Improving equity of choice for patients needing long-term ventilation

Project overview

St Oswald’s Hospice cares for children and adults. While staff working with children and young adults were able to provide good support for patients with long-term ventilation (LTV) needs, the adult staff team were much less confident.

There was a clear gap in provision for adults with long-term ventilation (LTV) needs. In 2019, the hospice was only able to support 60% of the adults with LTV who were referred to the inpatient unit, and only four adult day patients with LTV. 

With funding from St James’ Place Charitable Foundation, through Hospice UK, the hospice set out to address this skills gap so that patients with LTV needs could have better access to the specialist palliative care provided by the hospice.

Outcomes

The hospice established a long-term ventilation (LTV) special interest group, which included Link Nurses from each service. The group worked together to develop an organisational strategy for the management of children and adults with LTV in the hospice.

The special interest group worked with the Newcastle Home Ventilation team to develop a competency framework for adult patients (there was already a LTV competency framework for children). All staff were surveyed to establish training needs and a comprehensive training package was developed.

The training includes:

• 25 online learning modules
• self-guided workbooks
• extra face-to-face sessions for clinicians (so that LTV leads can assess their competency against the new framework).

The training is graded so that it can be tailored for the needs of all hospice staff (for example non-clinical and clinical).

Since the project began, the hospice has not had to refuse any patients because of their LTV needs. The Newcastle Home Ventilation Team report being more confident about referring patients to the hospice.

Key facilitators

During the COVID-19 pandemic, several nurses from the children’s hospice team began working on the adult inpatient unit to help cover for staff who were sick or isolating. At the same time, there was a marked increase in referrals for LTV patients.

The children’s hospice nurses were able to provide hands-on support and ‘on the job’ training, which greatly increased the adult nursing team’s skills and confidence at supporting ventilated patients. This meant the hospice could accommodate all of the ventilated patients who needed support during the pandemic.

All staff were eager and willing to learn about LTV.

Working with the Newcastle Home Ventilation Team was very positive. It has given both organisations a focus for closer collaboration and sharing expertise. As well as learning from the Home Ventilation Team, the hospice has provided support around managing difficult conversations and advance care planning.

Challenges

Staffing has been a challenge for the hospice throughout the COVID-19 pandemic, and some team members have had to miss training sessions due to sickness, self-isolation or having to cover for colleagues. In response, the hospice extended the project by 6 months. 

There were several changes within the Link Nurse team for a range of personal reasons, which had an impact on the project.

The results of the staff survey indicated that the training programme needed to be broader than originally envisaged. The final training programme includes all aspects of respiratory care including tracheostomy, cough augmentation and suctioning.

The steering group was also able to adapt the training to cover issues relating to the Covid-19 outbreak, for example PPE requirements.

The hospice now has a comprehensive training package which will be used to ensure that all new staff are confident in supporting patients with LTV.

The project has reinforced the benefits of cross-team working, and the hospice plans to encourage this in the future.