Supporting District Nurses to reduce hospital admissions

Project overview

Willowbrook Hospice was approached by its Integrated Care Board (ICB) in February 2023.

At the time, the District Nurses were struggling to prioritise palliative patients, which meant that patients were having to be admitted to hospital. The hospital was not always able to discharge patients with palliative care needs, as they were unable to arrange suitable home care. This meant that some patients were not able to die in their preferred place of death.

The hospice was asked if it could help reduce patient admissions and increase discharges from hospital for palliative patients. After reviewing various options, the hospice devised a plan to do this by supporting the local District Nursing teams.

Willowbrook does not have a Hospice at Home or Community service. But the team was keen to help provide much-needed care for palliative patients in the community. During the first half of 2023, two of the hospice’s inpatient bedrooms were being refurbished, which freed up some staff capacity.

The hospice met with St Helens District Nursing and agreed to embed two Band 6 Willowbrook Hospice senior nurses  into the neighbourhood team, starting from April 2023. The nurses are known as “Willowbrook Community Nurses”.

Outcomes

Having two Willowbrook Hospice (WBH) nurses in the District Nursing (DN) team has been incredibly valuable - so much so that another senior nurse has been added to the team. The WBH nurses will visit any patient with palliative care needs but will prioritise  in supporting patients at the end of their lives.

The WBH nurses have the capacity to spend more time with patients, and have supported people to die at home, in their preferred place of death. This is not only valuable for the patient themselves, but for their carers and family who would otherwise have had to experience the death of a loved one alone. 

In the first three months, the WBH nurses made 146 patient contacts, none of which would have been possible before the collaboration was set up.

The DN team has a relatively new workforce, having seen several staff members retire recently. The hospice nurses are very experienced nurses who are able to share knowledge and skills. Some Newly Qualified Nurses have shadowed the hospice nurses and learned how to complete Individualised Care and Communication records.

The hospice nurses  have reintroduced Advance Care Planning (ACP) to the DN team, and are training the DNs to have ACP conversations with patients. They have also been able to provide education and training around aspects of care for patients with palliative needs, such as administering subcutaneous fluids.

The DNs are much more aware of what the hospice does and are able to refer people to the outreach service. The team are also identifying families who need bereavement support, before their loved one has died.

Key facilitators

The Integrated Care Board (ICB) approached Willowbrook about this project and provided some transformation funding which enabled them to pay the extra staff costs such as mileage.

It was helpful that the request came at a time when two of the hospice inpatient beds were closed for refurbishment.

The St Helens DN team has been very open to working with Willowbrook. The nurses are keen to learn and provide the best possible care to patients. The WBH Nurses who are embedded in the team have previously worked as DNs, so they have been able to fit in well with the team. All the nurses can see the positive impact of being able to spend more time with patients.

As a result of the programme, one of the DNs has even enrolled as a member of Bank staff at the hospice.

Willowbrook has monthly meetings with the manager of St Helens District Nursing, to monitor progress and solve any problems that might arise.

Willowbrook already has a contract with Child Bereavement UK to help provide support for families, which has been invaluable for this service.

Challenges

It is important that the hospice nurses who are embedded in the community still feel like a part of the hospice team. Because the hospice shifts are longer than a DN shift, the nurses are able to start their shift working in the community and then finish it off in the inpatient unit.

There are several patients who have been on the community caseload and then admitted to the inpatient unit, so this provides excellent continuity of care. It is reassuring to patients to see someone they recognise.

Willowbrook would like to evaluate the service and are collecting qualitative and quantitative data. They hope this will enable them to get the service commissioned once their inpatient beds are refurbished (in September 2023).

Depending on capacity, the hospice would like to continue the service for as long as possible.
 

Image: courtesy of In-Press Photography via The Centre for Ageing Better.