bluuebunny/crossref_metadata_2025 huggingface dataset:
THE USE OF QTC PROLONGING MEDICATIONS & DRUG INTERACTIONS IN PALLIATIVE CARE PATIENTS: AUDIT OF PRESCRIBING IN A TERTIARY CANCER CENTRE
Authors: MacKay Helen , Edgecombe Jane
Published: February 2014

Background

Use of medications which prolong the QTc interval in Palliative Care is under scrutiny due to risks of provoking potentially fatal arrhythmias. Risks are increased by drug interactions involving Cytochrome P450 enzymes (CYP450). Prescribing guidance recommends risk assessment when using such medications. Palliative care patients may represent a particularly vulnerable group.

Aims

This audit aims to establish prescribing practice of the Hospital Specialist Palliative Care Team (HSPCT) in Beatson West of Scotland Cancer Centre (BWoSCC) regarding prescription of QTc prolonging medications and/or those with clinically significant CYP450 enzyme interactions.

Methods

Cases were identified through the HSPCT patient database. Snapshot review of case notes and prescription charts was undertaken for patients seen by HSPCT in BWoSCC over a two-week period. First & second consultations by HSPCT members were assessed.

A database was created to collate information including: patient demographics, presence of risk factors for QTc prolongation, QTc prolonging medications prescribed, CYP450 enzyme inducing/inhibiting drugs prescribed, ECG review & documentation of risk assessment.

Results

Twenty-nine case notes & prescription kardexes were reviewed. Majority of patients were female (n=20), with gynaecological malignancies being most common. Twenty seven patients possessed risk factors for QTc prolongation, with 21 having two or more risk factors.

Twelve patients were receiving at least one QTc prolonging medication, with most (9 of 12) established on these prior to HSPCT review. Three patients were co-prescribed QTc prolonging & CYP450 inhibiting drugs, increasing the risk of harm.

Documentation of risk assessment was poor–recorded in one case only.

Conclusions

This audit suggests that many patients reviewed by the HSPCT received QTc prolonging and/or CYP interacting drugs, despite possessing multiple risk factors for QTc prolongation/CYP450 interactions. Patient numbers were small and the majority reflected non-HSPCT prescribing.

Interventions involving HSCPT, other prescribers, & ward pharmacists have taken place to improve awareness, risk assessment & prescribing practice. Second round data collection is in progress.
TEAM-BASED LEARNING: TEACHING THE HEART AND MIND OF PALLIATIVE CARE
Authors: Middleton-Green Laura
Published: February 2014

As a domain of knowledge for healthcare professionals, palliative care is complex and demanding; not least for educators. Effective teaching in palliative care relies on educators both being able to develop and encourage interpersonal skills, and also to capture an authentic sense of the real world in teaching clinical aspects of care. The recommendations of the Francis Report present a challenge to educators: how do we "educate" (literally, "to develop the faculties and powers of") the palliative care providers of the future? How do we ensure they are competent, compassionate communicators?

Team-based learning is currently being piloted in at the University of Bradford as a means of achieving these goals. This technique, developed by Larry Michaelson and colleagues in the United States, uses sound pedagogical principles to encourage debate and dissent between small teams related to complex and ambiguous areas of knowledge. The role of the educator is to guide and facilitate discussion, and challenge preconceptions and assumptions. There is minimal use of lectures other than to consolidate conclusions. It was decided to pilot the technique within the palliative care content of the curriculum, because of the opportunities to develop students skills of critical thinking, awareness and compassion.

Initial analysis of questionnaire and focus group data within Bradford is overwhelmingly in support; students are demonstrating evidence of increased critical thinking, more effective teamwork, evolving listening skills, and satisfaction at learning in a way which they perceive to be much more akin to clinical practice than didactic lectures and seminars. This presentation will look at the structure of team-based learning, review the evidence, and examine how it was applied specifically to palliative care using scenarios based on Patient Journeys in the last year of life. The opportunities for its use in clinical, interprofessional and post-registration palliative care education will be explored.
EDUCATING PROFESSIONALS FROM ACROSS THE GLOBE TO IMPROVE THE QUALITY OF PALLIATIVE CARE PROVISION; A FULLY ONLINE ACADEMIC PALLIATIVE CARE PROGRAMME
Authors: Stevens Elaine , Milligan Stuart
Published: February 2014

The receipt of palliative care at the end of life is an international human right (Brennan 2007). However 32% of countries continue to have no palliative care services (World Palliative Care Alliance 2011) while in countries that have well-developed services these are not equitable (Scottish Government 2008). One key to improving palliative care provision globally is to offer accessible, evidence based palliative care education that meets the needs of professionals from a variety of clinical and geographical locations (Stevens 2008). This poster will present information on a novel multi-professional palliative care programme which is delivered fully online and leads to a recognised academic qualification in palliative care. The poster will identify the programme learning outcomes and detail its content and delivery methodology. The poster will also detail who the programme is aimed at and where, geographically and clinically, past students have come from. The teaching and learning strategies employed that allow students to meet the learning outcomes will be outlined. The main benefits of the programme on individual clinical practice, taken from student evaluations, will also be presented.
LET US SHOW THEM THAT THEY CAN! — INVOLVE THE YOUTH IN PALLIATIVE CARE PROVISION IN THE RURAL COMMUNITIES
Authors: Njama Martha
Published: February 2014

Background

The emerging cases for people who need palliative care is so overwhelming and it would not be right to leave the whole burden to the nurses only. It is important to involve other players; family members, community members, local leaders, church leaders and more importantly, the youth. Equipping the players with palliative care skills would drastically reduce the burden that is currently on the shoulders of the nurses.

Aims

To educate and train the youth in the rural areas. To equip the youth with basic skills of palliative care provision aimed at enhancing palliative care provision within the communities and to show the youth that they have a big role to play in the community. To make the communities be less dependent on the nurses except for emergencies. Download some of the burden from the nurses. Increase community knowledge and understanding on how to handle patients with different terminal illnesses.

Results

In Prometra Kenya youth program, 378 have been trained on various aspects of palliative care including communication skills. The youth have proved to be good learners and that they can effectively disseminate the information and pass the skills to their peers. They are being used by the communities as care providers.

Conclusions

The youth are very energetic and they can be an important asset to the community if given the tools. They can be used to take care of the patients at home while the adults do other family activities. They appreciate the recognition by the communities. The adults are more productive as they use the time they would have used with the patients for other economic activities. The youth have a lot of untapped energy that can be helpful to the communities. The youth are cooperative, reliable and able to work closely with the adults and nurses.
IMPROVING PATIENT CARE - THE LEEDS DEDICATED PALLIATIVE CARE AMBULANCE SERVICE
Authors: Borrill Deborah , Colam-Ainsworth Will
Published: February 2014

Background

Leeds have benefited from a bespoke palliative care ambulance service since 2007 when work done with Marie Curie and the “Delivering Choice” programme highlighted the need for the service.

Early consultation with stakeholders identified that a lack of appropriate ambulance transport can be one of the factors that restricts or prevents the fulfilment of a patient's previously expressed wish to die in the place of their choice.

Aim

The aim of the dedicated palliative care ambulance service is to provide flexible, prompt, safe and comfortable transport to patients moving to a place of their choice towards the end of life and to those needing palliative treatments and investigations.

Method

The Hospital Specialist Palliative Care Team, Leeds Commissioners, Yorkshire Ambulance Service (YAS) Leeds Hospices and Leeds Community Health worked closely together at a local level to improve the present palliative care ambulance service.

Leeds commissioners have now funded a second ambulance to run on weekdays, covering the busiest times and new dedicated crews have been recruited and trained by the local hospice.

Results

This service will benefit patients, carers, healthcare professionals and healthcare providers by:

Helping patients achieve their choice for place of care by reducing delays in discharge caused by restrictions to transport

Ensuring appropriately trained ambulance personnel will provide quality care services to patients at the end of life during transportation

Providing effective ways of working with professionals

Providing better coordination and connectivity between hospital, hospice, community and ambulance services

Conclusion

In providing patients with choice in place of care at the end of life, whilst improving service provision, it is expected that the number of patients dying at home will increase. Future plans are to monitor present demand with a view to expanding the service further to support the transfer of palliative patients in Leeds.
CAN ELECTRONIC EVALUATION OF EDUCATION DEMONSTRATE BENEFIT TO PRACTICE?
Authors: Myers Laura , Mahoney Mary
Published: February 2014

Background

St Catherine's hospice has designed a new organisational strategy, which includes reaching more people who are dying and their families, regardless of their illness. The success of such an endeavour is dependent on knowledgeable and confident clinical staff. A pilot electronic evaluation project has been established and is beginning to produce data showing the effect of education on practice.

Method

Electronic links to questionnaires were sent to course participants immediately before and after attending study days and three months later. Core data comprised self-reported ratings of understanding and confidence based on learning outcomes. Additional pre-course data established the rationale for attendance and expected learning. Post-course data identified learning and how it would be used in practice, as well as feedback on the content, delivery, and pitch of individual sessions. The three month follow up questionnaire provided participants with the opportunity for reflection on their learning and asked for examples of its use in practice.

Results

Completion of the forms was inconsistent; some participants finding the process easy, while others were hampered by their inability to use or access computers. A great deal of data was generated, including graphs showing enhanced self-reported post-course levels of confidence and understanding, qualitative comments, and use of learning in practice. Three types of reports were created: one for educators, containing all data and used for course review; the second for individual speakers, providing feedback on their sessions; and a third for commissioners to demonstrate perceived learning and application to clinical work. The project brought about a structure for gathering evaluation data and producing reports that are clear, concise and illustrate the difference education makes to practice. The design and implementation of this electronic process was initially resource intensive and now provides a structured method for data collection and analysis.

Conclusion

Electronic evaluation of hospice education provides clearer data that learning benefits practice.
DEVELOPING AN EDUCATIONAL INTERVENTION TO HELP STUDENTS PROCESS THEIR EXPERIENCES IN END OF LIFE CARE
Authors: Brock Martin , Brown Michelle
Published: February 2014

Background

Barriers exist which often compromise the care a patient and their relative/carer receive at the end of life.1One barrier that has been identified is the preparation student nurses receive in order to adequately care for this group of patients.2Subsequently the DH suggested that “end of life care needs embedding in training curriculums at all levels and for all staff groups”.1(pg 14)

The general population may not experience or deal with death until they reach middle age.3A number of student nurses therefore may have limited experience in dealing with the emotional death and grief.

The nursing programme is competence based therefore student nurses may view their own distress negatively. The impact may be inhibit sharing and seeking support.

EOL education may be challenging as it can provoke anxiety. Providing an environment that reassures and feels safe with a philosophy of shared compassion for all involved is an essential element within end of life educational interventions.

Aims

Introduce an educational initiative that provides a culture for change

Improve end of life care experiences for all involved

Develop a pathway of support which will allow students to process their experiences and achieve the necessary skills.

Framework

Embed initiative within each stage of the BSc (Hons) nursing award.

▸ Cooperative learning

▸ Safe environment

▸ Peer support promoting a sense of family4

The effectiveness will be measured using an adapted version of the Evaluation Toolkit

Conclusions

High quality end of life care is essential and pre-registration training has been acknowledged as an area where shortcomings may be addressed.

Student nurses require supportive educational interventions surrounding end of life care that facilitate changes in knowledge, behaviour and attitudes in preparation for their transition into the nursing profession.
AN EDUCATIONAL TOOLKIT: SPECIALIST PALLIATIVE CARE TELEPHONE ADVICE LINE
Authors: Haywood Chris , McConaghy Margaret , Thompson Anthony , Molyneux Clare
Published: February 2014

Background

Audit has shown that Integrated Specialist Palliative Care Telephone Advice Lines provide expert support to healthcare professionals caring for patients with palliative and end of life care needs. Governance arrangements including education and support for staff in answering the telephone is variable. A toolkit was devised to support both nursing and medical staff who respond to calls within a Hospice Inpatient Unit.

Aims

Produce a toolkit with a clear framework to facilitate, enhance and improve knowledge, skills and confidence of staff in responding to calls made to a Specialist Palliative Care Telephone Advice Line

Aid individual clinical decision making recognising individual limitations; providing guidance on when to escalate to Senior Colleagues

Address individual training needs of staff in a cost effective way

Methods

PowerPoint slides for awareness sessions and training

Pre and post evaluation documentation

Combination individual and group training using actual calls

Written reflection with supervisory follow up

Focus on timely, constructive, positive feedback and sharing good practice

Repeated at 6 months

Results

Improvements of quality aspect of calls by use of the toolkit

Notable improvements of staff knowledge, skills and confidence

Positive impact on Governance

Clearer identification of education and training issues that arise when providing this type of service

The Toolkit

Guidance documents

DVD with actual calls

Proforma: reflective practice

Pre & Post evaluation

Powerpoint presentation

Useful tips

Conclusion

Toolkit is clearly effective as a quality improvement initiative.

Awareness heightened; quality of calls matter for patient safety and professionalism

Strengthened confidence and communication across services

Easily able to be replicated

Easily repeated to ensure improvements are maintained

Could be used as a method of ensuring staff competence as part of Personal Development Plans

Could be used to support mandatory education and training for those services providing 24/7 Telephone Advice
DEVELOPING A MOUSEMAT AS AN EDUCATIONAL TOOL IN PALLIATIVE CARE
Authors: Powell Paula
Published: February 2014

This poster describes the development of a mousemat to aid GPs in safe and effective prescribing at end of life. The mousemat has advice on prescribing anticipatory medication and using syringe drivers. This innovative approach has been hugely welcomed by GPs who find it practical and accessible.

300 have been given to GPs, OOH services and District Nurses in St Helens and Knowsley and other areas across Merseyside and Cheshire plan to adapt the format for local use.
EVALUATING A PROFESSIONAL DEVELOPMENT PROGRAMME
Authors: Hedges Christine , Wee Bee
Published: February 2014

Background & Aims

This project used the Kirkpatrick™ model of learning to help evaluate a Senior Nurses' Professional Development Programme (PDP). It acknowledges that the educational impact on practice, both directly and indirectly, is difficult to measure and is in need of development. In light of this, we aimed to use the Kirkpatrick learning framework to consider a more comprehensive evaluation.

Evaluation tools

Kirkpatrick's model identifies 4 levels/stages of learning which assist an evaluation. We concentrated on levels 2 and 3.

Level 2

– Evaluation of traineelearning: Likert scales quantified increases in topic understanding and confidence levels.

Level 3

– Evaluation of traineeBehaviour: A focus group gained feedback on changes in practice.

Results

Level 2 — Evaluating evidence of learning —

We were able to present increases in topic related learning and confidence, identifying differences.

Level 3 — Evaluating changes in practice —

Changes in practice emerged in two separate ways. Firstly, changes resulted from the programme's topics of education, critical appraisal and research design, pain management and leadership/time management. Secondly, benefits emerged from having attended the programme itself. There were increases in; commitment to practice development, group cohesion, positive working practices between teams, a valuing of and commitment to the ethos and style of the PDP itself as a model for education and training.

Conclusions

The Kirkpatrick model provides a sound structure for training evaluation. Using quantitative and qualitative methods, were able to: quantify positive increases in understanding and confidence in the session topics, undertake a focus group which identified positive changes in practice and commitment to professional development recognise the need to extend the programme's evaluation to stakeholders (Kirkpatrick's level 4)
TO INTEGRATE OR NOT TO INTEGRATE
Authors: Cummins Janet , Joyce Annemarie , Gallagher Lisa
Published: February 2014

The Development of an Integrated Community Advance Care Planning Service across neighbouring Boroughs and its impact on the uptake of End of Life Care Tools.

Background

The first Advance Care Facilitator was introduced in Knowsley in December 2008; the overall purpose of the post was to make quality improvements in the provision of End of Life Care by supporting the development end of life care tools;-The Gold Standards Framework (GSF), Preferred Priorities for Care (PPC) and the Liverpool Care Pathway (LCP). A second facilitator was taken on in February 2010; both facilitators were employed by 5 Boroughs Partnership. In August 2011 Willowbrook Hospice won a contract to host a Facilitator and Admin Co-ordinator to cover neighbouring St Helens. A proposal was put forward to join forces with Knowsley and Halton to develop an Integrated Community Advance Care Planning Service and in April 2011 agreement was reached for the three areas to work together. Unfortunately Halton pulled out of the agreement but the Partnership between Knowsley and St Helens went ahead.

Aim

The aim was that facilitators would work together – maximising opportunities in an efficient cost effective manner.

Results

In the first 12 months of integration the team delivered education to a total of 1080 people;-

EOLC tools

6 steps Care Home Programme

GSF Care Home Programme

Opening the Spiritual Gate

Verification of death

Syringe Driver training

Dying Matters – Public Engagement.

The team conducted the following audits

GSF

PPC

LCP

EOLC Tools

Conclusion

Integrating services enabled the team to deliver education to a wider group of people in a cost effective manner and audit outcomes in a shorter time than if they had worked separately by sharing and pooling knowledge, skills and resources.
USE OF KETAMINE FOR INTRACTABLE PAIN IN TERMINALLY ILL PATIENTS
Authors: Shah Tejal , Holtom Nicola
Published: February 2014

Background

There is insufficient evidence from controlled clinical studies to support the use of Ketamine in refractory cancer pain. This has lead to lack of confidence and inconsistent clinical use of the drug among many specialist palliative centres in the United Kingdom.

Aims

▸

To analyse the current practice and barriers in prescribing Ketamine.

▸

To capture the confidence of specialist palliative care physicians in prescribing Ketamine.

Methods

Specialist palliative care doctors across the region were invited to reply to a questionnaire based survey via email.

Results

43 doctors participated in the study. 81.4% have used Ketamine for controlling intractable pain during ‘end of life’ situations in addition to strong opioids, 60.5% used it as an adjuvant with opioids in the early stages of pain relief and 51.2% used it to enable the reduction of opioid dose due to its side effects.

Confidence amongst the specialist palliative care physicians ranged from 3 to 10 on a visual analogue scale (10 representing the most confidence), with an average rating of 6.8. Lack of expertise and familiarity (55.9%), lack of evidence (44.2%), and side effects (25.5%) were the barriers observed in the use of Ketamine.

Only 32.6% (4) centres had a written protocol for use within the service and have developed shared guidance for the community services. 79.1% of the respondents felt they would benefit from further training and education.

Conclusion

Randomised controlled trials are difficult within the palliative care patient population. This has resulted in a lack of uniformity in practice of the use of Ketamine. Almost 80% of the survey participants felt there was a need for further research and education in the use of Ketamine.

Recommendations

Developing written departmental policies with shared guidance to generalists would help in a more consistent and effective use of the drug amongst specialist palliative doctors. Education and training are required to improve confidence with its use.
AN INNOVATIVE DEVELOPMENT APPROACH FOR ACUTE HOSPITAL SENIOR CLINICIANS TO IMPLEMENT THE NATIONAL EOLC STRATEGY 2008
Authors: Edwards Annette , Hicks Fiona , Winterburn Kathryn , McTague Laura , Carey Anne-Marie
Published: February 2014

Background

Approximately half the annual 600,000 deaths in England occur in acute hospitals although research indicates that most would choose to die elsewhere. The National End of Life Care Strategy encourages senior clinicians outside the speciality of palliative medicine to engage with end-of-life care and make it a routine part of their practice.

Aim

To pilot a programme enabling consultant colleagues from other specialties to identify their own learning needs, engage with the issues, undertake specific technical/clinical learning about palliative and end-of-life care, and identify improvements in their own practice. Having increased their own expertise, they would share and spread learning to clinical colleagues within their departments.

Method

Funding for the pilot was obtained from Yorkshire and Humber Strategic Health Authority (SHA) for a group (approximately 6) of motivated hospital consultants, and a GP to provide a community perspective, in two trusts – one large Teaching Hospital and one small District General. The programme was led by consultants in palliative medicine who had been trained in facilitating action learning, supported by a small steering group. It included joint clinics and ward rounds, one-to-one meetings and bespoke training as identified by participants. Work was progressed through Action Learning Sets. Evaluation included Training Needs Analyses, questionnaires and audit of practice.

Results

In addition to improved knowledge about palliative care in general, participants identified increased openness in discussing end-of-life issues and confidence in provision of community services. Service improvements include changes in content of outpatient and discharge letters, development of guidelines, implementation of the AMBER care bundle and Rapid Discharge, and addressing DNACPR practices in their departments. Participants have opted to continue meeting quarterly and act as champions for end-of-life care.

Discussion

Trust “buy-in” to the programme is essential to its success. Innovations have been different in each Trust. A proposal has been submitted to extend the programme to two other trusts before national roll out.
ACTION LEARNING AS A NOVEL APPROACH TO CHANGE CLINICAL PRACTICE
Authors: Hicks Fiona , Winterburn Kathryn , Edwards Annette
Published: February 2014

Background

End-of-life care is essential to medical practice. Encouraging behavioural change in senior doctors who are trained to cure, and may see death as failure, is crucial to improving care and may benefit from novel approaches. Action Learning is a recognised tenet of management development but is rarely used within the education and development of doctors.

Aim

To evaluate the role of Action Learning as part of an end-of-life care development programme, bringing consultant colleagues together to encourage reflective practice, surface and resolve problems, share and consolidate learning.

Method

This SHA funded pilot involved 2 trusts, each including 6 or 7 consultants and a GP. Both groups were facilitated by 2 consultants in palliative medicine, meeting monthly for 18 months. The programme was evaluated using training needs analyses at the beginning, middle and end, participant questionnaires asking for anonymous feedback and audits of practice and service developments. The 4 facilitators met together 6 weekly with a consultant in Organisational Development from the SHA in their own Action Learning Set and completed reflective diaries.

Results

The use of action learning was highly valued by participants, many of whom had never previously met nor encountered this method of learning. The group provided an opportunity to discuss issues and “try out” difficult conversations in a challenging yet safe environment. Sets were very well attended, and regular meetings provided the impetus to complete agreed tasks.

Some facilitators initially struggled with the concept, but confidence grew during the learning process and as genuine peer learning enabled participants to help each other.

Discussion

This pilot supported the idea that action learning can address learning needs and support behavioural change in senior doctors. This approach could be considered to address other areas within health care where organisational change is needed.
EVALUATION OF IMPROVEMENT IN PERCEIVED CONFIDENCE AND COMPETENCE IN KEY PALLIATIVE MEDICINE TOPICS FOLLOWING 1 MONTH ELECTIVES FOR INTERNAL MEDICINE RESIDENTS
Authors: Watkinson Deborah
Published: February 2014

Background

Postgraduate medical training in Singapore is changing from UK-style to a US-based residency hybrid. Previously trainees joined our hospital palliative medicine rotation for 6 months and had a comprehensive series of tutorials and practice-based learning. Now the challenge is to deliver an appropriate programme to residents who choose a 1 month elective option and are at various stages in junior residency.

QuestionPre-posting meanEnd-posting mean% improvement12.453.363722.273.646031.543.271141.935852.273.184062.4532272.813.452381.543.0914991.363.36147101.273.54179112.543.4536122.643.2724132.362.6412142.183.0942152.363271623.3668171.913.1866182350191.543.09100

We wished to determine whether our learning programme (specific weekly case based tutorials in key areas conducted by a small group of tutors for residents only, supplemented by practice-based learning) was effective. A self-evaluation questionnaire of perceived confidence and competence in 19 symptom control and communication domains, appropriate to an internal medicine resident was adapted from previous published surveys and linked to the stated learning outcomes for the elective residents. Students were asked to complete a pre-posting and end-posting survey to determine improvement.

Results

for the first 10 residents evaluated are presented.

Conclusion

This evaluation demonstrated that it is possible to improve resident's perceived confidence in key areas with most improvement in confidence in using parenteral opioids, end of life symptoms and practical procedures.

This exercise helped consultants to know where to focus teaching and practice during the posting and encouraged residents to realise that they had improved.

Further work is planned to link this to their pre- and end-posting MCQ scores to evaluate whether perceived improvement links to improved knowledge scores and the relationship to year of residency.
DECIDING RIGHT: RIGHT CARE, RIGHT PLAN, RIGHT PATIENT; AN INDIVIDUALISED APPROACH TO PALLIATIVE CARE'
Authors: Than Tun , Adam Zahida , Wadhhwa Preeti , Ayubi Mohamed
Published: February 2014

Background

Recognising the scope for improvement in palliative care services across Leicester city, the commissioning group, the local hospice (LOROS) and Macmillan Cancer Support collaborated in launching an innovative “Deciding Right“ project. The project aims to promote identification of patients in their last year of life to provide a timely and robust multidisciplinary care based on the patient's choices.

Description

The project emphasizes on training and education of local health care professionals at various levels. Four locality GP mentors, appointed to facilitate and deliver the objectives of the project, received training at masters level in conjunction with Demon Fort University. The unique collaboration of the commissioning group, local palliative care consultants and Macmillan Cancer Support paved the pathway for the appointed mentors to access training at national level through Macmillan GP support program in addition to locally provided mentoring support from the palliative care consultants. Furthermore, the project also promoted identification of a palliative care lead GP for each participating practice. All lead GPs are given training in identification of patients in their last year of life along with communication skills to conduct effective and timely discussion with the patients and families to develop and implement the mutually agreed palliative care plans in collaboration. The target group for training extended to include sessional GPs and carers from local residential homes to enable them to understand and apply core concepts of palliative care.

Results and reflections

The project achieved improvements in the palliative care register across the city and paved the path to develop further through implementation of after death audits (ADA). It also highlighted the need for more comprehensive guidelines for anticipatory prescribing. Initial survey of ADA data has shown that most (>90%) of the patients who have care plans achieved their choices including their preferred place of death.
HELPING PEOPLE WITH VERY SEVERE COPD: FEASIBILITY STUDY OF A NOVEL HOLISTIC INTERVENTION
Authors: Kendall Marilyn , Buckingham Susan , Ferguson Susie , Sheikh Aziz , Murray Scott , MacNee William , White Patrick , Worth Allison , Boyd Kirsty , Pinnock Hilary
Published: February 2014

Background

Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death worldwide. Research shows that people with severe COPD have unmet needs and that the traditional palliative care model is not appropriate.

Aim

To pilot and evaluate the HELP-COPD intervention–a proactive holistic assessment of supportive and palliative care needs.

Method

The intervention comprised a home visit by a respiratory nurse, following discharge from hospital after an exacerbation, to discuss social/psychological/spiritual/physical needs, provide advice/information and make further clinical/social care referrals as appropriate. A HELP-COPD Action Plan was completed and a summary given to the patient and their general practitioner. Follow-up included three phone calls over six months.

Qualitative evaluation comprised interviews with participating patients, lay-carers and health professionals, alongside documentary analysis of the completed action plans. Interviews were recorded, transcribed and entered into NVivo for thematic analysis.

Results

23 patients, from two hospitals, received the pilot intervention. 31 interviews were completed. Patients were generally positive about the assessment, openly discussing concerns and coping strategies in all domains. Professionals considered that the intervention was feasible and potentially valuable. Positive actions included facilitating discussion with their GP on palliative use of opiates, reinforcing referral to pulmonary rehabilitation and providing contact details of local voluntary services. However, fewer unmet needs were identified than expected, and some patients were reluctant to access proffered services/information. Participants highlighted overlap with discharge planning and case management provided by community teams.

Conclusion

The HELP COPD holistic assessment was feasible and generally welcomed by patients. Fewer actions were identified than anticipated; perhaps due to a combination of inappropriate timing, reluctance to accept social services, duplication by existing services and long-term adaptation reducing recognition of need and of the seriousness of the condition.

Conflict of Interest and Funding

This work was supported by The Dunhill Medical Trust [grant number: R210/0711]. No conflicts of interest to declare.
RENAL FUNCTION AT THE END OF LIFE, A SNAPSHOT OF RENAL FUNCTION
Authors: Salt Susan , Heaton Sophie
Published: February 2014

As a result of the concerns raised about the use of artificial hydration at the end of life which has led to the phasing out of Liverpool Care Pathway, a review of 50 consecutive patient's blood results, who had died since January 2013 on an adult hospice in-patient unit was conducted looking for trends that could be explored further.

Results

2 patients did not have any recorded blood tests within 4 months of their death so were excluded

Interval before deathNumber of patientsUrea above normal rangeCreatinine above normal rangeBoth abnormal3 days or less87 (88%)
( max 36.6)8 (100%)
(max 285)74–7 days before death93 (33%)
(max 9.2)2 (22%)
(max 150)18–14 days before death137 (54%)
(max 21.5)4 (31%)
(max 172)2More than 14 days before death187 (39%)
(max 15)3 (17%)
(max 179)2

The remaining patient results were as follows

This initial survey suggests some interesting trends.

The next 50 consecutive deaths in the hospice are being analysed and more in depth analysis in terms of diagnosis and renal function six months prior to death is currently being carried out.

These results will be part of the final presentation.

Conclusion

This is a snapshot of one hospice clinical review of patients blood test, rather than part of a structured clinical study. It is therefore uncontrolled and will have inherent bias. For example it is more likely that blood tests will be carried out if there is concern about impaired renal function, and this is more likely to happen closer to death. However the initial results suggests that both creatinine and urea levels do increase the closer death is, but not to catastrophic levels.
EXPERIENCE OF LIVING WITH ADVANCED HEART FAILURE IN UGANDA
Authors: Namukwaya Elizabeth , Murray Scott , Leng Mhoira , Downing Julia , Grant Liz
Published: February 2014

Background

Health systems in Africa which were mainly designed to manage acute communicable diseases based on a biomedical model now need to be able to handle the emerging non-communicable disease epidemic. Cardiovascular diseases such as heart failure are increasingly prevalent. Research from high income countries reveals that patients with heart failure have multidimensional needs especially a high symptom burden even when on drugs with a mortality benefit. We predict outcomes are likely to be even worse in African settings where access to these drugs is limited and poverty is rampant. Currently palliative care is mainly for HIV and cancer patients and has little impact on heart failure patients. In order to plan care based on needs it is necessary to elicit patients' perspectives of their needs and experiences of living with incurable illness.

Aim

To understand the multidimensional experiences, needs, and use of services of patients living and dying of heart failure.

Methods

In depth qualitative interviews are being conducted using the grounded theory approach with patients with heart failure recruited in Mulago hospital in Uganda. The interviews are supplemented by administering the African APCA POS questionnaire. Purposive sampling is being used for recruitment. Thematic saturation is expected to be achieved at a total of about 16 patients.

Results

Preliminary analysis has identified the following themes: Lack of awareness of symptoms of heart failure which lead to late presentation, association of symptoms to witchcraft, significant distress from physical symptoms, recurrent admissions, increasing dependency associated with loss of dignity, loss of valued self, psychological distress, different theological ideas relating illness and the Divine and financial problems.

Conclusion

Heart failure patients in Uganda have multidimensional needs some of which are similar to high income countries but others are unique to the African setting. Such patients could greatly benefit from a palliative approach.
INTEGRATING PALLIATIVE CARE SERVICES IN LOW SOCIAL ECONOMIC STATUS
Authors: Kinyanjui Asaph
Published: February 2014

To offer quality and sustainable palliative care services there is need to equip health care workers with appropriate knowledge, attitude and skills.

Waterloo Project

The project was based on WHO Public Health Model.

The project was funded by The Diana Princess of Wales Memorial Fund and The True Colours Trust Fund. Other key stakeholders: Kenya Ministry of Health, Kenya Hospices and Palliative Care Associations, and African Palliative Care Association.

Back ground

The overall purpose of the Waterloo project is to improve the quality of the lives of those affected by life threatening illnesses by ensuring freedom from pain and other distressing symptoms, providing psychosocial, spiritual and bereavement support through integration of palliative care in to the public health systems.

Method

At the start of the project, a comprehensive data collection questionnaire was designed to collect baseline information on; hospitals with established palliative care services, type of services offered, staff trained in palliative care, availability of morphine and existence of a stand alone palliative care team. 11 level 5 hospitals were the focus of this project.

Successes

Through KEHPCA and Ministry of Health the following have been achieved;

A) 9 hospitals in have fully integrated palliative services.

B) 220 healthcare workers have received 5 days training course.

C) More than 4oo doctors sensitized on palliative care especially pain management.

D) Inclusion of palliative care needs in some hospital budgets.

Challenges

High turnover of hospital administrators in some hospitals affecting the integration of services.

Some staff trained in palliative care services deployed in non clinical areas.

Lack of essential palliative care medicines in the hospitals.
A REALIST LITERATURE REVIEW OF TRANSITION TO ADULT SERVICES BY YOUNG PEOPLE WITH LIFE-LIMITING CONDITIONS IN IRELAND
Authors: Kerr Helen , O'Halloran Peter , Nicholl Honor , Price Jayne
Published: February 2014

Background

As a result of improvements in care and treatment more young people with life-limiting conditions are now living beyond childhood, meaning they must make the transition from children's to adult services. The loss of long-standing relationships with providers of children's services combines with poor co-ordination of services to make this a daunting prospect for young people and their families. However, there is little evidence on transition services for young people with life limiting conditions, with few models of good practice in the literature.

Aims

The purpose of this review was to determine the factors that promote or hinder the transition to adult services for young adults with life limiting conditions, and identify gaps to be addressed.

Methods

A comprehensive search of the literature was undertaken using key terms, of the following databases; MEDLINE and the Cochrane Database of Systematic Reviews. 314 articles were sourced and inclusion and exclusion criteria were applied to highlight the most relevant literature.

Results

Studies were reviewed using a realist review approach and three themes emerged from the literature. Barriers and facilitators to the transition process were identified associated with: 1. The patient 2. Parents/carers 3. The organisation.

Conclusion

It is unclear from the literature what the specific factors are that promote or hinder the transition process for young adults with life limiting conditions who go through the transition from children's to adult services, therefore, research is required to identify the factors that promote and hinder the transition process in Ireland. This research is currently being carried out by the author as part of Doctoral studies. The three year full time Doctoral study commenced in January 2013 and is funded by the All Ireland Institute of Hospice and Palliative Care.
INVOLVEMENT OF THE TRADITIONAL MEDICINE PRACTITIONERS AND THE RURAL COMMUNITIES IN PALLIATIVE CARE PROVISION TO THE TERMINALLY ILL PEOPLE
Authors: Njama Martha
Published: February 2014

Issues

Gone are the days when palliative care was known for cancer patients only. Today, the need for palliative care is on the rise due to the increasing number of terminally ill cases from other diseases; communicable and non communicable. The challenges of brain drain and work overload for nurses. With this kind of scenario, we must not ignore or underestimate the role of the Traditional Medicine Practitioners as they are known to be the community primary health care providers, community members and the spiritual care providers. Distance to the palliative care centres and hospices in the rural areas is a barrier.

Description

Prometra Kenya has supported Traditional Medicine Practitioners and the community members with trainings aimed at building skills to improve care planning, counselling, communication, delivery of care to improve the quality of life for those with chronic diseases or life-limiting illness and protection from being infected. After the first group was trained, they are now trainers of other community members.

Lessons Learned

Traditional Medicine Practitioners are respected by their communities and even the terminally ill patients feel free to discuss secret issues with them. The family members are more productive because they utilize the time that would have been used for hospice or center visits to do their work. TMPs and community members can handle patients with little supervision. The model is cost effective.

Conclusions

Use of community model has proved to be a success in the rural areas. It has also brought knowledge to the TMPs and the communities. Rural communities are uniquely positioned to meet the challenges of providing palliative care through collaborative efforts. The communities need to be encouraged on the skills building trainings.

Recommendations

More support is needed to facilitate more training to the Traditional Medicine Practitioners and the communities. Incentives to encourage community trainings.
SURVEY OF PATIENT SATISFACTION WITH MEDICAL CARE ON A HOSPICE INPATIENT UNIT
Authors: Lucraft Helen , McNamara Paul
Published: February 2014

Background

Unlike our previous inpatient surveys, we focussed solely on the medical input. Our medical Clinical improvement volunteer, an experienced clinician, carried out this project.

Aims

To survey 40 inpatients on their experience of our medical input.

From Aug '12-Feb'13, forty inpatients completed the questionnaire. 5 of the 10 questions (asterisked*) were benchmarked against national comparators. This benchmarking was undertaken by the Centre for Health Service Research, University of Kent, in 2004/5 and 2008/9.

Q1. How soon after arrival did the doctor see you? Q2. Was the doctor polite and courteous?* Q3. Did the doctor understand your priorities and concerns?* Q4. Were you able to ask the doctors questions when you wanted?* Q5. Did the doctors explain what they thought was happening?* Q6. Are the doctors available to see your family? Q7. How would you rate your medical care?* Q8. Any aspect of your medical care you are unhappy with? Q9. If you could change one thing in your medical care? Q10. Any comments or suggestions for the doctors?

Results

In the five questions which were nationally benchmarked, (asterisked*), our results compared favourably, exceeding them in each case. Qs 1&6 also scored highly.

The final three questions, asking patients to critique their medical input, only provided limited suggestions. This made us wonder if it is difficult to make critical comments; however this was done with a volunteer, not a staff member.

Patient concerns expressed were calls for consistent daily medical review and patient anxieties around discharge home.

Conclusions

We were heartened that inpatients felt overwhelmingly positive with their medical care. We have responded to the comment about consistent review and we aim to repeat the survey in eighteen months.