The Integrated Personalised Plan for the last days of life (IPP) document and audit
Judith Coleman, Jean Levy and Julie Kinley
A key part of the practice development work carried out by the St Christopher’s Care Home Project Team (CHPT) with staff in nursing homes in five Clinical Commissioning Groups (CCGs), has been supporting the staff with their residents’ end of life care.
Initially a document called the Integrated Care Plan (ICP) was used to provide a framework for this care. This document had emerged from a research study undertaken by Jo Hockley with care home staff in Midlothian and was based on the Liverpool Care Pathway (LCP). Nursing home staff reported that they found the tool useful to guide their care.
Following the withdrawal of the Liverpool Care Pathway from national use the ICP document was reviewed and amended by the CHPT to incorporate the Five Priorities for Care of the Dying Person. These focus on providing quality end of life care and were set out in the “One Chance to Get it Right” report, published in 2014 by the Leadership Alliance for the Care of Dying People.
The new document, named the Integrated Personalised Plan for the last days of life (IPP) provides a structured approach for staff to both guide and document the care they provide for their residents in the last days/ hours of life. It encourages a team approach to care, incorporates the patient’s wishes and encourages communication with the resident’s family and their inclusion in care and decision making.
A fifteen month project, funded by St Christopher’s Hospice, aimed to train staff in seventeen nursing homes across 3 CCGs how to use the document and implement it in practice. A robust training plan was set out that recommended the tool should only be used once a minimum of 80% of care staff in the home had received training. An audit of the first 50 documents used across the seventeen homes was then carried out. This reviewed use and completion of the document, its usefulness as a tool to support care delivery and the quality of the end of life care delivered.
In addition to review of the document the managers and staff of the homes involved in the project were asked for their thoughts and experiences of using the IPP. Data from this review has enabled the IPP to be adapted and developed for future use, thus completing the audit cycle. The document will continue to be used within nursing homes in Croydon, Bromley and Lewisham.
A summary of the project report is available below.
Coleman J., Levy J., Wiggins S. and Kinley J. (2017) Using a new end-of-life care plan in nursing homes Nursing & Residential Care 19(1), 38-41