• Palliative medicine · Oct 2014

    Randomized Controlled Trial

    The effect of using high facilitation when implementing the Gold Standards Framework in Care Homes programme: a cluster randomised controlled trial.

    • Julie Kinley, Louisa Stone, Michael Dewey, Jean Levy, Robert Stewart, Paul McCrone, Nigel Sykes, Penny Hansford, Aysha Begum, and Jo Hockley.
    • Care Home Project Team, St Christopher's Hospice, London, UK j.kinley@stchristophers.org.uk.
    • Palliat Med. 2014 Oct 1;28(9):1099-109.

    BackgroundThe provision of quality end-of-life care is increasingly on the national agenda in many countries. In the United Kingdom, the Gold Standards Framework for Care Homes programme has been promoted as a national framework for improving end-of-life care. While its implementation is recommended, there are no national guidelines for facilitators to follow to undertake this role.AimIt was hypothesised that action learning alongside high facilitation when implementing the Gold Standards Framework for Care Homes programme will result in a reduced proportion of hospital deaths for residents and improvement in the care home staff ability to facilitate good end-of-life care.DesignA cluster randomised controlled trial where 24 nursing homes received high facilitation to enable them to implement the Gold Standards Framework for Care Homes programme. The managers of 12 nursing homes additionally took part in action learning sets. A third group (14 nursing homes) received the 'standard' Gold Standards Framework for Care Homes facilitation available in their locality.Setting/ParticipantsIn total, 38 nursing homes providing care for frail older people, their deceased residents and their nurse managers.ResultsA greater proportion of residents died in those nursing homes receiving high facilitation and action learning but not significantly so. There was a significant association between the level of facilitation and nursing homes completing the Gold Standards Framework for Care Homes programme through to accreditation. Year-on-year change occurred across all outcome measures.ConclusionThere is a danger that without national guidelines, facilitation of the Gold Standards Framework for Care Homes programme will vary and consequently so will its implementation. The nurse manager of a care home must be actively engaged when implementing the Gold Standards Framework for Care Homes programme.© The Author(s) 2014.

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