District Sister Anne Carey, S/N Maria Betts, S/N Laura Jamison, S/N Sinead Wilson, S/N Louise McCrory,
S/N Rosie O'Mahony, Margaret Diamond (Professional Nurse Lead)
The regional end of life care strategy for adults in Northern
Ireland, Living Matters: Dying Matters (DHSSPSNI, 2010),
recommends that once identified, patients nearing the end
of life should be placed on a Palliative Care Register (PCR)
and be appointed a Key worker.
Evidence indicates that, if patients are identified and
included on a palliative care register, they are more likely to
receive proactive, well coordinated care.
In the NHSCT, it was agreed that the District Nursing (DN)
Sister was best placed to be the Palliative Care Key Worker
(PCKW) and would lead the DN team in co-ordinating care to
meet the holistic needs of patients in their last year of life.
Invest time in engaging
the team, early in
Set realistic outcomes
with readily accessible
Stick with the Quality
it does work!
To increase the number of patients aligned to Ballymena East
Central, District Nursing team (identified as being in their last
year of life) who are included on the LCID Palliative Care
Register from -
5% to 80% by 1 October 2019.
Why is it important?
80% of patients would prefer to be cared for and die at
48% of deaths are still occurring in hospital.
There is significant variation in compliance with
maintaining an accurate Palliative Care Register across
District Nursing Teams in the NHSCT.
There is a lack of evidence in some teams to indicate that
patients are being cared for in their preferred place of
What are the barriers?
Living Matters, Dying Matters - a palliative and end of life care strategy for adults in Northern Ireland (DHSSPS, 2010).
CYCLE 1 Provide staff with guidance on use of LCID
palliative care register.
CYCLE 2 Educate Staff on "Why" improvement is
necessary - benefits for patients and staff.
CYCLE 3 Share data charts with team.
CYCLE 4 DN Sister attended Advanced Communication
CYCLE 5 Introduce a "buddy system" to support less
Continue to review
measures until "Aim"
Spread to other DN teams.
Design a patient
information leaflet on
Palliative Care Key worker
and the LCID register.
"I feel much more courageous in
discussing end of life care with
" I didn't realise we done so
many palliative care visits in a
month - its great having the