
missioning fo
CQUINs – Com
amework
novation fr
Quality and In
Use your multidisciplinary team to enable identification and overview of complaints
related to end of life care
Review of clinical coding
Data from the National End of Life Care Intelligence Network’s End of Life Care
Profiles will inform how you are doing to enable you to prioritise and develop your
Trust’s end of life care quality improvement dashboard1
Disease specific reports from the National End of Life Care Intelligence Network2
The end of life care quality assessment tool (ELCQuA)3
The NICE end of life care for adults quality standard4
National Council for Palliative Care reports on the palliative care workforce.5
www.endoflifecare-intelligence.org.uk/profiles.aspx
www.endoflifecare-intelligence.org.uk/resources/publications/default.aspx
3
www.elcqua.nhs.uk
4
www.nice.org.uk/guidance/qualitystandards/endoflifecare/home.jsp
5
www.ncpc.org.uk/site/policyandcampaigns/Workforce
1
2
2

3. The route to success ‘how to’ guide
TOP TIP
hat good looks
Think about w
e
1 of this guid
e from Section
lik
igures 1 and 2
nd consider F
a
ese
g pages. Use th
on the followin
y
what is alread
to help identify
your Trust.
happening in
3

4. Section 2
Figure 1: Key drivers for excellence in end of life care
Primary drivers
Quality in acute hospitals
Key drivers highlight the process for
moving toward excellence:
Person centred/
family care
Excellence in end of life care
Leadership
Outcome Measures
Care that is compassionate,
equitable, reliable, improves
the care experience, makes
best use of resources.
Full compliance with national
quality markers.
Reduction of harm.
4
Effective
teamwork
Safe, effective
reliable systems
Measurement

5. The route to success ‘how to’ guide
Secondary drivers
1. Engage individuals and families as active partners in care
2. Open transparent communication that is respectful of preferred priorites for care and preferred place of death
3. Involve families in the physical care of their relatives
4. Involve families in improvement teams
5. Facilitate user feedback within service improvement
6. Care after death
1. Leadership explicit with organisation’s Trust Board agenda
2. Senior management objectives
3. Clinical champions for end of life care
4. Competent trained staff – partnership between hospital palliative care teams/long term conditions
5. Culture of compassionate care by staff caring for individuals approaching end of life
1. Agreed standards for effective communication with individual and family
2. Effective identification and development of management plans
3. Discharge liaison/Community/GPs/Ambulance/OOH/Social care
4. Adopt common end of life care Pathway language – e.g. The route to success for acute hospitals
1. Implement end of life care good practice models – productive series, advancing quality, clinical audit
2. Use of agreed prognostic indicator guidance
3. AMBER Care Bundle in use across Trust
4. Advance care planning, Preferred Priorities for Care, Do Not Attempt Cardio-Pulmonary Resuscitation,
Liverpool Care Pathway
5. Electronic palliative care co-ordination system (EPaCCS), rapid discharge home to die pathway
6. Symptom management
1. Safe and effective care with regular review of Serious Untoward Incidents, complaints etc
2. PROMS
3. National bereavement survey (VOICES)
4. The route to success dashboard – each trust to develop own utilising ‘how to’ guide metrics for
wards and boards
5

6. Section 2
Figure 2: The end of life care pathway for acute hospitals
The six steps of the end of life care pathway are not discreet or incremental but interact and overlap
along the person-centred pathway. Most hospitals will be providing some of this care, for some
people, some of the time. Where are your gaps and what can you do to fill them?
Step 1
Discussions as
the end of life
approaches
honest communication
triggers for
discussion
Step 2
Assessment, care
planning and
review
l Open,
l Conduct
l Identifying
l Agreed
l Advance
l Assessing
care planning.
a holistic asessment
care plan and regular
review of needs and preferences
l Advance
needs of carers
care planning.
Step 3
Co-ordination
of care
l Strategic
co-ordination working
with primary and community
health services, ambulance/
transport services and social care
l Co-ordination of individual care
l Discharge
l Rapid
planning
discharge home to die
l Fast
track continuing health
care.
High quality end of life care making best use of resources
Senior clinical descision-making close to the patient and
an appropriately trained and supported workforce
Strong governance including board oversight and senior management engagement
© National End of Life Care Programme (2010) adapted from the End of Life Care Strategy (Department of Health, 2008)
6

7. The route to success ‘how to’ guide
Step 4
Delivery of high
quality care in an
acute hospital
environment
to specialist palliative
care advice around the clock
Step 5
Care in the
last days of life
l Dignified
l Identification
l Access
l Review
l Specialist
hospital palliative care
team
l Access
to spiritual care
l Access
to tailored information.
of the dying phase
of needs and preferences
for place of death
l Support
for both the individual
and carer
l Recognition
of wishes regarding
resuscitation and organ
donation.
Step 6
Care after death
l Recognition
that end of life care
does not stop at the point of
death
l Timely verification and
certification of death or referral
to coroner
l Care
and support of carer and
family, including emotional and
practical bereavement support.
High quality end of life care making best use of resources
Senior clinical descision-making close to the patient and
an appropriately trained and supported workforce
Strong governance including board oversight and senior management engagement
Related references:
Improving outcomes guidance in supportive and palliative care. NICE 2004
Treatment and care towards the end of life: good practice in descision making. GMC 2010
7

8. www.endoflifecareforadults.nhs.uk
Published by the National End of Life Care Programme
ISBN:
978 1 908874 04 7
Programme Ref: PB0005 A 02 12
Publication date: Feb 2012
Review date:
Feb 2014
© National End of Life Care Programme (2012)
All rights reserved. For full Terms of Use please visit www.endoflifecareforadults.nhs.uk/terms-of-use
or email information@eolc.nhs.uk. In particular please note that you must not use this product or
material for the purposes of financial or commercial gain, including, without limitation, sale of the
products or materials to any person.
Supported by the NHS Institute for Innovation and Improvement