Central Manchester University Hospitals NHS Foundation Trust

Promoting High Quality Care and Dignity For All Deceased Persons (Adults) And Their Families

case-study-januar

Central Manchester University Hospitals is a large teaching hospital located in Manchester city centre comprising five specialist hospitals providing health care to a diverse population. It treats more than one million people per year. On average, there are 1200 adult deaths per annum. The Trust adult mortuary also provides a City mortuary service to care for a further 1200 deceased persons who have died in the community.

The death of a person causes distress to the deceased person’s family and loved ones so it is essential to manage all aspects of their care sensitively. Review of local practice highlighted the lack of formal guidelines and policy to support best practice for deceased persons and their families. Standards of care after death were found to differ not only between but also within clinical areas, and the need for change was identified.

The purpose of the initiative was to promote high quality, dignified and standardised care for the deceased person and their family following deaths occurring both within hospital and community settings. During their journey to the adult mortuary with the porters, care within the adult mortuary concluding when the care of the deceased person is transferred to the funeral director.

Current practice within the organisation, including incidents and complaints to capture family/carer and professional feedback was scrutinised together with relevant local and national guidance. Consultation within and beyond the organisation was key to understanding the entire care in a variety of settings as well as to recruit support, and for promotion. A Macmillan Palliative Care Nurse Specialist led a multi-professional policy development group.

A comprehensive new policy with organisational ratification was developed. Supporting documentation was developed incorporating new requirements in addition to those of pre-existing policies. Standardisation of care and the processes to follow was a key driver. The new policy was embedded into organisational practice through a three-month multi-disciplinary education programme delivered by the lead and the End of Life care facilitator.

The initiative has enabled current practice to be challenged and has resulted in a huge organizational change in practice and culture. Clinical practice is now evidence-based with a huge focus on high quality and dignity. Trust staff started to question their own individual practice but also their team’s approach to this aspect of care, having previously delivered care embedded in a ritualistic approach.
As a result of this work, both clinical and non-clinical staff have received training with specific feedback from bereaved families and evidence from national guidance to gain a clearer understanding of the importance and rationale to deliver dignified care. This incorporates the promotion of personal, religious, and cultural wishes in care after death; considering family involvement; and the improvement of communication ensuring consistency in language to maintain quality and dignity. Staff fed back that they had never received formal training in this aspect of care and this has enabled them to reflect on their practice.

The initiative is special as it has given an aspect of care that is so important the opportunity to be high on the Trust agenda. It has challenged opinion and aspects of care that were grounded in tradition and ritual, and has striven to ensure that regardless of which area a person has died in that they will receive high quality and dignified care.

The initiative also provided all Trust staff who care for the deceased person with clear guidance of the process and procedures to follow after a death, and formal, standardised training including staff groups who do not routinely receive such training including porters and administration/clerical staff. Over 600 Trust staff received formal training delivered in small groups to allow interactive teaching in a protected environment.

Professional and carer feedback has been extremely positive, with many staff wishing to support the initiative in the future by becoming champions and contributing in the audit process.

Learning Points

  • Identifying an appropriate lead that is dedicated, passionate, and determined is paramount.
  • Key attributes of members of the working party included commitment and compassion. Collaborative working and elicitation of family and professional views, as well as the incorporation of national guidance is essential.
  • Employment of a variety of promotional activities as well as ensuring compatibility with the organisation’s ethos/principles is necessary to secure commitment of both clinical and strategic levels within the Trust.
  • The use of real examples from practice within training helped staff understand the real needs of deceased persons and their families and the rationale behind the required care.
  • An awareness of the enormity of such a project is vital; one must be prepared to uncover more areas for consideration than initially anticipated.