Organisation in collaboration sets up a project to deliver compassionate care to patients in prison settings, delivering personalised care and enabling patients to spend their last days with dignity

Outline:

Working in collaboration with St Luke’s Hospice and the Prison Service the healthcare department facilitated specialist nurses from the hospice to attend the prison on a regular basis to review and support end of life care at HMP Dartmoor. These patients would normally have to be escorted to the hospital or be transferred away from the prison for end of life care.

This project has allowed patients to be involved within their care planning and remain in an environment with their fellow prisoner friends and spend their last days with both dignity and respect in a place of their choosing.

The development of a complex care lead nurse has supported the project and is pivotal to the success of achieving streamlined communications and multi-disciplinary working, including a range of healthcare professionals, prison colleagues and prisoner buddies (trained prisoners to support other prisoners with social care needs).

Challenges- Delivering end of life care in prisons is challenging due to regime constraints, environmental conditions (old building, space within cells and general facilities) and supporting a patient overnight in a non-24 hour healthcare facility.

Solutions - By having an in house service of specialist palliative care nurses to regularly review patients has allowed us to effectively monitor any signs of deterioration, expert advice of symptom control etc.

The introduction of a new complex care lead nurse role has allowed “protected time” for the nurse to hold a caseload of patients to review, work alongside prison colleagues to support end of life, being a direct point of contact for all end of life patients, and organise training and awareness events and effective care plan.

Goals - There have been financial outcomes in terms of reduced escort costs for specialist nurses clinics. However, the driver for this project was to improve patient access to the end of life services and the promotion of dying with dignity and having choices. The whole prison approach for end of life care has been based on compassion, “doing the right thing” and tackling the obstacles we are faced with head on.

Outcomes:

The outcomes were measured by patients that have accessed the service. A case study review has also been completed for a patient that died at HMP Dartmoor. The study demonstrated how as a whole prison approach the patient had a “good death”. This was also recognised within the PPO report that noted that his care at HMP Dartmoor exceeded that of the care he potentially would have received in the community.

Our complex care lead nurse also runs a “living with cancer” patient forum group and feedback from patients have again demonstrated the value of patients feeling empowered to make decisions, be actively involved and have a choice with regards to dying.

Spread:

St Lukes submitted a nomination into the Nursing Burdett Awards in 2018. As a joint project, we received a 1st place award under the category of end of life care and overall winners.

Since these awards, we have continued our commitment to continue our drive for quality end of life care and to support this project and the ongoing journey we created a new nursing post for complex care patients. Since the development of this post, we have successfully set up our Living with Cancer fo Charter. Our ultimate aims are to be recognised as a Compassionate Prison that actively supports the community within.

Value:

Our values focus on patient experience. The complex care lead nurse role pulls together all the services that support an individual who is end of life, ensuring that the patient receives, compassion, dignity, respect in an environment of their choosing with the people around them that can provide support.

Involvement:

The key stakeholder are; The Primary Care Team at HMP Dartmoor, St Luke’s Hospice, HMPPS including HMP Dartmoor Prison Senior Management Team. The project set out to engage all of the above and the “buy-in” focussed on patient outcomes and dignity agenda.

The prison contribution has been essential in achieving a quality end of life service as individual care plans have meant that usual regime is changed to suit the individuals needs, for example, an open door policy at night, investing in vetting of specialist nurses, engagement in training events, pressure of additional escorts to hospitals and facilitating short notice appointments. Allowing increased family visits, phone calls, changes to dietary requirements, adaptations to the fabric of the environments etc.