What’s the problem?
Improving palliative and end of life care for care home residents is an urgent priority both in the UK and internationally. Whilst over half of care home residents die within the first year of admission, care home residents often experience poor care in their final weeks and months. Care home residents increasingly have multiple complex health needs and staff frequently report lacking confidence in providing end of life care. This often results in avoidable hospitalisations, sometimes leading to burdensome interventions, which can be distressing for care home residents and their relatives.
This study aims to improve palliative and end of life care by implementing an approach developed in Australia called ‘Palliative Care Needs Rounds’, or Needs Rounds for short. It aims to do this by reducing unnecessary hospitalisations, strengthening staff confidence and capability, and increasing advance care planning so that caring practices are aligned with resident needs, wishes, and preferences.
What are Needs Rounds?
Needs Rounds combined three things:
- monthly one-hour meetings where care home residents who are at risk of dying without a plan in place are discussed in turn to understand their needs as they approach the end of life. They are run by a senior clinician from a palliative care team (usually a nurse) and attended by several care home staff.
Needs Rounds involve discussing resident physical, psycho-social, and spiritual needs, and devising tailored action plans to address these. Needs Rounds often include education to help staff understand more about symptoms, deterioration, and how to look after people with life limiting conditions. - direct clinical care. This clinical work is triggered by discussions at the Needs Rounds meeting. Not all residents who are discussed will need to be seen by the specialist from the palliative care team, but it is part of the approach for those with complex needs.
- Multidisciplinary and family meetings. As with direct clinical work, sometimes it becomes clear in the Needs Rounds meeting that it would be helpful to have a broader group of people updated and involved in discussing next steps. A multidisciplinary meeting might include someone from primary care, or the hospital. A family meeting might be needed if there is disagreement or uncertainty from the person’s relatives about next steps.
The approach is always personalised, so the response will vary depending on the person’s needs.
Needs Rounds use a published checklist. You can use the checklist for free.
Our Australian research involving 1700 care home residents showed a number of significant benefits. Using Needs Rounds resulted in a reduction in the number and length of hospitalisations which also led to substantial cost savings. Staff reported increased confidence and capability to provide end of life care leading to improved quality of death and dying for residents. Rates of advance care planning also increased. We aimed to replicate these positive outcomes by developing an adapted version of Needs Rounds that is responsive to care home settings in the UK.
Findings from the UK study can be seen on the ‘findings’ tab.
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