Improving Bereavement Services - PowerPoint Presentation

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Improving Bereavement Services

At Speedwell Practice (and beyond maybe?)

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Why bereavement as a project?

I wanted to work on something that affects all of us at some time in our lives.

I imagine everyone in this room has some experience of death and dying and the pain and feelings that go hand in hand with that.

Among us there will be lots of differing circumstances – miscarriages, suicides, expected deaths, untimely deaths, accidents and times when death is a relief.

For our patients during Covid-19 pandemic, not being able to be with family members as they are dying may lead to increased feelings of guilt and grief.

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How the idea began!

Malcolm and Hilary- Malcolm sadly passed away in April 2020after a long illness, which was complicated by Covid-19. I was with Hilary when she called her practice to book a routine test some weeks later and the receptionist at her surgery acknowledged her loss.

It meant everything to Hilary.

Their surgery is much smaller than ours and they knew Hilary and Malcolm very well (because of his long-standing health issues) but is there a way we can offer the same to our patients?

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Frances and Lesley

I’m so glad that these wonderful women were friends of mine.

They and their families were also patients at Speedwell Practice for many years.

Both sadly passed away in 2020 and it got me to thinking about the current service we provide for our families and friends around bereavement support and offering help or signposting for help with grieving.

I have their family's permission to use photos and include them in this presentation. I had to move the photo to the end as seeing them makes me cry – a lot!!

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Death and dying

Over half a million people die in Britain each year and, on average, a GP will have approx. 20 patients die annually.

Bereavement is associated with significant morbidity and mortality

(1)

A study reported in the British Journal of Psychiatry concluded that persons exposed to sudden and unexpected loss of a close relative are subject to increased psychiatric morbidity and should be regarded as a high-risk group (2)

This year Covid-19 has made situation worse, families unable to be with their dying relatives, whether they died of COVID-19 or in hospital for other reasons.

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What is bereavement?

Bereavement is the experience of losing someone important to us. It is characterised by grief, which is the process and the range of emotions we go through as we gradually adjust to the loss.

Losing someone important to us can be emotionally devastating - whether that be a partner, family member, friend or pet. It is natural to go through a range of physical and emotional processes as we gradually come to terms with the loss.

Bereavement affects everyone in different ways, and it's possible to experience any range of emotions. There is no right or wrong way to feel. Feelings of grief can also happen because of other types of loss or changes in circumstances, for example:

the end of a relationship

the loss of a job

moving away to a new location

a decline in the physical or mental health of someone we care about.(4)

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What is grief

Grief is not just one feeling, but many emotions that follow on from one another.

You may find your mood changes quickly, or that you feel very differently in different situations.

People who are bereaved sometimes say they feel ‘up and down’.

You may feel:

shocked or numb

sad

anxious or agitated

exhausted

relieved

guilty

angry

calm

lacking in purpose

resentful.

You might also find it difficult to concentrate or carry out tasks that would normally be easy.(5)

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Complicated Grief

The vast majority of individuals who lose someone usually adjust over a period of six to 12 months and finally develop a new sense of normalcy in their life. But for others, this process becomes troublesome and prolonged. When people get stuck indefinitely in grieving, preventing them from processing the death and moving on with life, a condition known as complicated grief (CG) may eventually arise (3).

CG is a chronic, impairing form of grief, distinctive from depression and post-traumatic stress

It is this grief reaction we are hoping we can help avoid, with support and information.

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CG is a chronic, impairing form of grief, distinctive from depression and post-traumatic stress

Bereavement is a common human experience and grief represents the normal reaction to the death of a loved one. The vast majority of individuals who lose someone usually adjust over a period of six to 12 months and finally develop a new sense of normalcy in their life. But for others, this process becomes troublesome and prolonged. When people get stuck indefinitely in grieving, preventing them from processing the death and moving on with life, a condition known as complicated grief (CG) may eventually arise (3).

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What is our current practice?

Deaths are recorded in a special book which is kept in a locked cupboard and kept up to date by our secretaries.

Doctors usually write condolence cards to families, especially if known to them – often over many years and through difficult times.

Demand on time is high and limited time to spend on this activity.

I ran a survey monkey to see who was involved in bereavement care, if they thought we provided a good service and would they like to see a change? It was sent to approx. 30 people and 12 responded.

https://www.surveymonkey.com/analyze/wjLwfDVg7mRI2cLReGZVbQqjS0CiqRB108rnuCKGJM8_3D?tab_clicked=1

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1) Do you deal with bereaved patients in your role at Speedwell? 12 responses

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2) Do you feel confident in talking to patients about bereavement? Or where to signpost?

5 said Yes 6 said No 1 abstained

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Do you think our patients think we offer enough support while they are bereaved? 

7 said Yes 4 said No 1 didn’t know

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Written responses

“I think we do, JSC's letters are always lovely, I am unsure of waiting times for bereavement services. Maybe we should think about a standard procedure for grieving relatives”

   ”I don’t know”

 ”Not sure as have not seen many patients in my training who are recently bereaved”

 difficult to know as

I

don't have much experience

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Would you be interested  involved in offering bereavement support, if you aren't already? Signposting, monitoring, calling? Please comment.

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My to do list………a work in progress!

Talk to deceased relatives and gauge their wants and needs. What did we do well and what can be improved. DONE

To ask nursing colleagues how they manage death and bereavement via Barnet GPN WhatsApp group

DONE

Discuss monthly email notification to all clinician and admin staff re patients who have passed away.

DONE- tasking named GPs Card insert or template letter - see slide!Website page. DONEPractice leaflet. ? Needed – link to website?Identify those who said they would like some input to effect change. LET ME KNOW!

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Relatives

So far I have spoken with a few relatives, but plan to call more, including relatives of patients who passed away due to Covid-19

General air of disappointment that they were not contacted by anyone at the surgery, despite being registered with us for 30 years.

Not sure if it would have made a difference? But might have been a nice touch.

Frances - Hospice patient – her family felt that had good support and guidance from The

NLHospice

team.Lesley's family felt that they didn’t need support at the moment, but happy to know where to look in future. A contact would have been nice but not essential.

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Actions completed so far and plan…….

Monthly review of patients who have passed away – KL

Bereavement added as a problem if relatives are registered with us - KL

Task will be sent to named or best known GP if letter not already written-KL

Happy to write on your behalf if patient not well known

Template letter to be added – will ask Peter and Kate

(DONE)Web page info and links to be complete – will discuss with Kate (DONE)How to monitor if contact is useful?? Not sure how to measure this? (Discussed with Jag Mundra)

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Card insert message/ template letter

Dear

The doctors, nurses and staff at The Speedwell Practice are very sorry to hear of your recent bereavement. We would like to offer our

sincerere

condolences.

If you feel that there is anything we can do to comfort you at this time please know that all you have to do is to ask.

Alternatively, consider one of the local support organisations freely available as listed below.

Our thoughts are with you and your family. We hope that knowing others care about you and are thinking of you will help you through this difficult time.

With sincere sympathy

___________________________________on behalf of

The doctors, nurses and associated staff

The Speedwell Practice

020 8445 7587

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LOCAL ORGANISATIONS

Please look at our own website:

http://www.thespeedwellpractice.nhs.uk/welcome,36027.htm

Barnet Bereavement Service

https://www.barnet.gov.uk/directories/support-organisations/barnet-bereavement-service

020 3759 4347

Covid-19 Bereavement

https://www.barnet.gov.uk/news/new-barnet-covid-19-bereavement-support-and-counselling-service

North London Hospice

https://northlondonhospice.org/our-care/bereavement-service/

0208 343 6819

Sudden Infant death support

https://www.teddyswish.org/who-we-are/

Bereaved by Suicide

https://www.mind.org.uk/information-support/guides-to-support-and-services/bereavement/bereavement-by-suicide/

Bereavement by Traumatic events

Anyone can contact CRUSE if they want to talk about themselves. Day by Day helpline 0870 167 1677

Young person’s helpline Freephone 0808 808 1677

https://www.cruse.org.uk/get-help/traumatic-bereavement/death-from-violence-and-crimeAbundant

Marie Curie Bereavement Support Centre

https://www.mariecurie.org.uk/help/support/bereavement#

tel:08000902309

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Local support

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In Times of Bereavement

In the unfortunate event that a person has passed away, there are three things that must be done in the first few days;

Get a medical certificate from your GP or hospital doctor (this is necessary to register the death)

Register the death within 5 days (8 days in Scotland). You will then receive the necessary documents for the funeral.

Make the necessary funeral arrangements.

Register the death

If the death has been reported to the coroner (or Procurator Fiscal in Scotland) they must give permission before registering the death.

You can register the death if you are a relative, a witness to the death, a hospital administrator or the person making the arrangements with the funeral directors.

You can use the ‘

Register a Death

’ page on the gov.uk website that will guide you through the process. This will also explain the registration process for Scotland and Northern Ireland.

Arrange the funeral

The funeral can usually only take place after the death is registered. Most people use a funeral director, though you can arrange a funeral yourself.

Funeral directors

Choose a funeral director who’s a member of one of the following:

National Association of Funeral Directors

National Federation of Funeral Directors

Society of Allied and Independent Funeral Directors

These organisations have codes of practice - they must give you a price list when asked.

Some local councils run their own 

funeral services

, for example for non-religious burials. The 

British Humanist Association

 can also help with non-religious funerals.

Arranging the funeral yourself

Contact the Cemeteries and Crematorium Department of your local council to arrange a funeral yourself.

Funeral costs

Funeral costs can include:

funeral director fees

things the funeral director pays for on your behalf (called ‘disbursements’ or ‘third-party costs’), for example, crematorium or cemetery fees, or a newspaper announcement about the death

local authority burial or cremation fees

Funeral directors may list all these costs in their quotes.

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What is grief?

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The Ball in the Box analogy for Grief

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In the early stages, the ball is very big. You cannot move the box without it frequently hitting the pain button. It rattles around on its own in there and hits the button over and over again, sometimes so much that it feels like you can’t stop it – you can’t control it – it just keeps hurting.

But as time goes on, the ball gets smaller. It doesn’t disappear completely and when it hits the pain button, it’s just as intense, but generally, it is easier to get through each day.

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Web page advice

When someone you love dies – we hope this page offers you advice nad some comfort.

When somebody loses a loved one, it is usually very difficult and trying time.   The emotions you are going through are probably quite normal.  Often, people think they’re going mad or crazy because they either see things or can’t quite get their ‘head’ straight.   One moment, you may be thinking that you’re fine and doing okay and then at another moment, unexpectedly, you might find yourself in floods of tears.   All of this is quite normal.   The important thing is not to question how you feel but to allow it simply to be.

At the bottom of this page, you will find a list of local organisations in Barnet that offer free Bereavement Support.   Please don’t hesitate to call them.   But before you do, please continue reading this page (in which we hope you find some comfort).

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A BIT MORE ABOUT THE GRIEF REACTION

People who experience bereavement often wonder whether they are depressed.  Most of the time, they are not – instead, what they are experiencing is a grief reaction – where one’s mood is expected to be low.   You may find comfort in knowing that most people manage to carry on with their lives a few months after a loved one has passed on.   Grief usually passes through three stages, but these stages are not separate, nor do they necessarily follow in sequence.

5 stages of grief

denial.

anger.

bargaining.

depression.

acceptance.

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This project has evolved…..

Now includes a monthly search of our patients who have passed away

Did they have Co-ordinate my Care plan in place?

Did we manage to help them meet their wishes at the end of life?

What went well?

What could have been done better? Improving patient care and reducing distress for families.

Now included in Palliative care meetings and is a useful audit tool to help us improve our Practice with End of Life matters for our patients.

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References

1)

Shear MK. Grief and mourning gone awry: pathway and course of complicated grief. 

Dialogues Clin

Neurosci

 (2012) 14:119–28.

2)

Morbidity following Sudden and Unexpected Bereavement | The British Journal of Psychiatry | Cambridge Core

3

) PubMed

Abstract

 | 

Google Scholar

4)

https://www.mind.org.uk/information-support/guides-to-support-and-services/bereavement/about-bereavement/

5) https://www.mariecurie.org.uk/help/support/bereaved-family-friends/dealing-grief/grieving-your-way

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Frances and Lesley – my inspirations

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Feed back so far from colleagues

End of life/ death audit: Thanks for doing this, it is certainly useful to see the recent deaths as we do sometimes miss these if off on annual leave. Also useful to see how well we are doing with CMCs. Really good to have a proactive approach to Bereavement support.

Hi Karen,

Thanks for your hard work on this. My feedback!:

It has been very helpful to have a list of RIP patients, as sometimes if a doctor is on AL etc, it can be easy to miss who has passed away and it can be embarrassing speaking to the family without knowing! Great to see how many CMCs are done as this percentage should be growing - important for the LCS! It is good preparation for the Palliative care practice meeting to have this information. Good to review the ones with no CMC. It'd be useful to collate the main learning points from this data to present at the practice meeting if

poss

!

Thanks Karen

BW

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Hopefully we can make a little difference to our patients at the saddest time in their lives, maybe help prevent future health problems and feel we have done our job well