bluuebunny/crossref_metadata_2025 huggingface dataset:
ARCHAEOLOGICAL RESEARCH AND CONTEMPORARY ATTITUDES TO DEATH AND DYING
Authors: Croucher Karina
Published: February 2014

Background

The disciplines of palliative care and archaeology have rarely had the means or incentive to engage. This research introduces a new project which initiates dialogue between the study of the ancient and the contemporary. The project is in its exploratory stages and participation in PCC will inform future research direction. Archaeological evidence provides new information which challenges culturally-constructed notions of acceptable mourning behaviour, providing new insights into grief and mourning, and the anticipation of death and loss. For instance, Neolithic case studies include the phenomena of plastered skulls (the recreation of faces of the deceased onto crania, using clay or plaster), a practice which, rather than being abhorrent or disrespectful, suggests deep-rooted reactions to death, dying, and a need to keep the dead physically and emotionally close.

Aims

To bring archaeological case studies into the Palliative Care profession to:

▸

Provide evidence for the longevity and deep-rooted experiences of grief and loss (including Continuing Bonds)

▸

Provide a tool for facilitating discussion around death and mortality using a removed yet compelling data set (currently problematic with contemporary attitudes and near-taboo status of death)

Methods

The archaeological analysis is qualitative and has taken a case-study, contextual approach. In addition, data from excavation sites has been analysed to determine age, sex, cause of death, use, display, decoration, damage, repair and location. Presenting archaeological data at PCC is a preliminary stage of the project, inviting responses from PCC delegates which will inform future research direction and collaboration.

Results

Archaeological research demonstrates strong evidence of Continuing Bonds in archaeological contexts, yet this is rarely communicated outside of archaeological discourse. Engagement through PCC will provide further incentive for collaborative research between Humanities and Health Care professionals in exploring the potential role of the past in informing contemporary practice around death, dying and end of life care.
OLDER PEOPLE'S CANCER PAIN EXPERIENCE, PRELIMINARY FINDINGS FROM A QUALITATIVE STUDY
Authors: Dunham Margaret , Collins Karen , Allmark Peter
Published: February 2014

Aims

Despite knowing that cancer and cancer treatment can cause pain there is limited knowledge of how older people experience cancer pain and how this affects their daily lives. Here presented are some methodological insights and early findings from a PhD study that aims to consider how older people construct the experience of cancer pain and how this is informed by expectations and experiences.

Method

A qualitative diary-interview study was conducted with purposively selected older people who had been diagnosed with cancer and were in receipt of specialist palliative care. A two week page-a-day diary informed a subsequent interview to ensure holistic and person focused data about experience.

Findings

Older people are willing participants but tend to adopt a stoic role when living with cancer pain. Preliminary results show that older people are reluctant to self identify as living with worsening cancer pain and unwilling to express and discuss their pain as a problem, rather something to adapt and live with. Carers and or health care professionals may reinforce vulnerable and stoic stereotypes through gate keeping with associated stances of protection and advocacy. The participants appeared to be satisfied with the care provision for symptom management. However, the convention of stoic ageing is knowingly maintained with occasional glimpses of vulnerability. This image contrasts with the presented and perceived representation of older people with cancer as vulnerable.

Conclusions

Representation of the voice of older people through a diary may help the individual to present their experience more effectively to a third party. Awareness of older people's experience of cancer pain, through diary use and shared experiences, may give health care providers a greater understanding of the older persons support needs.
USING QUALITATIVE EVIDENCE TO HELP UNDERSTAND COMPLEX PALLIATIVE CARE INTERVENTIONS: A NOVEL EVIDENCE SYNTHESIS APPROACH
Authors: Candy Bridget , Jones Louise , King Michael , Oliver Sandy
Published: February 2014

Background

Many palliative care interventions that aim to enhance patient or family wellbeing are complex. This is often because the intervention involves multiple elements and it is unclear which of these elements contribute to its success. For example, an intervention that aims to support family caregivers may involve both emotional support and education. Different interventions, while being the same over-arching type of supportive intervention, may differ in what is provided to the caregiver. This makes it difficult in a systematic review to provide conclusions for palliative care practice. Qualitative evidence has potential in intervention design.

Aims

Using a case example on promoting adherence to therapy, we present novel approaches that may help enhance understanding of complex interventions.

Methods

In a table we combined (1) qualitative evidence synthesis on patients' suggestion on adherence promotion, with, (2) the content of interventions from multiple trials that aim to promote adherence. This created new data relationships, where the intervention content did and where it did not correspond with the content of effective interventions. We summarised the relationships narratively, statistically and using set-theory. We did this to compare techniques.

Main results

Across the techniques we found consistent evidence that certain patient suggestions, if taken up in the intervention, may enhance its success. Many of these related to positive activities, such as clear instructions or emphasising the value of treatment. Suggestions absence in effective interventions were those in relation to more challenging aspects to adherence.

Conclusions

Our approach of summarising pooled evidence on patients' views and intervention content provided new evidence on how to develop interventions. Our findings are strengthened as similar results, were found using different analytical techniques. Our approach provides a potential opportunity to make greater use of qualitative evidence on patients' and families' perspectives in relation to palliative care. The method may help accelerate better supportive interventions.
A QUALITATIVE STUDY EXPLORING THE VIEWS OF INTENSIVE CARE UNIT STAFF ON THE USE OF A SUPPORTIVE CARE PATHWAY TO GUIDE THE CARE OF PATIENTS WHO MAY NOT SURVIVE THEIR ICU ADMISSION
Authors: Radcliffe Christina
Published: February 2014

Background

The need to provide quality palliative care within the intensive care unit (ICU) is increasingly recognised. Mortality and morbidity are high, and studies have noted benefits to providing palliative care support within ICU; however, there remain barriers to achieving quality end of life care.

Aims

Within a large tertiary referral centre ICU, a Supportive Care Pathway (SCP) was introduced with the aim of providing holistic care to patients and families where it was recognised that the patient may not survive their admission. This study aimed to explore the perceptions of intensive care doctors and nurses regarding the advantages and disadvantages of the SCP.

Methods

This was a qualitative study. Sampling was purposive. Semi structured interviews were conducted by the primary researcher and transcribed verbatim. Interviews continued until data saturation was reached. Analysis was by grounded theory.

Results

10 face to face interviews were conducted, with 5 doctors and 5 nurses working on ICU. The study found that the SCP aided in reaching a consensus between team members caring for an individual patient. It was felt to empower staff to question the trajectory of care, and it was useful in helping to manage the expectations of family members, and at times, of colleagues, about ICU care. Participants found that dealing with uncertainty was a difficult part of managing care on ICU, and there were concerns voiced that it was difficult to identify the correct patients to put on the SCP, and that the SCP could become a self fulfilling prophecy. There were also concerns about the SCP becoming a euphemism for dying.

Conclusions

Participants were generally positive about the SCP and felt that it provided a useful mechanism for communication of the goals of care. There may be a role for similar care pathways more widely within intensive care units.
HOW DO GOLD STANDARD FRAMEWORK MEETINGS SUPPORT PALLIATIVE CARE DELIVERY AS PART OF PRIMARY CARE SERVICES? AN OBSERVATIONAL STUDY
Authors: Haraldsdottir Erna , Baughan Paul , Forbat Liz
Published: February 2014

Background

Whilst uptake of the GSF is widespread there is a lack of evidence to demonstrate how it supports GPs and district nurses to deliver palliative care in primary care. This small study provides insight into the use of GSF meetings within 3 GP practices within NHS Forth Valley.

Aim

To identify how GP practices make use of GSF meetings in order to improve palliative care in primary care.

Methods

GP practices that were considered as ‘good examples’, in relation to use of GSF, were invited to take part in the study. 8 GSF meetings were observed and tape recorded. Thematic analysis was used to analyse data, providing order to the data set and allowing for key themes to emerge and be identified.

Results

There is ongoing uncertainty amongst GPs related to the criteria for when/what patients should be on the palliative care register, especially for patients with long term condition other than cancer.

There was much variation between the GP practices in regards to how many patients they had on the register from 5–54 and this was not in the expected relation to size of practices.

GSF meetings were constructed through informal dialogue without any use of formal documents for assessment or management plan.

GSF meetings were used for a brief update on the patient condition and situation, key symptom and how they were coping at home.

Only one of the three practices used GSF meetings systematically to check if documents related to Advance Care Planning were in place.

Conclusion

It appeared that the main benefits of the uptake GSF was related to increased awareness, for those who attended the meeting, of the patients' current situation, possible supporting better coordination of care. However it is unclear how the information sharing benefitted patients in relation to clinical outcomes. Further research is needed to explore how uptake of the GSF improves clinical outcomes.
INTEGRATING PALLIATIVE CARE INTO A REGIONAL REFERRAL HOSPITAL IN KAMPALA THROUGH A LINK NURSE PROGRAMME
Authors: Downing Julia , Batuli Mwazi , Kivumbi Grace , Kabahweza Josephine , Leng Mhoira
Published: February 2014

Background

In order for palliative care to be provided to all in need, an integrated approach to service delivery is needed, where a mixture of specialist and generalist care is provided. A needs assessment in 2010 showed 40% of patients in Mulago hospital have palliative care needs. Thus the Makerere Palliative Care Unit (MPCU) developed a programme to train link–nurses across the hospital supported by a referral pathway and identification process.

Aims

To integrate palliative care into all wards of Mulago Hospital through a link-nurse programme.

Methods

27 link nurses from 11 clinical areas, were trained and mentored over the past 2 years. An evaluation of the programme was carried out using quantitative and qualitative data collection methods including; pre and post course confidence ratings; course evaluation forms; review of link-nurse activity sheets and action plans; review of MPCU patient documentation; Most Significant Change (MSC); and focus group discussions (FGDs).

Results

Link nurses cared for 1,684 patients during 2012, of these, 336 (20%) were referred to MPCU for specialist input. Referral patterns suggest the complexity of patients referred to MPCU has increased with >75% of MPCU patients having complex needs requiring specialist input. Results of the evaluation suggest the link-nurse programme has helped integrate PC throughout the hospital. There has been a change in attitudes, the nurses have developed new skills and knowledge, there is improved relationships and better outcomes of care. Challenges identified include heavy work-load and the need for training for other staff.

Conclusion

The link-nurses felt they were able to provide better PC to those that needed it, and had a stronger relationship with the MPCU both in terms of support, but also for referrals. The integration of PC throughout hospitals is vital, and the link-nurse programme demonstrates a successful model.
PROPOSAL OF A COMPREHENSIVE MODEL FOR PALLIATIVE CARE SERVICE DELIVERY IN THE REPUBLIC OF SERBIA
Authors: Downing Julia , Baskott Jo , Haraldsdottir Erna , Lukic Nina , Milicevic Natasa , Naylor Mike
Published: February 2014

Background

Following the adoption of a national palliative care strategy by the government of the Republic of Serbia in 2009 it was decided to develop a comprehensive model of palliative care service delivery which is appropriate to the circumstances and resource constraints of Serbia.

Aims

To develop a comprehensive model for palliative care service delivery that is appropriate and affordable for Serbia, in partnership with the Ministry of Health and key stakeholders.

Methods

A model of care was developed in four phases: (1) Review of existing legislation and the context and provision of health services in Serbia (2) The development of service delivery standards, and instruments for palliative care implementation. (3) A participative field study in three sites to gather information and conduct discussions with stakeholders, Issues covered included the availability and use of existing resources; provision of health services at the different levels, and key deficits in service provision. (4) Drafting of model of palliative care service delivery. (5) Consultation with key stakeholders.

Results

A draft model of palliative care service delivery has been proposed using available Serbian practice & experience complemented with good practice from neighbouring countries & international PC. The proposed model includes the following resources: a policy, model implementation guide, resource plan, quality indicators, standards of care, instruments for implementation, and best practice guidelines. The consultation process is ongoing and due to be finalized by the end of the year.

Conclusion

The development of a model of service delivery which sets out guidance for the provision of care at each level of the healthcare system is a vital component in operationalising palliative care. Whilst initial draft documents may be finalised, it is important to recognised that any model of palliative care service delivery needs to be fluid and respond to the ongoing needs within the country.
HEALTH PROFESSIONALS’ PERSPECTIVES ABOUT ADVANCE CARE PLANNING IN PARKINSON'S DISEASE: A QUALITATIVE STUDY
Authors: Jackson Timothy , Gerhard Alexander , Walshe Catherine
Published: February 2014

Background

People with Parkinson's disease face repeated hospital admissions and medical interventions in the last year of life. Advance care planning (ACP) is advocated, aiming to empower patients by engaging them in decisions about their future. There is little evidence about the optimum timing and content of ACP or how this process should be coordinated for those with Parkinson's disease.

Aim

To discover the views of health professionals on best practice for ACP in Parkinson's disease and how organisations might better support multi-disciplinary teams to undertake ACP.

Method

Qualitative design, using semi-structured interviews with a purposive sample of health professionals, with experience of Parkinson's disease or ACP in other neurological conditions (n=16). Participants were recruited through neurology, elderly medicine, and palliative care departments at three organisations (a tertiary neurology centre, teaching hospital and a hospice). Interviews were audio-recorded and transcribed. Iterative thematic analysis comprised familiarisation, coding and categorisation. The study received all necessary governance approvals.

Results

There was consensus that prognostic indicators and patient cues should prompt discussions at an appropriate time for each individual. Potential discussion areas included preferred place of care, artificial nutrition and hydration, and future hospitalisation. Participants felt the organisational approach to ACP should be better coordinated through improved collaborative working across different settings and use of tools such as electronic palliative care records. Some felt professionals should be offered further training, but most felt that different aspects of ACP could be undertaken by a range of medical, nursing and other staff.

Conclusion

ACP should be a personalised, flexible and dynamic process for patients with Parkinson's disease. Organisations should support different staff groups to undertake ACP, providing appropriate tools, training and resources. Better joint working between palliative care, neurology and elderly care teams and allied health professionals should be encouraged and supported.
WHAT IS THE QUALITY OF END OF LIFE CARE FOR THOSE WHO DIE AT HOME? A STUDY TO EXPLORE THE VIEWS AND EXPERIENCES OF BEREAVED CARERS'
Authors: Lees Carolyn , Mayland Catriona , West Angela , Germaine Alison
Published: February 2014

Background

The quality of end of life care has been the focus of much government policy. Collecting data from those who are dying is complex (Mitchell, 2002) but it appears that relatives and carers' views provide a valuable evaluation of the patient's end of life care, synergised with their own unique experiences as carers (Maylandet al, 2012).

Aim

To explore bereaved carers' experiences of end of life care for those who had died at home using a validated tool.

Methods

A mixed method approach comprised of a self completed questionnaire allowing respondents to provide narrative to support their responses. Two hundred and ninety one patients who had an expected death at home were identified. Narrative data from the questionnaires were analysed using framework analysis identifying prominent words and phrases, expanded to include associated key words or themes (Richie & Spencer, 1994).

Results

Four main themes and associated sub themes emerged from the narrative data. The main themes were coordination and continuity of care, competence, compassion and communication. Quantitative data will not be presented here.

Discussion

The findings from this study reflect that generally good quality care was provided for those who died at home. There were examples of well orchestrated care with services working well together, but there were times when adequate support was not evident.

Conclusions

With the number of deaths globally set to increase there is a need to identify tools which measure the quality of end of life care for those who choose to die at home in order to improve the experiences of patients and carers. The CODE questionnaire represents a user friendly, comprehensive tool to achieve this.
DEPRESSION AMONG PALLIATIVE CARE INPATIENTS IN A SONGKHLA HOSPITAL, SOUTHERN THAILAND
Authors: Vichurangsri Teeraporn , Sae-Chit Kallaya , Nilmanat Kittikorn
Published: February 2014

Introduction

Depression is common in patients with advanced disease. However depression remains under detected.

Objective

This retrospective study was aimed to describe depression among patients seen by an advanced practice nurse in Songkhla hospital.

Methods

Subjects were hospitalized patients who were consulted to a palliative care service. In general, every patient consulted to a palliative care team received a routine first assessment by an advance practice nurse. A routine assessment included demographic data, clinical data and health profiles. The nurse administered two questions screening tool (2Q) for depression screening. “Do you feel depressed?” and “have you lost interest or pleasure or felt boring?” If it was found ‘positive result’ for depression, further 9Q–nine questions for depression and suicidal minds assessment was applied. Patients' palliative care nursing record were recruited into the study between January 2013 and June 2013. Descriptive statistics were used.

Results

A total of 188 nursing records were reviewed to estimate the incidence of depression. At a screening section, using 2Q short form Depression Screening Questions, 35.1% of the subjects had negative result while 18.6% had positive result or were risky for depression. The rest (46.3%) were not able to assess, because patients were unconsciousness or on ET tube. Those being at risk for depression were further assessed by 9Q. According to the original cut-off point of 9Q, .5 % of those assessed classified as severe depression (9Q>19), and 2.1% were at moderate level of depression (9Q 13–18) and 6.4% were at mild level of depression (9Q 7–12). 9.6% were at the borderline level of depression.

Conclusion

The findings suggest that health professionals should recognize psychological distress among this population by providing an initial screening assessment and preventive intervention.
AFTER IWANTGREATCARE: SERVICE USER FEEDBACK AS A MEANS OF REFINING THE IWANTGREATCARE QUESTIONNAIRE
Authors: Bowyer Anna , Finlay Ilora , Byrne Anthony , McCarthy Jacqui , Harrop Emily , Sampson Catherine , Snow Veronica , Nelson Annmarie
Published: February 2014

Background

The iWantGreatCare (iWGC) questionnaire was developed by the Palliative Care Implementation Board and aims to evaluate palliative care service provision in Wales, through the appraisal of care, as encapsulated in 10 questions and a free text box.

In order to fully reflect patients' and families' experiences of care, we previously undertook a qualitative analysis of the free text comments of 596 patients and carers, which highlighted areas not fully assessed in the scored results. Following this analysis, we are undertaking a further project to refine the questionnaire to accommodate patients' and carers' priorities and concerns.

Methods

The questionnaire was refined via an expert consensus day with healthcare professionals, researchers and a lay representative, utilising the qualitative free text analysis, and is now being tested using face–to-face, semi-structured, cognitive interviews with patients (n=10) and carers (n=10), who use palliative care services at two hospices in South Wales. The questionnaire comprehensively encompasses the elements of palliative care previously identified as important to patients and carers. Interviews aim to test whether the questions are understandable and pertinent to those completing the questionnaire. Interview transcripts from recorded data are to be analysed using a six phase thematic analysis.

Results

It is expected that the interviews will inform the final questionnaire revision prior to being presented to the Palliative Care Implementation Board for their consideration. The results of these cognitive interviews and the refined questionnaire will be outlined and discussed in this presentation.
DO HOSPITAL NURSES ADMINISTER NASAL FENTANYL SPRAY CORRECTLY? – A SERVICE EVALUATION
Authors: Fingas Samuel , Bourke Anne-Marie , Spawton Vanessa , Richardson Sian , Miller Elizabeth , Ahmedzai Sam H
Published: February 2014

Background

PecFent®is a powerful fast-acting fentanyl nasal spray which is used for breakthrough cancer pain. When it is not administered correctly or titrated quickly enough, we suspect aspects of patient care may suffer, with sub-optimal pain control, loss of confidence in the medication, and unnecessary cost to the health service.

Aims

To assess hospital nurses' confidence and competence in administering PecFent®. To identify specific needs for further training.

Methods

We used a convenience sample of 5 nurses (who had previously administered PecFent®) per ward or hospice unit in Sheffield where PecFent®is commonly prescribed. A guided questionnaire-based interview, involving a standardised scenario using placebo PecFent®, was piloted on 4 specialist nurses. The scenario required the nurse to titrate the dose from 100 to 200 mcg and administer it to an actor, followed by questions on confidence, previous experience, training, and understanding of PecFent®.

Results

A total of 35 nurses were interviewed from 7 wards/units. 29% (10/35) chose the correct dose of 200mcg. Commonest reasons for reluctance to titrate the dose up were: “long interval since previous dose” (n=16); and “only had 100mcg doses previously” (n=8). Only 40% enquired about effectiveness of the previous dose. 34% gave a spray effectively (primed device, aiming at nasal septum, no deep inhalation, one nostril/spray). 6% gave the correct dose effectively. 69% of nurses had given PecFent®>10 times previously. 54% rated their confidence as ≤7/10. Only one nurse had received formal training; 80% of nurses had learnt through observing a colleague. 77% wanted further training.

Conclusion

We have demonstrated lack of confidence and competence in administering and titrating PecFent®effectively. We are making a training video to cover priming, direction of spay, instructions for breathing, and dispelling the myths about titration.
VARIATIONS IN METHADONE PRESCRIBING AND OUTCOMES — A SERVICE EVALUATION IN SHEFFIELD AND CHESTERFIELD
Authors: Bourke Anne-Marie , Theobald Rebecca , Ahmedzai Sam H
Published: February 2014

Background

Methadone is a synthetic opioid used in refractory pain. There is increased awareness of methadone related adverse events including respiratory depression and QTc prolongation. In our region several methods exist for methadone initiation, falling into two categories: switching one opioid to methadone (stop and go — SAG) and adding methadone to another opioid (addition — ADD).

Aims

To characterise how methadone is being used locally. To quantify the nature and frequency of methadone induced side effects.

Methods

All patients prescribed methadone by the palliative care teams in Sheffield and Chesterfield over an eight month period were included. Data were prospectively collected on diagnoses, indication(s) for methadone, method of conversion, ECG recording, pain scores and side effects.

Results

25 patients were prescribed methadone, all as inpatients. 20 patients had malignancy, the remainder chronic pain. Methadone was chosen in all cases due to persistent pain and/or medication side effects. A SAG method was used for 72% and ADD for 28%. The median daily oral morphine equivalent dose prior to initiation was 240 mg (range 50 mg – 1000 mg). 92% had an ECG prior to commencing methadone.

Following titration, the median methadone dose was 10 mg BD (range 4 mg – 40 mg BD). Average pain scores reduced from 7/10 to 3/10 in both groups.

28% reported side effects of sedation, nausea, confusion or hallucinations. 2 patients required naloxone and 3 developed QTc prolongation, all in the SAG group.

72% were discharged home, 8% were transferred to another hospital and 20% died. None of the deaths were attributable to methadone.

Conclusion

Locally, methadone is prescribed for patients with chronic pain as well as those with malignancy. Methadone results in clinically meaningful pain relief regardless of method of initiation. A SAG method is used most frequently. All five clinically significant adverse events were reported in the SAG group.
CHALLENGES OF PROVIDING PALLIATIVE CARE IN A CRITICAL CARE SETTING
Authors: Davies James , Vora Vandana
Published: February 2014

Background

An ageing population with complex co-morbidities and rising public expectation for high quality life sustaining treatment has seen a rising demand for critical care. End of life care strategy (2008) recommends delivery of high quality service in all locations including acute hospitals.

Aim and method

To retrospectively review all referrals to Hospital Palliative Care Team (HPCT) over a 12 month period from specialist and general critical care units of a large teaching hospital. The objectives were:1) to identify reasons for referral, 2) to assess impact of palliative care interventions on patient care and 3) to identify the unique challenges of providing palliative input into critical care. Information was extracted from Infoflex, an electronic patient database that captures details of referral, diagnosis, patient assessment and palliative care interventions.

Results

36 patients (22 male, 14 female) median age 65.5 (range 39–94) from critical care facilities were referred to HPCT over 12 months. 21 had a diagnosis of malignancy. Reasons for admission included sepsis, multi organ failure and post-operative care/complications. The reasons for referral were symptom control, support with withdrawal of therapy and management of terminal care including support to carer. 32 out of 36 patients have died. Of these, only 11 died in a critical care unit. The HPCT was able to facilitate and achieve preferred place of death outside acute hospital for 11 patients. The biggest challenge was communication as the combination of critical illness and invasive interventions often diminished the capacity of patients to make decisions. Discontinuity of care and accepting the shift in goals from intensive treatment to palliative care was emotionally difficult for staff and family.

Conclusion

Despite the challenges, it is possible and appropriate to give compassionate palliative care to dying patients and their carers in a critical care setting through good interdisciplinary team working and communication, adopting a proactive approach.
FIVE YEARS ON: THE INCREASING USE OF ULTRASOUND IN A HOSPICE
Authors: Lee Bernadette
Published: February 2014

Background

Since 2008, several new doctors have attended the Focused Abdominal UltraSound in Palliative Care course. The course taught the examination protocols for ascites, liver, urinary tract and deep vein thrombosis (DVT). A log book was kept with the scanner.

LocationYearNew doctors trainedNumber of doctors doing scansNumber of scansNumber of patientswardOPDhomenursing home200863241624000200903151315000201014221620200201147242017250201216402930721total12–125941061171

Aims

The aims were to audit:

the frequency of use

whether the course examination protocols were followed

the impact of having ultrasound

whether cleaning of the transducer was recorded

Information from the log book and patient records were used to complete the audit.

Results

In the last 3 years, the number of scans increased from 22 to 40. There was a trend for patients who might need paracentesis to be assessed before admission was requested.

All 125 scans followed examination protocols.

The clinical indications were confirmation of ascites (97), urinary bladder (14), hydronephrosis (3) and groin DVT (1). Each scan had been helpful in the clinical decision making: paracentesis were done on 22 occasions, prescription of diuretics (1), referral for PleurX drain (1) and insertion of urine catheter (12). 92% (115/125) log entries recorded cleaning of transducer.

Conclusions

There has been increasing and appropriate use of ultrasound last 5 years. The use of inpatient beds were optimised. Cleaning of the transducer needs to be done each time and recorded. Annual audit of ultrasound use is planned.
IMPROVING NURSING DOCUMENTATION
Authors: McMullen Laura , Gale Sue
Published: February 2014

Background

Audits in 2008 and 2009 show documentation was incomplete in 50% and 57% of cases: below an ideal standard of 91–100%. Omissions were due to poor utility by nurses and unsuitable pro-forma design, (duplication, lack of clarity, haphazard) and time consuming when transcribing to additional sheets at discharge. Nurses re-designed their pages which redressed problems highlighted and facilitated its use at discharge to community Health Care Professionals (HCPs). The resultant pro-forma was audited.

Aim

To ascertain completion of the new documentation compared with previous audits, confirm its use to community HCPs, and identify areas for improvement.

Method

The documentation was audited retrospectively using a copy of the pro-forma as the audit tool. Analysis was RAG rated: RED less than 70% completed, least acceptable, actions required. AMBER 70% – 90% completed, acceptable but scope for improvement. GREEN 91% – 100% completed, ideal standard.

Results

15 sets of notes were audited (65% of one month's admissions). Data were collected on pages completed by nurses, which totalled 117 fields. Overall, 74% of the fields achieved either GREEN or AMBER status with the remaining 26% in the RED. Information commonly omitted related to community services, such as was the patient registered as ‘palliative’ with their out-of-hours GP provider, community HCP's contact details, and care planning post discharge. Data missing on admission included; co-morbidities, metastasises, contact numbers and expected discharge date. Results for tests/investigations were not documented in most cases. Each patient's community HCPs were sent a copy on discharge.

Conclusion

Significant improvements made using the new documentation; 26% in the RED compared with 100% in both pervious audits. Patient information is more succinct, de-duplicated, streamlined, and comprehensive enough to use at discharge to community HCPs; a survey of the latter underway. Nurses encouraged, and are, more diligent in recording information. Community information pending further review.
'TAKING THE CLINIC TO THE PATIENT'
Authors: Waldock Joy
Published: February 2014

Background

Palliative care patients often struggle to attend outpatient clinics as they reach the end of life, preferring to be seen at home by Macmillan nurses. Sometimes a medical review is needed but as consultants often work across different settings with fixed commitments, ‘ad hoc’ home visits can be difficult.

Hospitals gain income from outpatient attendances and there is a pressure to ensure clinics are full and non attendance rates are kept low.

Within MYH (population ∼500,000) there were 4 palliative medicine outpatient clinics each week in three different hospitals. An average of 14% of clinic slots were filled. In October 2012 the decision was made to ‘take the clinic to the patient’ and one consultant changed the clinic and to offer ‘slots’ for home visits.

Aims

The aim of this evaluation was to see how many patients were seen at home in a 6 month period, whether they would have been well enough to attend a clinic and to assess the symptoms seen.

Results

1–3 patients/session

94% had cancer

41% had pain, 43% other symptoms, 16% psychological issues (some overlap)

38% were well enough to attend an outpatient clinic, 41% were not

In 21% might have been ‘possible but difficult'

Several patients were seen in the last 2 weeks of life, a situation where a clinic attendance is not likely to be appropriate.

Conclusions/recommendations

Numbers are small, there is capacity for more visits.

Patients were seen who would not have managed to get to a clinic.

There was still capacity in the remaining 3 clinics.

Arrangements are informal but seem to suit the community team.

Having one fixed day to do visits is helpful from the consultant's organisational point of view but may not be as responsive as ideal for the community team.
ISSUES ENCOUNTERED BY FAMILY MEMBER FOR CARING OF ELDERLY POPULATION: A PERSPECTIVE OF ELDERLY PATIENTS VISITING PRIMARY CARE CLINICS IN PAKISTAN
Authors: Ashfaq Tabinda , Mohammad Fauzia Haji
Published: February 2014

Background

Elderly population particularly aged 65years and more contributes to 380 million people globally and by the year 2020, this population is projected to increase to more than 690 million .This older population is vulnerable to various disabilities as a consequence of stroke, dementia, heart diseases and trauma and demands the need of care giving services provided by care givers to older population can improve their quality of life and survival.

Objective

To find out issues encountered by family members for caring of elderly population as perceived by elderly patients visiting primary care clinics in Pakistan.

Methodology

A cross sectional questionnaire-based study was conducted at the Community Health Centre (CHC), Aga Khan University Hospital (AKUH) Karachi, Pakistan. All consenting individuals, visiting the CHC and aged 65 years or above were interviewed after taking written informed consent and strict confidentiality was assured.

Results

A total of 400 elderly completed the interview. Majority were females, 65-69 years age, Over half of the individuals ie: 227 (85%) had received Care Giver experience for assistance and among these 195 (72%) had care provided by an immediate family member. Majority of the patients (86%) preferred family member as care givers and were satisfied by service provided by their family members (94%) however only 4% were not satisfied. Problems in providing care giving was faced by (43 %) of the care providers .most common issues encountered by family member while providing care giving included financial difficulty (3 0%) lack of time (30%) followed by job responsibility (22%),home responsibilities (10%) and, health reasons (6%) respectively.

Conclusion

Elderly care is provided by majority of the family members resulting in increased satisfaction level, however small number still not satisfied due to unfulfilled need of these older people. This demands that efforts should be made to strengthen the family support by increasing awareness regarding elderly care and arranging support system by the government.
IMPLEMENTATION OF A SMALL, PORTABLE, OPIATE CONVERSION GUIDE FOR STAFF IN AN INDEPENDENT HOSPICE
Authors: Bernstein Laura , Nightingale Laura
Published: February 2014

Background

Effective and safe titration of medication has a major impact on patient comfort. Confusion surrounding the differing ranges and potencies of opiates and benzodiazepines can result in under- or overdosing of medication leading to inadequate control of symptoms or resultant toxicities respectively. Through staff feedback, teaching sessions and review of drug errors, we identified that staff used differing opioid conversion guides and lacked confidence when converting between benzodiazepines. Staff identified the need for a consistent local approach when converting between different opioids or benzodiazepines using a guide that could be easily accessed across clinical settings.

Aims

To provide staff with a conversion table for opioids and benzodiazepines which is evidence-based, cost-effective, replicable and accessible across clinical settings.

To standardise prescribing.

To reduce drug errors related to opioid and benzodiazepine prescribing, conversion & administration.

Results

A small, portable, laminated conversion chart for opioids and benzodiazepines was created to enable consistent conversion between different drugs and between the oral, subcutaneous and transdermal routes. The chart is an identical size to the staff ID badge so that they can be easily attached together to a lanyard for ease of access and use.

Conclusions

Unanimously positive feedback was received from staff following the introduction of the conversion chart. In particular, staff value the accessibility and usability of the chart in clinical practice since it has been attached to their lanyard.

It enables less experienced doctors to prescribe accurately and empowers nursing staff to confirm doses prior to administering the medication, using standardised guidance. Following a positive reception, the lanyard-attached conversion chart has now been adopted by the local NHS trust. It is too early following implementation to assess impact on drug errors, but there are plans to review this through the local Medicines Management Group.
INTRODUCTION OF A REVISED, COMBINED ADMISSION AND DISCHARGE PACK, WITHIN AN INPATIENT PALLIATIVE CARE SETTING
Authors: Watts Anita , Gale Sue
Published: February 2014

Introduction of a revised, combined Admission and Discharge pack, within an inpatient Palliative care setting.

Background

Discharge documentation in a Specialist Palliative Care unit was found to be repetitive, time consuming, not user friendly, and poorly utilised by nurses.

Aim

To create a comprehensive, streamlined and user friendly admission to discharge pack. The intention was to enhance communication between multi-disciplinary and community teams.

Method

A group was formed to review and redress the identified problems. An admission-to-discharge pack was designed, reducing existing documentation. The scheme was piloted. A survey was sent to the target community health care professionals within one week of discharge.

Results

Survey response rate was 40%. All respondents indicated that the information was ‘Very useful’ and relevant post-discharge. No irrelevant material was identified; the format was reported as organised and comprehensive. Suggestions for additional information were ‘Do Not Attempt Resuscitation status (DNAR)’, medication summary, and inclusion of other inpatient specialists.

Discussion

The new documentation was successful in that it mapped relevant information from admission to discharge. It was also comprehensive enough to use at discharge to community HCP, thus negating the need for transferring information to additional referral forms; which is time consuming and repetitive. Inpatients' DNAR status is not transferable and should be re-assessed post-discharge, and a medication summary is faxed therefore no changes were made pertaining to these two request; ‘Other hospital specialist/s’ was added.

Conclusion

This survey showed positive feedback from community HCPs. The new documentation was well received and found to be useful. Providing timely and comprehensive information to community HCPs is imperative for care and its planning, especially at end-of-life when changes can rapidly occur due to the complexities within this client group. The overall aim was achieved and the documentation greatly improved. A subsequent audit confirms improved compliance with document completion.
THE CHOICE CAMPAIGN
Authors: Whitfield Andrea , Morris Tracey , Morris Trevor , Quinn Derek , Tymon Lorraine
Published: February 2014

The Choice Campaign Introduction Offering patients and their carers opportunities to have conversations about preferences for care is key to enabling realistic decisions and choices. Feedback from acute trust clinicians shows that holding these conversations can be difficult, resulting in lack of patient and carer involvement, increased bed days at end of life and carer distress in bereavement. Aims • To raise awareness that choice in place of care at end of life is possible • To encourage patients, carers and staff to initiate conversations about end of life care (EoLC) and advance care planning (ACP) • To empower staff to have effective and sensitive discussions with patients and carers • To reduce bed days Method As part of the Choice Campaign we designed a poster fronted by a young cancer patient and featured in local media. Pilots were held on 2 wards with training for staff and support provided to relatives at visiting times. The Posters are next to all clinical areas accompanied by information about ACP and contact details for the EoLC Coordinator with an Out of Hours answer phone for messages. Results Feedback from patients, carers and staff has been positive although some clinicians were initially concerned that the poster would cause distress and raise unrealistic expectations. Since launching the campaign the EoLC Coordinator has reported increasing contacts via the telephone helpline. There has been an increase in the use of the rapid discharge at end of life pathway . Staff are demonstrating an awareness of the importance of ACP. An evaluation will be included in the presentation. Conclusion The poster campaign is the first step in enabling choice in end of life care within the Trust. We plan to consolidate this through an intensive ward based programme of end of life training and outcomes monitored at Board level.
WHAT FACTORS INFLUENCE THE TERMINALLY ILL PATIENT REFERRED TO THE HOSPITAL SPECIALIST PALLIATIVE CARE TEAM IN A NHS HOSPITAL, NOT ACHIEVING THEIR PREFERRED PLACE OF DEATH? A CRITICAL EVALUATION
Authors: Damanhuri Geraldine
Published: February 2014

Background

The purpose of "The End of Life Care Strategy" document (2008), was to introduce a strategy to promote high quality end of life care (EOLC) for patients approaching the end of their lives. One quality marker was to ensure that individual patient preferences and choices for EOLC were documented, communicated and achieved if possible. There is evidence of an overwhelming preference for patients to die at home, hospice or nursing home.

Aim

To discover if patients known to a NHS hospital palliative care team achieve their preferred place of death (PPD). To explore, illuminate and describe reasons why this may or may not happen. Results will be used to inform, educate and improve clinical practice.

Research Design

A critical evaluation retrospective explorative case study using both quantitative and qualitative methods.

Setting

A NHS hospital in an inner city setting in Southern England

Sample

A non-probability purposive sample of 110 participants referred to the hospital specialist palliative care team from 1st April 2011 to 30th September 2011 who died before 31st December 2011.

Data Collection Method

Audit, a retrospective collection of data from case notes using a proforma/questionnaire developed from discussion with specialist palliative care professionals.

Data Analysis

The data collection system Meridian was utilised for data analysis and display with analysis of quantitative data and recording of qualitative data. Qualitative data analysis used a thematic approach.

Results

40% of participants achieved their PPD, 52% did not, and 8% not recorded. — Reasons for participants not achieving their PPD included, uncontrolled pain and complex symptoms, inability to guarantee 24 hour care in the community, discharge planning. delay in discharge, rapid deterioration and relatives concerns.

Conclusion

To facilitate patients achieving their PPD requires the use of a prognostic tool, courageous skilful communication, good documentation, out of hours care, improved education, early referrals.
CHANGING THE TIMES OF ADMINISTRATION OF CONTROLLED DRUGS REDUCES ERRORS
Authors: Grogan Eleanor , Hale Leanne , White Dawn , Duke Marie
Published: February 2014

Background

An innovative new palliative care unit opened in December 2011 within an NHS hospital with a completely new team, many of whom had not worked in a predominantly palliative setting before. A high volume of controlled drugs was given to patients and the number of errors, as reported by the electronic internal error reporting system, was higher than desired. Controlled drugs were given out to patients at the end of the nursing night shift (for morning drugs) and end of the late shift (for evening drugs). Changing the times of administration of drugs so that this was done at the start rather than the end of a shift was thought to offer a possible solution to this problem.

Aim

To reduce the number of errors made with controlled drug administration in a cost effective way.

Result

Before changing the timing of the controlled drug rounds there were 23 errors relating to controlled drugs reported in 13 months (7 relating to administration and 5 of these to administration of regular, rather than “as required”, medication). The controlled drug timings were altered slightly so that, instead of being done by the nurses at the end of a shift, they were administered by nurses at the start of their shift when they were less tired. Since changing to the slightly different times there have been 4 reported errors relating to controlled drugs in 6 months, none of which relate to administration of controlled drugs.

Conclusion

Maintaining a 12 hour gap between controlled drug administration but giving the medicine out at the start of nursing shifts has been a free and effective way to reduce the number of controlled drug errors occurring on the ward and reduce administration errors to zero.