bluuebunny/crossref_metadata_2025 huggingface dataset:
P115 Clinical Pharmacists - Hands on in the patients home at end of life
Authors: Bartlett Joanne , Seager Louise
Published: October 2013

The introduction of frontline clinical pharmacy services for patients in their preferred place of care is redefining the traditional role of the specialist clinical pharmacist in palliative care.

This innovative role allows patients, carers and other healthcare professions to access the expertise of the clinical pharmacist in the patients home and is aimed specifically at complex patient groups moving towards end of life.

The aim of the role is to enable patients with more complex drug needs to remain in their preferred place of care, the role sits in a wider specialist community team comprising of physiotherapists, occupational therapists, dieticians, social worker and nurses.

Referrals include

Complex symptom control i.e. unresponsive to or having experienced side effects and adverse drug reactions with conventional first and second line therapies

Patients with multiple co-morbidities on complex regimes who require rationalisation of their medicines

Patients requiring medication review/rationalisation including following discharge from secondary care

Drug/dose choice for patients with impaired drug metabolism or clearance i.e. renal/liver impairment

Advice on drug choice, route and formulation for patients with drug administration difficulties

Issues around access to specialist palliative care medicines in the community setting

Patients with a non-cancer diagnosis including those with end stage heart failure, renal failure, COPD, liver failure, motor neurone disease etc.

Patients on palliative chemotherapy

In addition to working with the specialist palliative care team there are many external links these include GPs, district nurses, specialist clinical nurses (community and hospital), consultants, community pharmacists and hospice at home to provide seamless care for palliative patients across the interface. This involves joint professional visits, attendance of GSF meetings or hospital MDT meetings etc.

The Clinical Pharmacy team prescribe for their patients ensuring timely access to specialist medicines and prompt symptom control
P116 Anticipatory medication ‘as stock’ for residents who are in the dying phase: a project in 3 nursing care homes
Authors: Morris Kathy , Hockley Jo , Gibbs Margaret
Published: October 2013

The Gold Standards Framework for Care Homes [GSFCH] and the Liverpool Care Pathway [LCP] guidance suggests the importance of obtaining anticipatory medication for the control of symptoms in the last days of life for nursing home (NH) residents. There is considerable wastage however as NH residents are dispensed anticipatory drugs on a named-patient basis. There is also evidence that when these drugs are not available residents are hospitalised inappropriately.

Aim

The aims of the project were to explore the frequency of symptoms experienced in the dying phase and to explore whether there was a need for residents to have their own supply of drugs by examining wastage. The idea was to establish a process in order for homes to obtain anticipatory medication as ‘stock’ and to capture the benefits of doing this.

Process

The managers of three NHs, who had shown interest in obtaining medication for the last days of life, met with a local GSFCH facilitator, specialist palliative care pharmacist and a pharmacist from the regulatory body. A proposal that included a list of necessary medication and how to acquire them was written. The NH staff developed the required Standard Operating Procedures. A prospective audit on medication used was commenced.

Results

Significant improvements in the availability of anticipatory medication were found. 53% of residents were symptomatic highlighting the need to have anticipatory medication available. No medication other than “stock” was required by NHs. If all residents had their own supply of medication £4,506 worth of drugs would have been wasted. All staff involved perceived that this work had been beneficial.

Conclusion

Anticipatory medication ‘as stock’ for people dying in NHs is an important step forward. There is less wastage of medication, less delay in controlling symptoms, reduced call out of GPs and less anxiety.
P117 The implementation of a locally developed advance care planning document across four diverse health and social care settings
Authors: Dempsey Debbie , Owens Sarah
Published: October 2013

Advance care planning (ACP) has seen its profile raised in recent years, with various UK government publications serving to drive forward the importance of identifying people’s preferences, wishes and expectations for their future care.

Clear documentation is essential for effective sharing of information amongst the multi-disciplinary team, in a bid to ensure an individuals plan is communicated, respected and goals of care are achieved.

In the author’s geographical area, it has been identified that there is no robust ACP document currently in use, particularly within the care home setting, therefore the author facilitated the production of a locally produced ACP document via the local palliative and end of life care strategy group.

This qualitative study used mixed methods including semi-structured interviews, questionnaires and a focus group to explore the introduction of this ACP document, highlighting both staff and patient’s/residents perceptions of the process and the identified challenges and benefits. Four sites were chosen to pilot the document, (local nursing home, day hospice unit, memory service, supported living complex) representing a diverse range of health and social care services.

Key themes emerged from the analysis of the interviews and questionnaires: Staff confidence, timing of discussions, patient empowerment, patient diagnosis and apprehension regarding legally binding decisions. The perceived importance of having ACP discussions was the underlying similarity between the services; however the challenges varied depending upon the nature of the setting.

The results identified that 23 ACP documents were completed in the pilot phase, with 80% of patients/residents stating that they would recommend this process to others. Reduction of anxiety, peace of mind and control were frequently expressed by participants.

A need for further research in those diagnosed with early dementia is indicated. Collaboration across services may be needed to develop ACP trigger guidelines that fit the complex needs of diverse patient/client groups. Also the challenge of maintaining training within rapidly changing workforces is acknowledged.

Key Words: Preferences, Documentation, Advance Statement, Advance Decision, Timing, Confidence, Communication
014 Challenging the perception of death and dying through documentary film making in a hospice
Authors: Erna Haraldsdottir , Hardie Amy , Kendall Marilyn
Published: October 2013

Background

Health promoting palliative care is a relatively new concept in palliative care that aims to increase public awareness and open discussion in relation to death and dying. A year long collaboration between a documentary film artist and patients and staff in a Scottish hospice addressed these aims. They produced 20 short films and a character led documentary feature film showing different strategies that led to increased vitality at the end of life.

Method

The film-maker worked with over 40 patients, family members and staff in the hospice to identify and expand on participants’ experiences and develop them as narrative for the wider community.

Following the patients’ lead, further research into music and performance arts required collaboration with a music director and choreographer in the day-care ward. An extended period of filming and editing followed, where the material was scrutinised and distilled into portraits and songs.

Results

The resulting documentary film follows patients in the hospice and in their homes, reflecting their strength and individuality, their hopes and dreams as well as their struggle with disease as they use music and creativity to mirror their personal identity and the day- to -day life in the hospice. Responses to the film qualify it as an art based research as watching it enables learning, enhances and challenge audiences’ understanding and perception of death and dying.

Key themes that patients raised were their need to be seen as individuals rather than patients and their desire to challenge preconceptions that dying patients are weak, vulnerable and passive.

Conclusion:

Making a film within a hospice has enabled patients to have a voice as individuals and challenge current perceptions of the dying patient.

Wide distribution of the film through television and cinema will encourage public debate across all medias, challenging assumptions about death, dying and the day-to-day life in a hospice.
P118 Advance care planning in care homes: an exploration with staff, residents and families
Authors: Stone Louisa , Kinley Julie , Hockley Jo
Published: October 2013

Aims

To explore staff, residents and families’ experience of participating in advance care planning discussions.

Background/literature review:

Within the UK, implementation of the Gold Standards Framework in Care Homes (GSFCH) programme is being promoted to develop the quality of end of life care for frail older people living/dying in care homes (DoH 2008). An integral part of this involves advance care planning (ACP) discussions. This study explored the experience of initiating and undertaking these discussions.

Methods

A qualitative descriptive study was undertaken in three nursing homes implementing the GSFCH programme. Following an ACP discussion, semi-structured interviews were undertaken with the resident, their family member/s and the staff member undertaking ACP. Thematic analysis was used to identify the main categories and themes.

Results

Twenty eight interviews were carried out. Five main categories arose: understanding ACP; undertaking ACP discussions; the impact of ACP discussions; use of documentation; and, relationship and rapport.

Staffs understanding of ACP varied and this affected the depth of their discussions with families and residents. The use of documentation either acted as a useful prompt or limited the discussion, blocked opportunistic cues and encouraged a ‘tick-box’ exercise. Staff had to face their fears around discussing death and dying. The assistance of a trained facilitator helped staff to develop knowledge, skills and confidence with end of life conversations. Residents were open to having ACP discussions, though the way it was introduced could impact on the result. Families found comfort that their loved ones future care had been considered.

Conclusions

Care home staff need to develop the knowledge, skills and confidence to engage in discussions around end of life care. The assistance of a trained facilitator who role models this process would enable this.
P119 Improving end of life care in Worcestershire: Advance care planning
Authors: Grint Tracey
Published: October 2013

Advance care planning (ACP) is a process of reflection and communication in which a person with decision making capacity is able to express his/her wishes regarding preferences and wishes for their end of life care. The End of life strategy ( 2008) highlights the need for proactive guidance in exploring a person’s preferences and wishes at an early stage within life limiting illness, resulting in the potential of unnecessary and unwanted crisis interventions being minimised. The newly formed, three clinical commissioning groups (CCG’S) for Worcestershire have acknowledged ACP as a priority and commissioned a countywide project, under the auspices of the End of Life and Palliative Care network for Worcestershire the role out and implementation of the new countywide ACP documents, this is seen as critical components of the quality improvement process in health and social care (Help the Hospices,2012).

A 12 month project overseen by an ACP Project Manager and hosted in collaboration with St Richard’s Hospice will see the Implementation of a training and awareness programme across all health and social care providers being undertaken. This is to enable collaborative countywide working and embed the ACP documents in to practice. Training and awareness will be developed for the workforce to enable underpinning knowledge and skills required in supporting patients through ACP discussions.

Enabling:

Patient choice regarding preference and wishes as end of life approaches

Proactive guidance for preferred place of care

Minimise crisis admission as end of life approaches

A skilled workforce across health and social care will enable a consistent approach to advance care planning countrywide ensuring a patient’s wishes and preferences are elicited, documented and shared.

Integrated care at end of life within the changing health and social care policy landscape will be delivered in line with the recommendations from, Preparing for the future: key operating principles (Help the Hospice,2012).
P120 The impact of advance care planning of place of death, a hospice retrospective cohort study
Authors: Rich Alison , Julian Abel , Bailey John
Published: October 2013

Objectives

There is limited evidence of the impact of advance care planning (ACP) on outcomes. We conducted a retrospective cohort study on deaths of all patients known to a hospice in a 2.5-year period to see if use of ACP affected actual place of death, hospital use and cost of hospital care in the last year.

Results

969 patients were included. 550 (57%) people completed ACP. 414 (75%) achieved their choice of place of death. For those who chose home, 34 (11.3%) died in hospital; a care home 2 (1.7%) died in hospital; a hospice 14 (11.2%) died in hospital and 6 (86%) who chose to die in hospital did so. 112 (26.5%) of people without ACP died in hospital. Mean number of days in hospital in the last year of life was 18.1 in the ACP group and 26.5 in the non-ACP group (p < 0.001). Mean cost of hospital treatment during the last year of life for those who died in hospital was £11,299, those dying outside of hospital £7,730 (p < 0.001). Mean number of emergency admissions for those who died in hospital was 2.2 and who died elsewhere was 1.7 (p < 0.001).

Conclusions

ACP can be used routinely in a hospice setting. Those who used ACP spent less time in hospital in their last year. ACP is associated with a reduction in the number of days in hospital in the last year of life with less hospital costs, supporting the assumptions made in the End of Life Care Strategy 2008.
P121 How implementing deciding right in Cumbria supports good practice in Advanced care planning (ACP): a case study
Authors: Chaddock Becky , Bradley Carol , Laycock Mel
Published: October 2013

Introduction

Deciding Right (DR) is an integrated approach to making decisions about future care. It draws together statute and good practice for ACP with children, young people and adults across all sectors of health and social care, and embeds this through shared documentation. It starts with a conversation between the professional and patient about their right to make care decisions in advance. The project is jointly hosted by three of the independent hospices in Cumbria, and is strategically linked with the 1% GP palliative care registers campaign.

Case Study

We will present a case study of Betty, 76yrs, with end stage COPD and multiple co-morbidities. This is a complex case featuring repeated hospital admissions and fluctuating capacity around end of life care. Through exploring this case history we will show how DR made a real difference to choice, control and sense of self for Betty, and to the health and social care management of her care. We will demonstrate how DR was important in facilitating multi-disciplinary working and critically, cross agency information sharing at end of life.

Discussion

Establishing DR shared documentation across the whole of health and social care has been crucial in rolling out ACP conversations and this approach is effecting change in organisational culture. Training and education for professionals builds capacity within the existing workforce to change current practice, and engagement with students helps to future-proof the principles of DR in Cumbria.

Learning points

Making ACP conversations the responsibility of all professionals is key to ensuring that conversations happen early enough in people’s journey for them to be well thought through and meaningful.

Agreeing and adopting shared documentation for Health, Social Care and 3rd Sector organizations is fundamental to ensuring that ACP conversations held are recorded appropriately and in a meaningful format for all concerned.
P122 Death, dying and dementia: Diminishing dilemmas and distress
Authors: Cowan Margaret Mary , Jenner Jo , Bankole Abdul
Published: October 2013

Background/context

There are currently 750,000 patients living with dementia in United Kingdom ( Alzheimer’s Society, 2011) with evidence of inappropriate hospital admission of patients with advanced dementia (Pace,et al, 2011). NICE, (2013) suggest a palliative care approach from diagnosis till death. Following a critical reflection relating to the end-of-life care of patient with dementia, the local hospice collaborated with local advanced dementia unit to hold bi-monthly meetings to improve planning care.

Aim

As a result of this collaboration patients are supported to receive their end-of-life care in familiar surroundings resulting in equality of care to those who are cognitively intact.

Approach used

Bi-monthly meetings assess newly admitted patients and identify patients approaching end-of-life. Discussions are documented in case notes with particular significance to DNACPR, preferred place of care/death and communication with relatives.

Outcomes

As a result of this collaboration the outcomes are fourfold

Patients can expect an agreed care plan at end of life, with coordination of specialist dementia and palliative care services.

Carers can expect increased support, are involved in advanced care planning, have access to newly formed carers group and access to bereavement care.

Dementia unit staff have increased expertise, improved their uptake of education on end of life issues, have received bespoke communication training and have rapid access to specialist palliative care advice.

Hospice staff have improved recognition of needs of advanced dementia patients and allows them an opportunity to seek advice on control of symptoms of other dementia patients

Application to hospice practice

This collaboration allows both units to transfer their skills to benefit an increasingly ageing population. It allows the hospice to plan ahead for the increase in future referrals of dementia patients in line with predictions.
P123 Improving end of life care on inpatient dementia wards
Authors: Campbell Carolyn , Hope Suzy , Stevens Deborah , Morris Alison
Published: October 2013

Introduction

This audit and service review looks at a collaborative approach to improving the end of life care for people with dementia on inpatient wards in Cornwall. It has prevented many inpatients resident on the inpatient dementia ward being transferred to the acute hospital for symptom control or terminal care.

Background

People with dementia over 65 years of age are using up to one quarter of hospital beds at any one time and it is estimated that that the majority of the 100,000 people who die with dementia are in hospital. Multiple initiatives have set out to improve the end of life care of these patients. Despite this, there is evidence that suggests that end of life care for people with dementia is significantly poorer than for people without dementia.

Methods

An inreach service to the dementia wards was provided by the hospice nursing and medical staff. The three key aspects were:

Guidance - specific end of life care guidelines were written collaboratively, taking into account the complexities of setting, staffing and patient group.

Confidence buliding - Dementia unit staff were educated in palliative care principles & skills, with hospice nursing staff & doctors providing peer education and support.

Support - the dementia units were given 24/7 access to the hospice advice line with availability of consultant review withing 24 hours when needed.

Results

Transfers of patients to the acute trust were reduced and end of life transfers eliminated in patients with contact with the inreach service. Staff confidence and expertise was developed to a high standard. Options for extending the service to nursing home settings are being explored.
P124 Improving End of life care for patients with Dementia
Authors: Parkes Nicola , Cross Gillian , Whitfield Andrea
Published: October 2013

Introduction

Dementia is predominantly a disease of later life but there are at least 15 000 people under 65yrs who have the illness. Symptom relief is often missed as these patients are unable to communicate effectively.

Aims of the Project

Improve the quality of End of life Care for people who are diagnosed with dementia admitted to hospital

Increase the awareness of staff caring for these patients

Promote advance care planning for people with dementia

Support families of people suffering from dementia with decision making

Methods

A flow chart was designed and coloured to reflect the local End of Life Care Model. There was close liaison with trust staff about developments in dementia care within the acute setting and teaching materials were developed to train staff on caring for patients with dementia in their last days of life.

Results

The Trust collated results from the dementia screening tool used to asses every patient over 75yrs; it demonstrated an Increase in knowledge for staff in trust to recognise dementia as a terminal disease.

Discussion

The project aimed to support patients with dementia from diagnosis to bereavement. The work was a collaboration between the Acute Trust and local hospice services. Work streams were formed to develop care pathways, integrated working and shared learning. The trust adopted the butterfly scheme which the CNS team promoted when visiting patients with dementia and raise awareness of importance of advanced care planning for these patients.

Conclusion

Improving the knowledge of staff around caring for patients that are dying who have dementia improves their ability to effectively observe and manage symptoms, improves the quality of care and job satisfaction whilst improving outcomes and relieving distress for patients and families.
P125 Piloting the design and delivery of a five-day course on End of Life Care for people with dementia. A joint venture
Authors: Myers Laura , Mahoney Mary
Published: October 2013

The drivers for this project included National guidance and policy, such as the Prime Minister’s Challenge (Department of Health (DH) 2012) and "Living Well with Dementia (DH, 2009) and the National end of life care strategy (DH, 2008), Regional influences were Dementia Local Implementation Groups (DLIG) and "Dementia-friendly communities". The development of the course was funded through the Regional Innovation Fund (RIF). The hospice is revising the organisational strategy, with a view to reaching more people who are dying and their families, through enhanced joint working.

The aim was to bring professionals together, sharing their specialist expertise to develop and deliver a five-day course to a wide variety of health and social care providers.

Initial work centred on accessing appropriate health and social care providers to help to design and deliver the course.. The group met regularly (over a period of six months), initially to establish the framework of the course and, subsequently, to design and agree the course content, intending to use facilitators from a range of disciplines.

A pilot five-day course was delivered in the Spring of 2013, attended by a diverse group of participants, including staff from mental health, learning disability, hospices, care homes, and community settings as well as a care commissioner. The course was facilitated by specialists from mental health, social care training, Alzheimer’s society, specialist palliative care, care home setting, palliative medicine and hospice education, as well as a person with dementia. An assortment of teaching and learning techniques were used to encourage shared learning. Electronic evaluation has provided evidence of participants’ learning.

This course has the potential to enable care providers to learn more about end of life care for people with dementia, reaching more people in all settings, in line with National, regional and organisational strategy.
P126 Respite Care Reframed - A Palliative Care Service For The Future
Authors: Laverty Diane
Published: October 2013

Respite care is currently disregarded as an essential component of palliative care despite interest on the part of Government and others to support home based end of life care and to increase access for people with chronic degenerative conditions.

During the last 2 years an East London hospice has delivered an updated model of respite care that recognises and responds to new emerging groups of users and seeks to enable more people to remain at home during their illness.

A new, nurse led service, headed by a nurse consultant, has been established which delivers planned respite care. The service proactively seeks to support people with non malignant conditions including young adults undergoing transition from children to adult services.

This shift results in time being given to a multi professional review of the patient and carer’s needs as a basis for establishing an updated care plan, designed to enrich the patient’s life and maintain their function and wellbeing. Access to other hospice services is also made available. It is particularly effective when the patient is admitted in a relatively stable state and can consider / negotiate different approaches to care in a safe environment. Seven beds are now open to provide this care. Development of this new model has required a different culture of care, development of staff skills and new working relationships within and outwith the hospice.

The service has been well used (average occupancy 80%). Review of activity data reveals a higher than average use of these beds by people with non cancer conditions (47%) and increasing utilization of young people undergoing transition (12 episodes). User satisfaction is high and the impact of care, measured through SKIPP is positive. Carer feedback, via focus groups indicates that the service is a vital one & suggestions about improvements will help inform service development plans.
P127 Hospice respite: Moving forwards not backwards
Authors: Day Lindsay , Gregory Amanda , Read Paul
Published: October 2013

Anecdotal evidence suggested that respite provision at an independent hospice was dominated by patients with neurological or non cancer diagnoses and that a small number of patients had a disproportionately large amount of respite admissions compared to those with a cancer diagnosis. A service review was undertaken to investigate whether the provision of respite was equitable across all patient groups. A retrospective review of notes identified patients referred for a respite admission within a 12 month period. The individual patient files were scrutinised to obtain relevant data for analysis, including the level of specialist palliative care received prior to admission. Respite provision appeared to attract a fairly equal number of referrals across cancer and non-cancer groups, although the latter were more likely to access multiple episodes of respite. Of the non-cancer groups, those with a neurological condition represented the highest proportion of patients accessing respite. It is likely that these results are due to the longer term, unpredictable nature of non-cancer conditions resulting in increased carer burden and subsequent need for respite care.The care needs of non-cancer patients suggest that a specialist palliative care centre is not necessarily required for respite. It is recommended that: alternative models of respite care are explored for these patients such as nursing home or an increase in home-care packages; the hospice continues to support local nursing home providers in order to facilitate the provision of high quality respite care within our community; during a patient’s first respite admission, an assessment is undertaken to determine the most suitable place for ongoing respite care; respite guidelines to be adjusted to reflect a specified number of admissions per year.
015 Collaborative leadership - working in partnership to improve the design and delivery of palliative and end of life care across East London
Authors: Bradley Ruth , Farag Dan
Published: October 2013

Background

In 2012, St Joseph’s Hospice and Marie Curie proactively formed a strategic partnership. Unified by the shared goal of enabling more people to achieve choice at the end of life, the partnership provides the required leadership, to facilitate change and develop across EoLC services.

Aim

The partnership aims to:

improve performance across the East London EoLC system;

develop a stronger EoLC voice locally through reforms across health and social care.

Meet the complex and growing demand for services through collaboration, innovation, and community engagement.

Approaches used

The partnership identified a number of themes that collaborative leadership could benefit from: Urgent Care; Care in the last days of life; Support for Families and Carers; Coordination of Care.

The partnership has been driving change and stimulating innovative solutions through:

Bringing together stakeholders from across health and social care, commissioning teams and service users to develop a shared commitment for change.

Designing new services to better meet local need with multi-borough, multi-disciplinary teams.

Developing robust business cases to support and inform commissioning.

Outcomes

Outcomes of the partnership :

Raising the profile of EoLC across East London, and placing the hospice at the centre of developments.

Design of an ambitious EoLC Coordination Centre.

Undertaking detailed baseline mapping of the support available for families and carers.

Hosting stakeholder and community events to raise an understanding of needs of families and carers, laying the foundations for change and development.

Application to Hospice practice

The value of partnership work to support hospice development :

The importance of hospices taking a pro-active leadership role in forming networks across East London.

The value of sharing resources, expertise, learning, and networks to make improvements and facilitate the redesign of care.

The recognition of the contribution that palliative and end of life care can make to the wider health economy.
P128 Does respite care address the needs of palliative care service users and carers?
Authors: Anna Wolkowski , Carr Susan
Published: October 2013

Research aims

To explore the perspectives and experience of respite care of married or bereaved palliative care service users and carers and to establish in what ways respite care addresses their needs. The research is located in a professional doctorate study.

Background

There are clear indications that over the coming years, as more people live longer into old age and die as a consequence of chronic disease, an increasing amount of support for carers of patients with palliative care needs will be required. In UK policy and guidance, respite care is frequently mentioned as a key factor in supporting carers. However, little is known about respite care for people in this group and the study addresses this gap in knowledge.

Methods

The approach was qualitative, the methodology was interpretive and the method used was constructivist Grounded Theory. Data collection was carried out by unstructured informal interview with couples who had experienced hospice respite care. Social network circle activity was undertaken as part of theoretical sampling.

Results

Respite care is valued by palliative care service users and carers although there are some fundamental tensions in service models which limit its potential. A theory of vulnerability and resilience was developed which accommodated issues of needs and acceptance, choice and risk, loss and gains.

Conclusions

The articulation of respite care needs and the insights gained in this study have the potential to influence hospice practice and provide a platform for innovative service development and improvement which is sensitive to the needs and capacity of local communities.

Application to hospice practice

A reframing of respite care as an empathic response within a new palliative care approach is proposed. Within this the centrality of the relationship is reinforced and the need for support over a potentially long and more uncertain trajectory is acknowledged.
P129 Equitable allocation in needs-led care: developing an assessment tool for respite allocation in a hospice for young adults
Authors: Ebeling Sophie , Cowee Deborah
Published: October 2013

Background

The hospice provides support for young people with life-limiting illnesses, central to which is respite care. It is recognised that decisions about respite care provision are of fundamental importance to patients and their families. The referrals team invests time, clinical judgment and combined knowledge to assess each case and agree an allocation of respite care.

A project was undertaken to develop a tool for allocation of respite care. This tool would structure the allocation of respite according to a matrix, allowing the team to provide evidence of equitable allocations, allow direct comparisons between cases and potentially improve time efficiency.

Aims

The aim was to develop and validate a simple scoring matrix which could be used to assess each patient’s need for respite and ensure an appropriate allocation of nights.

Approach

The tool was developed through a grounded theory approach, refining and developing the tool through testing until an accurate version was created.

Outcomes

This project has successfully captured, and defined, the collective knowledge and experience of the referrals panel. This collaborative decision-making process, that has historically relied heavily on personal and professional knowledge, combined with a holistic understanding of the complex lives and needs of patients and their families, has been explored. These tacit aspects have been articulated, defined and quantified in the assessment tool produced.

Application

This project represents a step forward, in response to current national agendas that call for hospices to demonstrate quality and equity ahead of GP Commissioning.

Adopting the tool will ensure that allocation continues to be a transparent and equitable process, which is able to be articulated and justified to patients, families and wider colleagues, allowing the organisation to demonstrate accountability and good governance.
P130 Progress for providers: End of Life - checking your organisation’s progress in delivering personalised support
Authors: Ball Philip , Sanderson Helen , Meyerhoff Tracy , Monks Nichola , Torkington Anne
Published: October 2013

Introduction

The hospice movement often uses the term ‘holistic care’ to describe what it provides, with it being applied differently depending on the care setting. Personalisation could be considered another version of holistic care. Based on this we took the opportunity of bringing both holistic care and personalisation together, to explore what this means in practice for end of life care.

Progress for Providers is a recognised series of self-assessments, to enable providers to see how they are doing in delivering personalisation. There’s not something of this nature already available to hospice managers. Personalisation has primarily been a term used by social care, with government plans to integrate health and social care by 2018, its key we start to embed personalisation to hospice care now.

Aims

The aim is to enable hospice managers, and anyone involved in supporting people at end of life, to know what personalisation looks like in practice and to introduce person-centred thinking tools that can add to the way that hospices can deliver truly personalised services.

Approach used

The authors met to produce the self-assessment tool using their knowledge, key reports and other sources of information to inform the statements of each area of assessment. The tool will be sent out for comment, refined and tested during the summer of 2013, to be launched in October.

Outcomes and applications to hospice practice

The use of Progress for Providers: End of Life offers an opportunity to critically examine local practice with a view to taking personalisation further.

While the future of hospices has been considered by the Commission, making progress in personalisation is another way to look at service provision to ensure it meets the needs of the people we support.
P131 Garden house hospice admission response criteria
Authors: Ebiredelu Augustina
Published: October 2013

Introduction

Referrals for admissions are received from health care professionals in the community and acute trust with GP’s knowledge. Requests are assessed by the admission co-ordinator and a member of the Hospice Medical team on an individual basis, without discrimination and in accordance with the admission policy.

A tool has been adapted from Luton Community Service Palliative care response criteria. It is based on RED/AMBER/GREEN (RAG) category model.

Aim

The aim is to ensure a responsive service based on patient needs. It provides clinicians with a user-friendly tool to support decision making when prioritising request for admission to the Hospice.

Method

An audit on the use of the tool was undertaken.

RAG tool covers 3 categories; End of life care, symptom management and Psychological/social support.

RED – Death expected within hours/days, Symptom control and Carer breakdown. Admission/bed offered within 24 hours

AMBER – Death expected within days/weeks, symptoms assessed but remain unresolved, Psychological support requiring regular observation. Patient is admitted within 3 days.

GREEN – Death expected within weeks/months. Respite for family. Admission offered if no red or amber patients are waiting.

The tool is used in conjunction with a list of questions when dealing with request for admission.

Using the criteria, admission was prioritised according to RAG tool and response time documented.

Results

During a 12months period, 202 patients were admitted to the IPU from home or from hospital. 140 of these admissions were considered to be RED requests, 47 were AMBER and 15 were GREEN.

Admission between 2–24hrs = 140

Admission between 24hrs – 36hrs = 47

Admission between 36hrs and over = 15

The RAG tool was found to be successful in prioritising request for admission. Streamlining the process of admission meant that patients requiring urgent admission were prioritised therefore preventing possible hospital admission and achieving their Preferred Place of Care and Death.
P132 To admit or not to admit? – the use of a waiting list scoring system to prioritise admission requests
Authors: Hodgson Aruna
Published: October 2013

The problem

A hospice inpatient unit was receiving more requests for admission than it could meet. Patients who were felt to need urgent admission would tend to be offered a bed ahead of those whose need was thought to be less urgent. This could result in those with complex moderate intensity symptoms having to wait a considerable time for admission, leading to ongoing suffering and often an escalation in their needs.

The attempted solution

A simple scoring system was introduced to assist with prioritisation. Referrers are asked to specify how urgently admission is required (Immediate = within 24 hours, Soon = within 3 days, Routine = within 5 days). Patients are allocated a score for priority of need and then accrue points according to each working day they are on the waiting list. When a bed becomes available, it is allocated to the patient with most points. When several patients have the same number of points and only one bed is available, the team discusses the relative needs of each patient to decide who will be offered the bed.

The outcome

Despite training prior to the introduction of the scoring system, there was initially some inconsistency in the way referrers assessed urgency, with a number of patients being listed as “Immediate” inappropriately. Following further discussion and education, this has improved. The system now works well and although demand for beds often still exceeds availability, the system allows them to be allocated in a fair and equitable way and has reduced the time taken to decide which patient (s) will be admitted when there are several on the waiting list. The system has attracted interest from other local hospices who are struggling with the same problem of over demand for beds.
P133 “Not only but also” Establishing a first point of contact and triage service
Authors: O’Grady Jackie , Cottingham Laura , Linehan Gail
Published: October 2013

Background

A South West London Hospice receiving around 900 referrals per year.

First Point of Contact (FPC) service was established following identification of variation in response times for initial contact to arrange assessment.

In collaboration, a Triage service provides immediate access to a Clinical Nurse Specialist (CNS) for advice, support and responsive emergency visits.

Aims

To provide an efficient, responsive referral service.

To provide accessible telephone support for patients, relatives and professionals

Provision of a responsive approach to requests for urgent home visits.

Service configuration

A team of three CNSs (WTE 2.2) covering 08:30-18:00 Monday-Friday.

Referrals reviewed on receipt with responsive contact

Urgent referrals initiate immediate FPC contact to assess and where necessary a same day visit by the triage CNS.

Routine referrals assessed by telephone within 48 hours with first visit arranged within two weeks

FPC attends weekly Palliative Care MDT meetings at both local hospitals

The triage CNS offers telephone ‘help line’ advice and support to referred service users and professionals.

Outcomes

Three month pilot (17thDecember - 17thMarch 2013) compared to November 2012 demonstrated:

70% improvement in response times to all referrals being contacted within 24hrs

94% of urgent referrals contacted within 24 hours

21% improvement in 2 week first visit

76% of received calls completed by Triage CNS supporting the community team.

A result of service questionnaire from relevant stakeholders is awaited.

Implication to delivery of specialist palliative care

Better end of life management within the community through advice given to GPs at point of referral e.g. ensuring appropriate documentation and medications in place

Improved access to the hospice for referrals and advice

Improved response to referrals

Improved communication, collaborative working and outcomes for patients.
P134 Pilot service evaluation survey to demonstrate ‘quality & efficiency’ of ‘hospice in-patient care’
Authors: Joseph Marie , Goldhill Alice
Published: October 2013

Introduction

Patients with uncontrolled symptoms will experience impaired quality of life [QoL].

Improvement in symptom management, therefore will lead to an improved ‘QoL’ which is one of the ultimate goals of management of patients in the palliative care setting.

The ‘WHO performance scale/status’{PS}, is designed to measure the ‘QoL’ of patients in the above setting.

It is measured between 0 and 4. [0---normal; 4---totally bed/chair bound, with gradations in-between]

{Note: The higher the value of the ‘PS’, the lower the ‘QoL’ of the patient.}

Aim

To demonstrate improvement in ‘QoL’ following successful symptom management

Methods

Survey all in-patient admissions to the hospice for ‘symptom control’ purpose

Identify symptoms on admission

Record ‘PS’ as a measure of patient’s ‘QoL’,on admission & on discharge

Record relevant clinical & therapeutic management measures

Pilot survey period:

Approximately 6 weeks

Results

14 patients were admitted for ‘symptom control purpose’.

Neuropathic pain, poor pain control [commonest], nausea and vomiting, shortness of breath, anxiety/low mood, constipation were the identified symptoms.

‘OPIOID switch’, Neuropathic Analgesic Agents, Continuous Sub-Cutaneous Infusion [CSCI/syringe driver], were the common therapeutic measures used.

Average PS on admission was: 2.7 {approximately 3}

Average PS on discharge was: 2.2 {approximately 2}

All patients were discharged home with an improved ‘PS’ indicating an improvement in their ‘QOL’ in comparison to the state on admission.

3 patients subsequently died at home.

Discussion/Survey implications

This pilot survey demonstrates to the Clinical Commissioning Groups [CCGs], an evidence of ‘quality and efficiency of hospice in- patient care’.

The findings in addition strengthen ‘staff morale’ in caring for patients in the hospice setting.

Conclusion

PS’ as a measure of ‘QoL’ can be a marker of good symptom management in palliative care.

April 2013
P135 Pro-active approach to falls management
Authors: Bourne Jacqui , Newsam Cathy , Moorey Alison
Published: October 2013

In common with many hospices, historically there has been a significant number of patient falls and this led to a team desire to take a proactive approach to falls management. A development group including user representation was set up with the aim of creating an individualised falls prevention care plan for use not only in the inpatient unit, but also in day-care and by the hospice at home team. This initiative was adapted from excellent work undertaken in Wales.

The existing accredited moving and handling staff trainers were recruited as champions for the introduction of this initiative which included the development and usage of;

Patient Falls Assessment Checklist

Bed Rails Risk Assessment

Falls Prevention Care Plans and

Information leaflet entitled “Reducing patient falls”

These initiatives above were supported by the use of an adapted manual handling traffic light system for patients who had recently fallen.

The champions took an imaginative and creative approach to introducing this change by incorporating role play and case scenarios in their teaching plans.

April 2009 to March 2010 Prior to initiativeApril 2010 to March 2011April 2011 to March 2012(high number of repeated fallers Jan/Feb)April 2012 to March 2013Falls not resulting in injury45194328Falls resulting in injury2318149

The equipment costs of approximately £8,000 for bed and chair sensors, low beds and crash mats seem a very appropriate investment when considering the results of this initiative, shown in the table above, fall numbers fluctuate but are always lower than prior to the initiative and there is an impressive year on year reduction in the number of injuries sustained. The improvements not only contribute to the organisation’s strategic objectives to improve care and safety but assist in providing essential evidence to the Care Quality Commission too.