Case study:

06 March 2008

Implementation of 24-hour intermittent end of life care by Herefordshire’s district nursing service

Key points

A new 24-hour seven day-a-week district nursing service in Herefordshire is providing those close to death with greater support and allowing them to die in their place of choice, surrounded by family and carers.

The new standardised service, implemented by Herefordshire PCT in December 2006, involves shift working between 8am and 10pm, with district nursing sisters providing an overnight on-call service.

As a result those who are dying have access to qualified district nurse team members for the full 24 hours.

The new arrangements allow for intermittent visiting day or night, which may be increased in frequency in end of life care, as advocated by recent NICE guidance.

So, for example, after medical and nursing consultation a district nurse was able to change a syringe driver regime in the evening for a patient who was dying at home in obstruction, a challenging condition to manage.

As a result the symptoms were better controlled and the patient went on to die peacefully at home, with the threat of a hospital admission prevented.

The carer was reportedly very appreciative of the evening visits made by the service.

A detailed review of the service after three months – including feedback from district nurses, patients and GPs – has shown it is efficient, equitable and cost-effective, and offers more choice and support to end of life patients.

However, there are things that can be improved and some changes are currently being implemented.

Although this has been a difficult period of change, staff have shown a tremendous commitment to the new service.

This has been helped by excellent human resource and staff side joint working.

Future plans include providing key worker training for district nursing sisters, exploring the possibility of having a district nursing coordinator /care tracker and reviewing the skill mix and allocation of resources within the service.