Case study:

11 May 2010

Comfort Care Boxes in Solihull NHS Care Trust

Key points

Solihull NHS Care Trust are now offering all patients dying at home a Comfort Care Box, containing a standardised range of nursing supplies, which can be kept close to the patient at all times.

The boxes, which contain nursing supplies, continence and catheter care supplies and are combined with an anticipatory medications box and the patient’s care plan, have helped improve the consistency and availability of nursing supplies in patients’ homes.

The development has been well received, especially by out of hours services. The community teams also feel that the boxes give a more professional impression. For patients and their families it has meant that supplies, anticipatory medications and the care plan can be kept together in one place in the home rather than in a number of different places.

The change was introduced after a retrospective audit of 20 patient care plans in the community identified a need for standardising nursing supplies in the homes of patients who were dying.

A working group of community nurses, community matrons and specialist palliative care was set up to review the audit and develop a community care pathway for GSF patients. The pathway included the use of Comfort Care boxes and Just in Case boxes for medications prescribed in anticipation.

The boxes, which have been in use for a year, are now issued to all community nursing teams and case managers. They are stocked ready for use at the community nursing bases then taken out to the patient’s home when needed along with the Just in Case box and associated community pathway documentation. A protocol for use of the boxes includes a standard stock list as well as instructions on how to use, collect and clean the box.

The trust’s community nursing teams were initially given a total of 40 boxes but this has since been increased to 60 to support the larger community nursing teams and the community children’s team. The End of Life Care Commissioning Strategy also funded pressure relieving mattresses for the boxes in 2008.

One potential challenge was finding enough room to store the boxes in the community nursing bases. For some teams this has been an issue but all teams have managed to create space to store the boxes not in use. All the boxes are stackable.

All community nursing teams were consulted on what supplies should be standard stock for the boxes and a stock list with quantities was successfully agreed. This will be reviewed annually.

All Care Trust palliative care training sessions now include information on the community care pathway and the Comfort Care boxes. Information is also available on the Care Trust palliative care intranet site.

The use of the boxes will be monitored as part of the Community Supportive Care Pathway audit in 2009.