Did you know that DHU Healthcare provides a Palliative Care Urgent Response Service (PCURS) across Derbyshire?
Preparing and talking about those final days of life isn’t easy so we want to tell you how our incredible team does it.
Since June 2021, an incredible team of nurse practitioners, nurses, and admin has been running the service from Chesterfield’s Ashgate Manor from 8 in the morning until 8 in the evening with just one car to cover the entire county. It’s been so successful it was extended to midnight across two shifts to make a 16 hour service with a view to extending it even further in the coming months.
Jill Davies is DHU’s Palliative Care Clinical Lead and Advanced Nurse Practitioner for the service, she said: “At its heart it is a simple idea but in my view it is absolutely essential. What we try to do is help people in their final days of life to die peacefully, with dignity, in comfort, surrounded by the love of their friends and family instead of in a busy hospital environment or at home and in pain. The calls we get vary in complexity but a typical call will involve us visiting a patient and family to give them very specific palliative care to enable them to fulfil their final wishes to remain at home.
“How it works is that a crisis call will come in to our dedicated end of life team and either myself or one of the nurse practitioners will triage. Our rapid response car will be ready and stocked up with the necessary medication, equipment and kit so that a nurse practitioner and one of our community nurses will go to the patient’s house, assess their needs and support the family through the process. The idea is that we can prescribe and administer in one visit to reduce waiting times and get the patients’ comfortable as quickly and effectively as possible. Most of our calls are for one off or ad hoc visits and we then refer or update other teams and organisations to provide longer term care and support.”
“The family is central to the patient experience”
Cecilia Green is a Community Staff Nurse at DHU Healthcare, she said: “When we get to the patient’s home we’ll see what’s there to make them comfortable, for example what mattresses they have, what care plan is in place and what medication, if any, they have. We then need to address the reason we’ve been called out which could be pain management, maybe they’re not eating, they could be fitting or any other cause for concern.
“We do explain to the families that they will see changes in their loved one in those final days. Their colour will change, there will be loss of appetite and breathing difficulties may become more common. These are the signs and symptoms of dying and we need to prepare families for what to expect. We have to remind ourselves that this is a new experience for these families so we approach every single moment of care with compassion; the family becomes central to the patient experience and we must remember that we are in their home.
Jill added: “That’s exactly right and when we get called out to a patient, that person isn’t a patient to the rest of the family, they’re Mum, Dad, Gran, Daughter. They know when something’s not right because they know and love them inside out so we need to ensure the care we give there and then is right first time – we only get one chance to get dying right. Families are often so embroiled in providing care that they are emotionally shattered and physically exhausted. They need practical help to take over some of the care responsibility so they can go back to being a Husband, Wife, Son or Daughter. That is where we can help by getting them the right help and support.”
“It’s absolutely about teamwork”
The team are hoping to see the service expanded to two cars which will enable them to operate a 24 hour service and cover the county more efficiently. They’ve also been working very closely with paramedics, 111 Health Advisors and social services to help them recognise some of the signs and to call the PCURS for advice first instead of sending someone to hospital.
Cecilia added: “It’s absolutely about teamwork and we’re doing this because a care gap has been identified and this urgent response service is fulfilling those patients’ and families’ needs. We are unfortunately seeing more and more younger people with recent diagnoses because their condition hasn’t been picked up earlier, which is an effect of the pandemic. But people are returning to focus on their health so we are going to see more of that.
“We’re also at a time where resources are stretched and each NHS service needs to focus on its area of expertise to be able to maximise those resources. If we have patients whose wishes are to receive palliative care at home, and we can help to make that happen, then more beds are available for the acutely ill. It is a new service and a new way of working but it’s at times of change that we need to think differently and approach care from a different perspective.”
“We ensure those final days are comfortable”
The team consists of a pool of around a dozen Nurse Practitioners and six nurses with significant support from care coordinators. The team will receive around 70 to 80 calls per week as Jill leads the team with more than 30 years of palliative care experience; Cecilia and her colleague Hannah Broderick make up the core of the team.
Jill said: “Most of the shifts are picked up from the advanced nurse practitioner and community nursing teams where there’s been lots of interest and enthusiasm. We provide all of the training and, though it can be emotionally draining at times for us, there is plenty of support and training through monthly sessions, regular supportive meetings and a WhatsApp group.
“I’m so proud of what we have achieved, what an amazing group of people we have working with us and the service that we provide at DHU Healthcare that makes such a difference to the lives of our patients. This is a very specific group of patients who will not get better. Our job is to ensure those final days are comfortable so that their families have the best possible memories of those last, precious hours, with someone who is very special to them.”