bluuebunny/crossref_metadata_2025 huggingface dataset:
P3 Making a difference in care homes
Authors: Andrews Wendy
Published: October 2013

Introduction

The Hospice undertook a project with 10 local care homes which had the highest rate of admissions to an acute hospital where the patient had died. The inital results in 2012 led to a further 12 months of funding with 10 more homes.

Aims

Reduce inappropriate hospital admissions from care homes for end of life patients

Promote the use of end of life care

tools

Methods

Registered Nurse led project with multi-disciplinary steering group

Baseline data:

After death analysis (ADA) – last 5 deaths prior to project commencement

Care home training needs analysis (TNA)

Project period:

Training programme based on TNA delivered and evaluated

Ongoing ADAs

Year end:

Collation of ADA information

Reviewed whether new skills and knowledge embedded.

Results

Year 1– 19% of nursing home patients and 57% of residential home patients died in an acute setting. Uptake of EOLC tools rose dramatically. 140 staff received EOLC training.

Year 2– Post-training, 19% of patients died in an acute setting and the ADAs suggested only 5% might have been avoided if end of life needs had been correctly identified. Uptake of EOLC tools increased with 90% of those who died having some form of ACP and nearly 80% having a valid DNACPR form. 157 staff received EOLC training

Discussion

The uptake of EOLC tools was the most obvious achievement and qualitative data indicated increased staff confidence as a major factor. The ability to measure a reduction in inappropriate hospital admissions was more difficult due to interventions from other in-reach projects. The importance of good engagement with GP practices was identified early on, but was outside the scope of this project.

Conclusion

This project demonstrated the value of EOLC training, tailored to care home staff needs. Hospices can increase opportunities for good end of life care in the community, without the need for specific patient intervention from specialist palliative care providers.
P4 VALE: Volunteers at life’s end, the LOROS care homes project
Authors: Kavanagh Jo , Faulkner Shani , Faull Christina
Published: October 2013

Background

Supporting people in the last hours of their life has a particular importance: a human presence may reduce fear, and agitation and promote a peaceful dying (1);provision of a ‘sacred space’ (2) performing rituals or an environment of valuing of the person’s way of life and beliefs may be a consideration; and witnessing the passing from life to death.

Aim

LOROS developed a novel pilot service recruiting and training volunteers to work with care homes to compliment their care of dying patients. The aim was to explore the feasibility and evaluate its added value.

Approach used

A three day training programme was developed for 9 volunteers : learning hand massage; a focus on common features of dying; features of dementia; and discussing the role and potential impacts on the volunteer. Volunteers developed ‘comfort packs’ containing readings, music, massage oil and religious icons. A regular support structure was developed.

Four care homes developed operational frameworks for contacting and integrating volunteers in to their team. Leaflets provided information to service users and processes were developed to discuss the service with residents and relatives.

Outcomes

Over seven months three of the four care homes utilised volunteers with 10 residents. Most residents who died did not need the additional support of a volunteer and some volunteers were not utilised. Where volunteers did provide support it was highly valued by staff and by relatives. Volunteers enjoyed the work and despite being needed infrequently there was no attrition.

Application to hospice practice

Hospice trained and supported volunteers are welcomed by care homes as part of their care team for dying patients. The need for their service is infrequent and unpredictable and when it does occur it is immediate and intensive. These practical factors make it difficult service to provide.
P5 The South Edinburgh care homes project: A community nurse specialist-led intervention to improve palliative care
Authors: Gardner Hilary , Finucane Anne , Stevenson Barbara , Muir Lynn , Oxenham David , Montgomery Emily , Gibson Hilary , Murray Scott A
Published: October 2013

Context

Approximately 20% of people die in long term care settings.(1)National and international policies call for care homes to provide reliably good end-of-life care. Hospices are well placed to support care homes to deliver palliative care to residents who would benefit. This project builds on two previous projects aimed at better meeting the needs of care home residents.(2,3)

Aim

To improve the delivery of palliative care to care home residents using a hospice-led model of care home support.

Approach used

Nineteen South Edinburgh care homes were approached by two Community Palliative Care Clinical Nurse Specialists (CNS) to take part in the project. All care homes agreed. Care homes were divided into two geographically defined clusters. The intervention is currently being delivered to the first cluster.

Key components of the intervention include: support from a dedicated Community Palliative Care CNS; identification of two palliative care lead nurses in each care home; a study day and three workshops based on the Macmillan Foundations in Palliative Care programme; implementation of key processes such as multidisciplinary palliative care review meetings, and support to use tools to help identify residents who may be approaching end of life.

Outcomes

The primary outcome is the proportion of residents who die in the care home. Other outcomes include the proportion of deceased residents who had an anticipatory care plan in place; DNACPR documentation in place; appropriate anticipatory prescribing and who died on the Liverpool Care Pathway. Outcome data is being collected before, during and after the intervention period.

Application to hospice practice

This project will show the extent to which a hospice based model of care home support enables care home staff to improve the delivery of palliative care to their residents. This would allow hospices to greatly extend their influence to reach non-malignant patients.
P6 One Step at a Time: Introducing an End-of-Life Care programme to a critical mass of local care homes
Authors: Godfrey Cathy , Stevenson Alex , Barber Bernie , Cath Baldry , Groves Karen
Published: October 2013

Aims

The Six Steps to Success programme was launched in the UK (North West) to support the delivery of end of life care in care homes. 36 (1162 beds) of the 109 nursing and residential homes (3,600 beds) in our locality (Southport, Formby and West Lancashire) have undertaken the programme and this poster demonstrates the impact of the programme upon the knowledge, skills and confidence of care home staff.

Design

The programme, delivered from the Hospice Hub by end of life care facilitators, includes:

A pre and post course self-assessment of knowledge skills and confidence

Post workshop evaluations

An end of programme questionnaire

This poster describes the analysis of these.

Results

The programme met the needs and expectations of 100% of participants. 100% found the education clear and felt well supported by the EOlc facilitators. Evidence shows that each cohort improved in knowledge, skills and confidence across all topics when measured on a 5-point self-assessment scale. Qualitative analysis of feedback indicates that the care homes are working as a team to utilise end of life care tools and improve patient experience approaching end of life.

Conclusion

The Six Steps to Success Programme has enabled care homes to bring about organisational change and develop frameworks to improve End of Life Care in their place of work. By working together, sharing experiences and ideas, supported by their facilitators and the local hospice (Queenscourt Hospice), care homes have developed comprehensive end of life care policies which have enhanced delivery of high quality care. By rolling out the programme to a large number of care homes over a 12 month period we are creating a ground swell of enthusiastic motivated care home staff with a desire to collaborate with those working in other health and social care settings to improve the experiences of their residents and relatives.
P7 Red Envelope Scheme
Authors: Young Shirley , Hickey Deb
Published: October 2013

Ambulance crews reported lack of information with regards to patient care & wishes, meaning their default position was Hospital admission as they could not ‘waste time’ looking for relevant documentation eg Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) forms, ‘hidden’ in copious patient records.

Aims

To give crews readily accessible Patient information, enabling them to make decisions about best care, recognising patient choice.

To prevent unnecessary or unwanted hospital/hospice admissions for palliative patients. A form was designed which included Information regarding patients’ Preferred Priority of Care, DNACPR, medications and contact details of relevant Health Professionals. This was agreed by the Ambulance Service.

An A5 Red envelope labelled ‘FOR AMBULANCE CREW ONLY’ held the completed form, to be The Scheme was piloted for 3 months from April – July 2012

During the trial 24 forms were completed and held by the patient and family

The checklist was described as ‘Directional Documentation’ by the Ambulance service. The contact numbers and information gave crews the opportunity to call and discuss the situation with other professionals.

Subsequent improved communication between services has resulted in Ambulance crews anecdotally describing a change in practice and increased confidence in making decisions to support patients to remain at home.

Discussion

In the absence of Electronic Registers within our locality, the intermediate solution was to introduce the Red Envelope Scheme which gave Ambulance crews the right information at the right time. However despite the large catchment area of the Hospice the Scheme reaches a small percentage of patients with palliative care needs.

Conclusion

Crews now look for a red envelope in the patient’s home. It gives support to crews to make the right clinical decisions and the opportunity to influence the patient journey in a more positive way.
03 Volunteers – sustaining hospices?
Authors: Scott Ros
Published: October 2013

Volunteers have historically played a vital role in the founding and on-going development of independent hospices. The governance of these voluntary organisations is also the responsibility of volunteer trustees, however, it is not clear whether volunteering is considered as strategic resource. This study aimed to explore how volunteering perceived strategically in independent hospices throughout the UK.

Purpose of the Research

The purpose of this research was to study the link between volunteering and hospice sustainability by:

Exploring how volunteering is understood by UK hospice senior staff, volunteers and trustees.

Considering the influence of volunteers on four key UK hospice sustainability factors: governance; service delivery; hospice economy; and community engagement.

Explore whether there is a link between volunteering and hospice sustainability.

Methods

Using a mixed methods approach a self-administered online survey which was sent to hospices across the UK. The questionnaire included both Likert Scale and free text questions. As this study sought to the strategic context of volunteering, the views of senior staff, trustees and volunteers were sought. Thirty one hospices took part with responses from 58 senior staff 56 trustees and 181 volunteers.

Findings

No recognition of the role of volunteers in governance.

Volunteers viewed as a strategic resource but not engaged in strategy development.

Lack of planning for volunteer involvement.

Volunteers are important to income generation, the quality and range of services offered and community engagement.

Hospice sustainability is highly dependent on volunteers, however

Current volunteering models may not be sustainable.

Implications

This area is the first study of its kind to establish evidence about the dependence of hospices on volunteers. It identifies opportunities for practice development in planning and approach. A toolkit is being developed to enable organisations to identify areas for development.
P8 Care across settings: Evaluating an integrated specialist nurse-led palliative care clinic within a general practice setting
Authors: Harrop Emily , Baillie Jessica , Byrne Anthony , Stephens Karen , Nelson Annmarie
Published: October 2013

Background

A community nurse-led palliative care clinic was introduced at a UK General Practitioner’s (GP) practice in April 2012. The clinic aimed to provide earlier identification of patients with cancer and non-malignant disease, initial patient assessment, education for GPs and other community professionals, and strengthen relationships with the local multi-disciplinary team. This provides a new model for engaging patients and ensuring that specialist palliative care is delivered across different clinical settings. Usually, clinical nurse specialists (CNS) support patients in the home. This new initiative brings a fortnightly clinic as a complementary resource to consolidate the joint primary/ palliative care approach.

Methods

This study evaluates implementation processes and the impact of the clinic on patient experiences and professional practices. It assesses uptake of palliative services and the management and delivery of palliative care by GPs and CNS.

Baseline interviews with GPs (n = 5) and CNS (n = 4) were carried out in February 2012. Semi-structured interviews with patients (n = 6), GPs (n = 6) and CNS (n = 4) are being undertaken to assess perceptions of the clinic.

Patient interviews will be analysed using an Interpretive Phenomenological Analysis (IPA) approach. Interviews with GPs and CNS will be analysed using Framework Analysis.

Results

Perceived aspirations for the clinic included: earlier referral; improved communication and continuity of care; psychological and practical benefits for patients/ carers; more targeted use of specialist nursing resources. Baseline interview data highlights the need for improved referral and communication practices, especially for non-cancer patients. Data from patient and follow-up interviews will be reported against these aspirations, with additional themes identified.

Conclusions and application

Conclusions will be drawn on the effectiveness of the clinic and implications identified for palliative care provision in primary care settings, including the potential to roll out a similar model more widely.
P9 Is there anybody there - telephone advice lines who needs them?
Authors: Livingstone Tracy
Published: October 2013

Background and Context

Nightingale House Hospice have offered a 24-hour telephone advice line to patients and their carers in North East Wales since the year 2000. Predominantly the area covered is urban with good access to a variety of health and social care services.

In 2010 the hospice were asked to provide a similar service providing advice on palliaitive care/specialist palliative care to health care professionals across all geographical areas of North Wales acting as a triage centre for palliative medicine consultant advice, this service was not made avaialble to patients and families due to concerns regarding potential volume of calls. This introduced a population located in large rural areas with more sporadic access to services.

Aim & Approach

The purpose of the audit was to encourage discussions about the ethics of delivering a two tier service based purely on geography but also considers the context of the calls in terms of the services available to patients within each locality in terms of model of service provided and also the hours of operation/delivery

Outcomes

This presentation details the findings of an audit of the advice call forms completed reviews and compares the data collected from both geographical areas covered by the advice line, considering the volume of calls from both areas, the time and duration of calls and also the reasons why people called.

Application to practice

The audit recognises some limitations in the method by which data is currently collected and reviewed providing guidance for the future in terms of what do we need to know in order to measure the impact and outcome of the provision of this service to patient s and their families.

The work also draws conclusions for practice in terms of identifying current need within our locality.
P10 Hospice rapid response service – a prospective analysis
Authors: Clayton Beverley , Spencer Lesley
Published: October 2013

Background/context

Following a retrospective analysis of urgent unplanned visits, evidence emerged that supported a new rapid response role for a clinical nurse specialist.

Main Aims

To enable palliative care patients in the community, who have complex needs or whose condition is deteriorating, to access prompt specialist palliative care services.

To assess whether more patients

are enabled to exercise their preference about place of death

Approach used

The service was available to new and existing patients for end of life care and support of urgent symptom control issues (N = 78). Referrals requiring urgent attention were passed onto the Rapid Response Nurse. The CNS worked flexible hours in order to support the needs of the patient. Data was collected prospectively over a six month period using survey monkey.

Outcomes

Seventy Eight patients supported over 6 month period. 38% had a non - malignant diagnosis. 67% of patients were referred for terminal care with the remaining requiring symptom control. As a result of the rapid response visit 86% of patients remained in their own home. None were transferred into the acute sector. 75% of patients who died within the 6 month period achieved their preferred place of death with only 6% who wished for a home death unable to achieve this.

Application to hospice practice

The service was timely, responsive and supported increasing numbers of patents to be cared for and to die in their preferred place of death. All visits responded to crisis therefore all patients had potential to be admitted to hospital. Patients in the Nursing homes were particularly vulnerable.

The service therefore prevented unnecessary admissions into the acute sector and supported Hospital Palliative Care Teams with rapid discharge home.

A Rapid Response Clinical Nurse specialist is effective – right skill, right intervention, right time.
P11 The stars that come out at night - Presenting the hospice ’8 to 8’ night nursing Service
Authors: Neil-Jones Dawn , Spencer Lesley
Published: October 2013

Background/context

Maximum impact in terms of achieving patients preferred place of care may be gained by focussing future service development on extending and improving care at home. This also ensures on-going collaboration between NHS and other providers of end of life care.

Since September 2011 the Hospice has been developing the ‘8 to 8’ service which provides a night nursing service for existing Hospice patients and more recently, through partnership working with other healthcare providers for dying patients not known to the Hospice.

Main Aims

To optimise the opportunity for patients requiring end of life care who wish to stay at home to remain in their preferred place of care

To prevent unnecessary admissions to hospitals

Approach used

The service is delivered by both bank and permanent members of staff and includes both registered nurses and senior health care assistants. All staff are inducted by the Hospice and given the requisite palliative care skills. The service is led by a clinical nurse specialist who supports and co-ordinates the allocation of staff according to clinical need. The nurses remain with the patient throughout the night.

Outcomes

Evaluation demonstrates that the service has exceeded expectations. Most patients referred to the 8 to 8 service are for terminal care with 95% of patients achieving their preferred place of death. The service now delivers 50 nights per month across the catchment area.

Application to hospice practice

The 8 to 8 service has been commissioned by two clinical commissioning groups since its inception and continues to expand and build on its success. It is delivered by specially trained nurses who are compassionate, efficient, caring and greatly improve the patient experience. Increasing numbers of complex patients are now able to be cared for in their preferred place of care.
P12 Hospice at Home Service Listening, responding, developing
Authors: Gibson Vanessa , McEvilly Liza , Standfield Robert
Published: October 2013

In 2008 the Department of Health (DH) identified increasing evidence that lack of co-ordinated community support was resulting in avoidable admissions and prolonged hospital stays. They went on to describe how hospice at home services could have a significant impact in enabling patients to die in their own home. The existing night hospice at home service provided practical support to patients and carers between 10 pm and 8 am. Building on the 7 C’s of the Gold Standards Framework (2005) the team promoted contingency planning and service co-ordination ensuring that they were already an integral and valued part of the community based services.

However, with an expected increase in the number of deaths from cancer and non-cancer deaths (Kings Fund 2011) and a local emphasis on preventing unnecessary admissions (Health and Well-being Board, 2012) a wide ranging review of the hospice at home service was undertaken in 2012. Service users and health care colleagues emphasised the importance of:

A 24/7 service

Rapid response

Not being reliant on external funding

Supporting carers via ‘on the job training and support’

Being accessible

Highly skilled, consistent and compassionate staff

The review also identified several unmet needs which could be addressed by an expanded hospice a home team, these included:

Crisis intervention, for example whilst acute symptoms were addressed, carer stress or ill health

Rapid response and extended packages of care for changing needs

Pre-admission to the hospice in-patient unit

Supported discharge from the hospice in-patient unit

Rapid discharge from the acute sector

Our service outcomes include:

Provision of a hospice at home service tailored to meet local needs

Increased integration of hospice services.

Cost effective use of hospice resources

Increasingly achieving preferred place of care/death
P13 Evening call
Authors: Levell Eirian
Published: October 2013

Introduction

The End of Life Care (EoLC) Strategy (2008) and Preferred Priorities of Care (2011) documents support enabling people to remain in their own homes.

Prompted by the volume of calls into the in-patient unit, and workload of the district nurses in the early evening, the hospice piloted an extension to the Hospice@Home (H@H) working hours.

Aim

To reduce unnecessary admission to hospital at the end of life by providing extended access to support and guidance for patients, carers and health care professionals.

Method

Following a three month analysis of telephone advice calls received by the Inpatient Unit (IPU), outside of H@H working hours, the pilot took place over a 9 month period. This extended the accessibility of trained nurse contact from 4.30pm to 9pm on a daily basis.

Results

Throughout the pilot phase, calls were recorded and outcomes summarised, paying particular attention to the purpose of calls, caller identity, and the time the call was received. These statistics provided evidence that the service was not routinely accessed after 7pm.

During the pilot, five admissions to hospital were prevented, primarily due to the swift response and symptom management by H@H. Patients and carers benefitted from the flexibility and accessibility of a trained nurse to action changes, provide continuity and reassessment from 8.30am until 9pm.

There were a high proportion of calls requesting complex symptom advice, reporting family distress and requesting an increase in care.

Conclusion

Staffing the extension to the service proved challenging however the pilot was positively evaluated by the district nursing team.

Guidance, reassurance and prompt response to need, undoubtedly contributed to the prevention of crisis admissions to the acute trust.
P14 The impact of audit on CNS team development
Authors: Gibson Vanessa , Patel June
Published: October 2013

In 2011 the Hospice Clinical Nurse Specialist (CNS) team were facing a significant increase in patient referrals numbers (approximately 70 per month). The demand for community based care, rather than acute hospital admission, was also resulting in increasingly complex and urgent referrals from all areas of the local healthcare economy. In addition, palliative and end-of-life care services traditionally available only to cancer patients were increasingly being accessed by patients with non- malignant diagnoses.

In response the CNS team undertook a month long audit of referrals to the community nurse specialist service. The audit revealed:

Low levels of referral information, resulting in delayed contact

Difficulties assessing levels of urgency

Lack of clarity regarding other services involved with the patient

Unnecessary home visits

As a result the CNS team has now introduced the following:

A new streamlined referral process

A full time specialist triage nurse who makes first contact with all referrals:

She:

Responds to all referral agencies

Assesses level of urgency

Holds her own low-level caseload that she contacts by phone

Helpline established and available to patients and health care professionals: this service provides immediate access to a highly skilled CNS

Accessing and completing the electronic notes systems to ensure comprehensive and up to date clinical information is readily available to the wider healthcare team.

Enhanced patient documentation

Continuous development is key and plans are being developed for:

A visiting ‘rapid response’ CNS

A nurse led triage clinic

Increased triage nurse hours

The CNS team have used audit to truly ‘hear’ what is happening in practice and as a result have used this knowledge to lead service redesign- a key aspect of the CNS role identified by National Cancer Action Team (2010)
P15 The right way to write? Development of new documentation for community palliative care
Authors: McPolin Hilary , McMullan Mary , McGinnity Grainne , Flynn Fiona
Published: October 2013

Background/Context

Efficient, comprehensive documentation not only provides a record of care, but also reflects the quality of that care whilst reinforcing care standards. However, documentation in palliative care has often fallen short of these ideals (McEvoy, 2000). Following the development of a centralised triage system for new referrals to a community palliative care service, it was recognised that there was duplication of information being recorded by both the triage staff and the community nurses. There was also a general consensus that the triage documentation should be incorporated into the nursing assessment tool to reflect the patients’ journey and promote continuity of care.

Aim

To develop user friendly, time efficient documentation that provides a comprehensive holistic assessment of specialist palliative care patients and their families.

Approach Used

A project team was formed with representatives from the triage team and the community nursing teams. Following a review of in-house documentation, Liverpool Care Pathway (LCP) and assessment tools from both hospital and community palliative care teams, a new tool was developed and piloted. Minor changes were made, based on the initial evaluations and subsequently, a second pilot was undertaken before the tool was finalised.

Outcomes

The new tool was rolled out to all the community teams in January 2013. Feedback to date suggests a reduction in both the amount of duplication as well as the amount of time spent on recording the required information.

Application to Hospice Practice

The new documentation tool reflects a holistic, comprehensive, specialist palliative care nursing assessment, in a user friendly, time efficient format. It has improved communication and accessibility of information and recognises the need to increase the capacity for recording the needs of carers. Better documentation can lead to better patient care.
P16 Planning your week: a new model for rural working
Authors: Hart Derek , Martin Cathy , Draper Maggie
Published: October 2013

An examination of caseload management is currently being undertaken by 2 community palliative care nurses who cover a large area, encompassing the environs of city to remote moor land. The remote areas have no mobile telephone access and poor infrastructure.

The caseload was analysed and divided into 7 geographical areas (zones). Visits were to be arranged to these zones on specific days to optimise efficiency, taking into account mdt commitments.

The aims were:

To increase efficacy of visits, reduction of interruptions

Reduce travelling time and mileage

Improve response time from referral to first visit,

Improve reliability and therefore develop stronger integrated working.

Improve wellbeing and support of the CNS.

Move from reactive “fire fighting” to proactive care where crises were predicted where possible.

The approach used was:

A time table of areas and days was created.

Two nurses covered the caseload of approx 60 patients.

The timetable took into account mentorship needs of the new CNS. It promoted men- tee and mentor working in neighbouring zones. Meeting places in the field (literally!) were highlighted should support be required.

1 nurse per day was allocated to triage calls and trouble shoot.

The administrative team were involved in planning and were aware of who to call.

Outcomes – to be measured / reviewed September 2013

Supportive mentorship of new CNS in rural environment

Reduced Mileage

Reduced interruption from mobile phone calls.

Reduced sickness

Improved record keeping. The two nurses were reliant on each others records to provide continuity of care.

A more efficient use of laptops reducing the need to return to base.

Development of professional relationship between nurses encouraging peer review.

Improved relationships with GPs and community nursing teams
P17 The community and hospice home nursing service
Authors: Spencer Lesley , Masetti Karen , Starnes Gina
Published: October 2013

Background/ Context

End of Life care support throughout Surrey had been fragmented and lacked an integrated approach. As a result three organisations came together to form the ‘Community and Hospice Home Nursing Service’.

The service supports a multi-disciplinary partnership approach to delivering nursing care at home. Central Surrey Health (CSH), and two Independent Hospices; Princess Alice Hospice (PAH) and St Catherine’s Hospice ( StCH) are now delivering a seamless seven day, 24 hour service.

Main Aim

To provide care that avoids inappropriate hospital admissions and enables more people to be cared for and die in their place of choice.

Approach Used

The service was designed following patient and carer feedback and necessitated hospices working together across traditional boundaries.

Key elements

Co-ordination via a single point of access

Additional clinical provision of night and day care by Staff Nurses and Senior Health Care Assistants.

Partnership approach to care delivery.

Importantly the Hospices involved are extending their reach to support those who have not or may not need referral to specialist palliative care.

Outcomes

Ninety eight percent of patients achieved their preferred place of care with 95% achieving their preferred place of death; 85% of those who were referred to avoid an admission to hospital achieved this; 28% of patients had a non- malignant diagnosis. The key performance indicator, aimed at increasing the number of referrals on CSH end of life care register by 5% was achieved with a 70.4% increase.

Application to hospice practice

Commissioners were delighted with the multi-professional and integrated partnership approach to care delivery and the solution focussed proactivity. They champion the partnership as a model for the future. The community and Hospice home nursing service suggests that an integrated approach to care delivery can improve outcomes whilst being cost effective.
04 St Joseph’s 1st Contact Team. A New Innovative Multiprofessional Model
Authors: Boyle Margaret , Bradley Ruth , Morris Angie
Published: October 2013

Background

The development of a new innovative service the St Joseph’s First Contact Team was identified in April 2012 as the critical project to commence the 3 year transformational change programme to develop community services. This pilot aspired to improve access to the ‘front door’ of St Joseph’s, improving response times for patients, their families and carer’s, ensuring all those referred were appropriately signposted to the whole range of services provided appropriate for them. The team consists of multi-professionals who are either in the team physically or as virtual members.

Aims of the Service were

To provide high quality, patient and carer focused, value driven services and experiences To meet the changing needs of local communities

Be more responsive to our local communities

Meet the strategic priorities of local Clinical Commissioning Groups and GPs

Continue to meet the mission and core values of the Hospice

Encourage innovation and develop staff

Share specialist knowledge and skills of end of life care with community partners

Approach Used

Utilising transformational change methodology, working groups were established to develop the project and to guide and influence service development. Patient and service users were consulted and their views informed the service model.

Outcomes

Outcomes-were measured using quantitative data demonstrating activity, referrals response times and user feedback. Qualitative review of assessments undertaken by the FCT and other related professionals during the pilot period was undertaken. Various methodologies were used to collect data including user and staff surveys and the PAL care system.

Applications to Practice

The first contact team has transformed how we respond to our referrals and has promoted multi professional working and greater understanding of the range of services offered to patients, carers and families. A working group led by the Lead Nurse will continue to develop and monitor the quality and service to meet the changing needs of our diverse communities.
P18 “This is so big”
Authors: Shrimpton Sue
Published: October 2013

Background

The death of a parent in childhood is one of the most profound losses a child will ever experience. Supporting children whose parents are terminally ill is therefore an emotive topic. Much research states that if the needs of the child are not met, there can be immediate and long terms problems such as delinquency.

A major driver for this study came from children talking at a child bereavement group telling me they had overheard conversations about their parent’ condition, but because they had not been told directly they felt they could not voice their worries.

Aim

To explore community palliative care clinical nurse specialists (CPCCNS) experience of supporting families with children.

Methods

Using a phenomenological approach, a purposeful sample of eight CPCCNS’ were interviewed. Interviews were recorded and transcribed verbatim. Using Colazzi’s analysis, themes were identified.

Results

The themes were:

Doubted ability

Not their role

Greater time in role increased confidence in ability

Acknowledgement of importance of support

Age, culture and religious differences

Referrals to other healthcare professionals and charities

Parallels in CPCCNS own life seemed to aid empathy

Conclusion

Care of the ‘whole’ family is central to the WHO (2011) definition of palliative care. CPCCNS’ are in a prime position to support children at their most vulnerable, otherwise a delay may mean the child remains unsupported and there is a greater risk of issues during parents illness and following bereavement. This study highlights the role of the CPCCNS’ using data and narrative from interviews.

Implications for hospice practice

Adequate support and training is essential in providing CPCCNS’ with the tools to support children of dying parents so they can feel able and more confident in this area of support.
P19 Widening access to hospice services: The development of a 7/7 community specialist palliative care nurse service and a rapid response service pilot
Authors: Saunby Deborah
Published: October 2013

Background and Context

In response to national Peer Review Standards and NICE Guidance to offer 7 day face to face visiting an opportunity to pilot a service within a hospice based Community Specialist Palliative Care Nursing Team arose. Within this the development in order to be more responsive a Rapid Response service has been developed.

Aim

To widen access for patients with specialist palliative care needs to holistic assessment by a Clinical Nurse Specialist and offer greater flexibility in options for home assessments. To offer an urgent response based on clinical need 7 days a week, for crisis intervention. To assess need for urgent admission to an inpatient unit bed or facilitate the patient remaining in their own home if desired.

Approach Used

A review of caseload configuration across the city with the development of 4 zone teams. A significant investment in resources to support an additional 3 WTE Band 6 Associate Community Specialist Palliative Care Nurses was agreed for a temporary period of 6 months, with successful recruitment to the posts.

All referrals to the hospice service are reviewed through a multi professional meeting and triaged according to urgency and priority, with the capacity for immediate home assessment, 7 days a week and greater flexibility for managing routine and follow up reviews.

Outcomes

Measures will be determined through review and analysis of all Rapid Response visits to determine whether patient preference over place of care has been met.

External stakeholders opinion regarding perceived satisfaction with 7/7 access and rapid response in the management of community patients.

Cost- benefit analysis of investment of resources on improved caseload management to inform strategic service development.
P20 The Sikh population of North West Kent: exploring the lived experience of caring for a dying relative at home
Authors: Cowan Margaret Mary , Withell Bridget
Published: October 2013

Research Aims

To explore the Sikh population’s experience of caring for a dying relative at home and develop an understanding of their experiences.

Background /literature review

Hill & Penso, (1995) reported under-use of specialist palliative care services by minority ethnic groups with minimal improvement noted in present day (Gunaratnam, 2007, DoH, 2008). Often, end-of-life needs are unfulfilled ( Worthet al, 2009, DoH, 2010, DoH, 2011). Locally, Sikhs account for 12.8% of the population although only 1% of referrals to local hospice are Sikh.

Method

A qualitative study, facilitating interviews in Punjabi and English, using interpretative phenomenological analysis to analyse the transcribed data.

Results/Discussion

Five super-ordinate themes identified:

Factors leading to the caring role;

Emotional effects of caring on the carer

Impact of caring on the wider family

Influence of the health care services

Religious and cultural influence

Lack of support from health care professionals emerged as an overriding theme An overwhelming sense of duty pervaded each family sustaining them to cope. The option of their relative being nursed in care home/hospice was unlikely as participants reported fears that care could only be received if it was paid for. Culture and religion played an important role in the caring role.

Conclusions

GPs and hospices need to take a major role in identifying patients with non-malignant disease to ensure referral to other services. Access to equipment is uncoordinated. Financial concerns over care are apparent in this population. Sikh carers need to be educated and supported to continue to support their relatives.

Applications to hospice practice

Allows equity of care to patients dying of non-malignant disease. Improves bereavement support for this population. Engagement with community may need to extend to outreach clinics to raise awarenss within this population. Extends education on end-of-life issues to this minority ethnic group.
P21 Comforting touch at home
Authors: Williams Sue , Birch Helen , McDonald Bernadette
Published: October 2013

Aims

Hospice at Home service works with other community services to fill gaps in end of life care for patients, whose preferred place of care is home. A twenty four hour / seven days a week sitting service is delivered predominantly by trained Healthcare Assistants (Aides), who recognised that anxiety and breathlessness might benefit from immediate, simple non pharmacological interventions.

Methods

Similar interventions are provided by appointment at the hospice and the Hospice at Home team were trained in simple skills and techniques (basic hand and foot massage, the importance of touch, and anxiety and breathlessness management). Regardless of the severity of condition, touch can always be safely administered and studies show massage as the second most commonly administered non-drug strategy to reduce symptoms. Hospice at Home Aides were encouraged to use these skills and techniques with patients, and teach them to families and informal carers where appropriate.

Results

We present audit and survey results of this positive partnership between hospice, Aides, complementary therapists, families and community services.

Conclusion

Families described better outcomes, empowered by doing something practical instead of feeling inadequate and helpless. Patients’ symptoms were relieved immediately in the home instead of waiting to attend the Hospice, and confidence levels and job satisfaction increased amongst the Hospice at Home staff because they could respond immediately by providing a non-pharmacological technique for these distressing symptoms in the patient’s place of choice - home. A cost effective, one stop shop!
P22 Patients Help To Shape New Day Hospice Programme
Authors: Birch Kathy
Published: October 2013

Background/Context of the work

Princess Alice Hospice had a thriving therapeutic but traditional model of Day Hospice. Staff identified, however, that some patients declined attendance or stopped attending after a short time. Feedback indicated this was due to the inflexible nature of the model.

Aim and approach used

A period of consultation was planned, with main stakeholders, to explore opinion and different models of care. Meetings were held with patients, staff, referrers, Trustees, hospitality and driving volunteers. A questionnaire was subsequently developed and sent to these stakeholders to provide further data. One hundred and fourteen questionnaires were returned and analysis of data provided evidence to support change while retaining some of the traditional model of care.

Outcomes

A redesign of the weekly programme to include three days of the traditional Day Hospice model and two days of new individual and group activities.

Increased flexibility in the service

Patients accessing different elements of the service at different stages of their journey

Full day, half day and one hour appointments

Additional carer support activities.

Opportunities for staff and volunteer development.

Ongoing re-evaluation of the programme and adaptations as needed.

A service which is now more receptive and open to change.

Application to hospice practice

Hospice services are being challenged to consider their future and plan strategically to meet the changing needs of the people they support1. Day services should not be exempt from this scrutiny. Changing a model of care can be difficult and painful, but services must ultimately meet the needs of the people they support to be viable. In a changing social and medical world Day Hospice services need to be flexible and open to change in order to deliver and sustain a future proofed service.

Reference

1Calanzani et al (2013)Current and future needs for hospice care.Help the Hospices, London.
P23 New model of day therapy services within Lincolnshire - opening doors
Authors: Mumby Mark , Jones Rachel
Published: October 2013

Historically the predominant case mix for Day Care was elderly patients, those in their last year of life and with primarily a cancer diagnosis.

In 2011 we reviewed how services could be provided countywide for a rural county population circa 712,000 (1) that would assist patients earlier in their palliative journey, those with non cancer diagnosis and attract younger patients. We aimed to increase the capacity to support more patients within existing resources and deliver a wider range of therapeutic interventions.

To achieve accessibility for the maximum number of patients, services were established in eight different locations including providing therapy within GP practices and community halls, and also inreaching to meet the needs of dementia patients in a nursing home setting.

Whilst the philosophy was unchanged, the service was redesigned and continues to develop responsively and with flexibility. A diverse range of therapeutic interventions are available and a plan of care is tailored to meet the individual patient and carer needs following assessment. New volunteer roles with specific profiles were developed to augment the nursing staff. The community engagement officer increases awareness to diverse and often hard to reach groups.

Evidence from patient reported outcome measures, piloting and evaluation enable creative and on going service design to meet emerging needs. Structured training programmes for staff and volunteers continue.

Increased access to the service is evidenced by data collection, demonstrating a 51% increase countywide, with 70% increase of 18-64 age group and 74% increase in non cancer patients, demonstrating greater opportunities for those with life limiting illnesses to be supported to reach their full potential.

This service will be sustained and enhanced by working in partnership, signposting, and through additional innovation such as commissioned Carers Assessment.

Lincolnshire Research Observatory.

http://www.research-lincs.org.uk/Latest-Population.aspx