Case study:

23 February 2009

Marie Curie Palliative Care Outreach Evening Nursing Service within East Riding of Yorkshire NHS PCT

Key points

A Marie Curie outreach team is providing a flexible out of hours palliative care service to all patients in the East Riding area who are in the dying phase, regardless of their condition.

The nursing service, which has helped reduce hospital admissions and facilitate early discharge, has been so successful it is about to be extended across the whole of the East Riding of Yorkshire PCT.

The service, which began as a six-month pilot, is funded jointly by Marie Curie and East Riding of Yorkshire NHS PCT and offers a 6pm to 11pm, seven days a week visiting service to patients with palliative care needs in the remote areas of Driffield and West Wolds. Four more teams are currently being recruited to cover the whole of the East Riding. It is expected this service will be fully in place by April 2009.

An audit of the pilot showed that 1,272 people were referred to the service between July and December 2006. Of those referrals 136 patients were seen for pain and or symptom management, 16 received the key proactive drugs and a further 30 were given catheter care between July and September. Potentially all these patients would have been admitted to hospital without these interventions.

Previously the high number of admissions was due to out of hours GPs being unable to visit symptomatic patients in remote geographical locations sometimes leading to them admit to the acute trust.

There have also been 190 referrals to the service from hospital and in some instances this has facilitated early discharge.

In addition 53 patients have been seen for the delivery of end of life palliative care, helping them to die at home if that was their preferred place of care.

A total of 530 contacts were made to provide advice and support to carers and relatives. And 18 call-outs to out of hours GPs have been avoided.

One problem that had to be overcome before the service could be launched was existing Marie Curie nurses’ reluctance to change the care they provided from overnight care of one patient to multiple visiting during the evenings. They also saw themselves exclusively as cancer nurses but the PCT wanted all palliative patients to be able to access the service irrespective of diagnosis.

The solution was to hold a training day, run by the Macmillan CNS team, which included updating on the Liverpool Care Pathway, key drugs and syringe driver competency training as well as giving nurses the opportunity to discuss the objectives of the new service. As a result the Marie Curie team agreed that, uniquely, this service would be available to any palliative care patient irrespective of diagnosis. Two RGN nurses also volunteered for the pilot and remain with the service now it is substantive.

The new service was cited as example of good practice within the Yorkshire and Humber Coast SHA Healthy Ambitions Report.