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The role of an End of Life Co-ordinator in a Dublin hospital

Author: Sarah Stack
20 December 2017

The Irish Hospice Foundation CEO Sharon Foley recently welcomed a new framework which informs the development of Irish adult palliative care services for the next three years.<br />

The aim is to ensure a seamless care pathway across inpatient, homecare, nursing home, acute hospital and day care services. It recommends that specialist palliative care services should be available to all patients in need, wherever they are, and whatever their disease.

Proposes targeted investment to develop service provision over 3 year timeframe and align service levels as recommended in the ‘Report of the National Advisory Committee on Palliative Care’ (2001).

Here we speak to Debby Gregg about her role as an End of Life Co-Ordinator at Connolly Hospital, in Blanchardstown, Dublin.

  • From your experience could you explain the work of an end-of-life co-ordinator?

The role of the end of life coordinator is to work towards ensuring that good quality end of life care is central to the hospital. This is done by striving towards the Quality Standards for End of Life Care in Hospitals. These evidence based standards guides us to the standard that we can work towards in regard to the patient, the staff, the family and the environment. The role of the End of Life Coordinator is to roll out various initiatives to implement these standards under the four streams mentioned above.

The End of Life Coordinator is a central part of the End of Life Committee here in the hospital. This committee is made up of a broad range of multi-disciplinary team members that all contribute to looking at the best way to strive towards good quality end of life care.

As End of Life Coordinator I work on all aspects of end of life care from the education and training of staff to audits and research. I also focus on enhancing the physical environment by creating family friendly rooms in the acute ward areas as set out in the Design & Dignity Guidelines. I liaise with the Irish Hospice Foundation and the other Acute Hospitals and feedback this information to Connolly Hospital.

I am involved in fundraising specifically for end of life and advocating to charities and Hospital Management for funding for different initiatives/projects. I am also involved in policy development in regard to palliative and end of life care.

  • What were you working as before you took on this role?

My previous role in Connolly Hospital was as a Clinical Nurse Manager 1 in the Residential Unit and Clinical Placement Coordinator which involved working with undergraduate Student Nurses.


  • What qualifications and skills do you feel are needed for the job?

I feel you need a good insight in regard to palliative care and the acute care services. It is important that this is from a management perspective in order to allow you to effectively manage the various initiatives and projects within the role.


  • What made you interested in this area?

My background since I qualified is in Palliative Care and Gerontology. This is a field I have always been drawn to and I love working in. I started out my career in Our Lady’s Hospice in Harold’s Cross. The ethos of the Hospice Friendly Hospitals programme is to “bring hospice principles into acute hospital care”. This is what sparked my interest for this role. Coming from the hospice setting I had vast experience of the difference in hospice and acute hospital care and this inspired me to get involved in working towards making changes to work towards the hospice ethos in the acute setting.


  • From your experience what would you say are the challenges faced by health care workers in hospital environments with regard to providing the best end of life care?

The environment in which we work in can be a challenge as our patients would have various acute needs and levels of dependency so the focus for each person is so different. However with the Hospice Friendly Hospitals programme it allows us to take what is best evidence based practice and transfer it to our setting in a way that works for the individual patient and their families. We are able to bring the principles of hospice care into the acute setting and adapt them to the environment we have to make improvements.


  • What kind of difference does your work make to patients, staff and bereaved families?

My work allows us as a hospital to continuously strive towards good quality end of life care for patients and their families. It empowers staff to be involved in this process through local projects and education. It allows us to better understand and empathise with the patients and families journey and make changes in line with what matters to patients and their families at the end of life.

  • In the absence of an end-of-life co-ordinator what kind of system existed for patients and staff?

Before the role was developed specific end of life care issues would have been dealt with by the CNMs/CNS or the ADONs for the areas. This would still be the case however with the role of the end of life coordinator there is more of a focus on specific end of life issues and improvements in end of life care. We also have an end of life committee that the end of life coordinator can feed into and escalate areas that need improvement and plan how this is carried out.

In the absence of an end of life coordinator there would not be a focused networking that we could link into between the hospital, the IHF and the other Acute Network Hospitals who are part of the programme. This is invaluable to us as we are all striving towards the same goal and it is really good to be able to share ideas and work together as a network.


  • Do you know if public hospitals in other counties have end of life co-ordinators?

From my time in this role I have come across information from other countries that suggest there is end of life coordinators in some places. This seems to be under a different name title but with the same ethos of the role of the end of life coordinator here in Ireland.

  • Could you explain the impact that the Hospice Friendly Hospitals Programme has had on your hospital environment?

·         We have increased awareness of end of life and what we hope to achieve within our hospitals

·         We have changed our environments such as some of our family rooms in line with the high standard from the Design & Dignity guidelines

·         We have developed initiatives to get more feedback from patients and relatives in regard to end of life care

·         There is more staff engagement in what we are working towards in our hospital

·         Increased staff education in the area of end of life care

·         Evidence based audits on aspects from the Quality Standards for end of life care in hospitals

  • What aspect of HFH do you think makes the biggest difference to patients at end of life and their bereaved relatives?

There is an increased staff awareness of death and dying and the impact of all areas of this for the patient and their families. The Final Journeys programme for example is one way that we are able to allow staff the time to reflect whilst updating their knowledge on what good end of life care is. We get excellent feedback at these sessions in regard to practices and it allows us to look at these areas and plan ways to make improvements where necessary. This training for staff has a good impact on care received by patients and their families at end of life.

The Design & Dignity Programme makes a big difference for staff, families and patients to have that space to take time out and also a space that gives that sense of peace when they are been made aware of a diagnosis that is terminal. Feedback we received from relatives has been very positive in regard to the impact of this environment for them. We hope to continue to learn more about what matters to patients and families and strive towards changes to improve on areas that are important.


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