We are celebrating the work of our amazing team, who make a difference to the lives of our patients and their families every day.
Meet Maggie, our Palliative Care Discharge Coordinator. Maggie is a key member of our Hospice Team at the Queen Elizabeth Hospital. Her role is centred around supporting patients requiring fast track assessments to enable them to leave the hospital and receive care at home. On a typical day Maggie will meet the hospital team to discuss new referrals of patients who are to be discharged home; referrals can come from within the Hospital or Community Palliative Care Teams, or from the wards. “I meet with the patients, liaise with the ward staff, therapists, doctors and next of kin to make sure all elements of the patient’s needs, their preferences and wishes are taken into consideration and that their care package (which includes any equipment and medication) is in place before they are discharged to their home. I also liaise with and refer to our Hospice Community Teams and use as many opportunities as possible to educate ward staff about fast track discharge planning.
What I love about my job is that I can get patients to where they want to be in a fast and efficient manner. I have a passion to ensure that patients at the end of their life have their wishes carried out and the majority of patients wish to be in their own homes. I enjoy being able to allay people’s fears about going home, being able to advise on the support networks that are in the community and more importantly being able to answer any questions that patients or their families may have. I am also fortunate to work in a very supportive team of specialist nurses and doctors where there are many learning opportunities.
My job is a new one to the Hospice. Before my role was in place, completing referrals and assessments paperwork was not always a straightforward process. This could result in delayed discharges and potentially people might die in hospital as opposed to in their preferred place. In my role, I can also make sure that patients and their families fully understand the community services that are available to support them.
An example I can think of is I recently completed a Fast Track Assessment for a patient. She had previously declined all community support, due to an extremely complex family situation. I spent a number of occasions with this lady during her admission and advised that community support was required for end of life care at home (which is where she wished to be). This lady was extremely anxious. I spoke with the Hospice Community Team and asked if they would come to the ward to meet the lady, to start to build a relationship and to give her confidence on discharge. With the lady’s consent the community nurse and I, met with her. I was able to do the initial introductions and allay her fears. This resulted in her agreeing to a referral on discharge. The lady was extremely grateful and thanked me for my time and patience.”
When a patient receives a fast track referral, it can cause feelings of anxiety and uncertainty for patients and their families. With the support of Maggie and her colleagues in the Hospice Team, people are getting to the place they want to be, more efficiently and by ensuring that people have the information that they need on discharge and are signposted to community support networks, it is making a difference to so many people.
What are some common questions that patients and families ask?
Who do I call if in pain? What do I do if the condition deteriorates? What happens if we get home and feel that we can’t cope and need 24 hour care? What happens if we need help overnight?
What is a Fast Track Assessment?
This is a type of assessment for those patients with a rapidly deteriorating condition who are approaching end of life. It identifies those patients with a primary need for healthcare intervention as opposed to social services care. The care package is fully funded by the NHS and care is provided by carers trained in end of life care.