bluuebunny/crossref_metadata_2025 huggingface dataset:
It's good to talk: an insight into counselling
Authors: Harrison Mark
Published: September 2011

Therapeutic movement remains valid right up to the end of life, maybe particularly so when “unfinished business” maybe hovers near. Counselling can meet and absorb the unpredictability that any client may bring to a Hospice, or any other care setting. This presentation is intended to promote the effective use of such a service in Hospices aiming to offer holistic care.

An insight into Counselling is presented, to promote understanding of how a space to talk can go far beyond other supportive relationships. Counselling can provide a lot of comfort, but it is designed to offer a whole lot more. A fictionalised re-enactment is offered, based on two actual counselling sessions, showing how highly distressing material may be worked with. It should be noted that this relates to experiences that some may find difficult to discuss.

The actual life experiences shared in any counselling is unpredictable. Once a relationship develops there is maybe an ethical duty to see it through even if a difficult referral might be made. In the palliative care realm specifically, there is sometimes maybe no time for a second attempt, or even a referral. For this reason, the added flexibility that person-centred counselling offers is useful here.

Any counselling might be seen as an emergent research process unique to the client, the counsellor and the relationship they form, allowing the client to explore whatever they may and find their way through their difficulties.

The presentation is intended to promote understanding of the space that person-centred counselling offers when facing the unpredictability there is in meeting any person in a holistic way. While this is based on an unusual and even extreme situation, the importance of being prepared to meet whatever may come is underlined.
Advance care planning documentation adopted county-wide
Authors: Chester Helen , Johnson Sally , Jones Sally
Published: September 2011

Introduction

The process of advance care planning is a vital and integral part of our practice. A need was identified for documentation to be developed locally to enable written records of patients' preferences and goals at the end of life which would also provide a tool for healthcare professionals.

Aims

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To develop an Advance Decision and Advance Statement form with guidelines for health and social care professionals.

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To develop patient information leaflets.

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To gain service user feedback about the use of the forms.

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To subject the forms to rigorous review by the hospice clinical governance committee, PCT and hospital trust committees before launching the forms and guidelines county-wide.

Method

The draft forms were piloted for 3 months at the hospice. Feedback about ease of completion, appropriate timing of discussions and positive outcomes or problems relating to use of the forms, were collated. The forms and guidelines were then subject to review in all care settings, including trust resuscitation committees and solicitor.

Results

All patients and staff involved in the pilot found the forms easy or very easy to complete. One patient died in his preferred place of care as a direct consequence. Most patients wished their GPs and hospital consultants to have a copy of their completed form. The forms are now progressing through the documentation committee; respective logos will then be added prior to their launch.

Conclusion

Introducing the forms across all settings, accompanied by education and training, aims to raise the profile of advance care planning and improve exchange of information so that professionals in all settings are aware of a patient's documented wishes for end of life care.
Small is beautiful
Authors: Stubbs Lucinda
Published: September 2011

Something's it's the small things….

In Summer 2010 we picked up an great idea from the NCPC for ‘Small is Beautiful’ aimed to get patient and carer feedback on what small things make a difference to them. Not only did the team at St. Michael's Hospice think this was a fantastic idea but it also fitted nicely with our commitment to using feedback to guide service development and improve the way in which we work.

While we felt it was important to know what our patients and families thought of the Hospice we also used it as an opportunity for staff and volunteers to feedback their thoughts.

Some of our patient comments:

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Feeling cared for.

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A home from home.

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Thank you for the cake, it was yummy!

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Treating each other as special.

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Being offered some lunch during a long visit, thank you so very much.

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Thanks for the comfortable sofas!

With regards to staff and volunteer feedback we have implemented many new initiatives including a rolling educational programme, a monthly staff bulletin, more social events and most importantly improved the quality of our tea bags!

We ran the campaign for 6 weeks and produced Boards which were displayed in patient areas, the Hospice staff room and our seven Hospice shops. People could put their comments on the board.

It was an interesting exercise for us all and provided us with a better understanding of what is important to our visitors and staff and allowed us to make some simple but necessary changes to the way in which we work. We hope to continue building on this in the future and plan to run the Small is Beautiful campaign again in April 2011 where no doubt we will receive some more interesting comments.
Learning lessons: how listening makes us more local
Authors: Ladds Martyn , Davison Steve
Published: September 2011

At Sue Ryder we'd like to share what people told us about the way we communicate and the specialist palliative and end of life care we provide. We'd like to talk about the things people told us and the improvements we're now making.

We asked what a specialist palliative and end of life care provider needs to do, to be better. After listening to what people told us, and looking at the health and social care sector, we're making visible changes in how people understand and experience our services. We'd like to share what we've learnt.

The session will share research findings. Sources include: IPSOS MORI and service-users. We'll talk about how the experience of inpatient and day therapy services. We'll describe the way we're now communicating with service users, families and friends. We'll refer to case studies including the Department of Health funded capital scheme at Sue Ryder – Manorlands Hospice. We'll also share what how introducing new touch-screen technology, and the Information Standard, can help improve the quality and integrity of print and online communications.

The session will cover lessons learnt, and how some assumptions were challenged. We'll show how listening is now helping us build a better future.

Objectives

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Share research evidence from IPSOS MORI, NOP, and service-users

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Case study the Department of Health capital scheme at Sue Ryder- Manorlands Hospice, Yorkshire

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Describe how we're increasing local engagement and identity

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Explain how new technologies and printed information can create better user experiences and assurance

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Describe how these lessons are influencing a new state of the art hospice facility at Peterborough, in Cambridgeshire (opens 2013).
Hospice apprentice with the South Asian community
Authors: Davison Steve , Hussaine Sikander , Taylor Vanessa
Published: September 2011

Presentation aim

To explore the implications for hospices of a 3 year DH funded project based at Sue Ryder Manorlands Hospice with the twin aims of

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Increasing the access for specialist Palliative care from the South Asian community

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Achieving the first aim by recruiting 10 unemployed people from the South Asian Community to 12 month apprenticeships with an NVQ in Health and Social care.

Methodology

It is recognised nationally that there is a very low uptake of specialist palliative care services from people from various ethnic minority backgrounds and also a significant problem in recruiting skilled healthcare staff from these same communities. Various research studied have identified the problems but little work has been undertaken to find practical solutions to engaging effectively with these communities. The project is set in an area of high deprivation and high levels of unemployment within the South Asian community.

Working in partnership with the PCT and local community organisations the project takes a community development approach to recruit unemployed people from these communities into apprenticeship posts which will give them the skills and qualifications in Health and Social care. As part of their apprenticeship each student is involved in developing shared understanding, new ways of working together as well as breaking down the barriers between the South Asian community and the various statutory and voluntary sector healthcare organisations involved in palliative care.

Results

An independent evaluation is being undertaken by the University of Bradford and the results of their interim report are used as the basis for this presentation.

Conclusion

The research demonstrates a practical model which can be adapted by any hospice who wants to increase access to hard to reach communities and improve recruitment from similar groups.
Challenges in the transfer of patients from hospice to nursing home: a model for future partnership
Authors: Traxler Polly
Published: September 2011

Introduction

Transfer of patients to nursing homes for end of life care is often difficult. Patients and carers express anxiety and feelings of abandonment during the process. At The Hospice of St Francis we reviewed 10 hospice discharges in order to plan the introduction of transitional support volunteers to regularly visit patients and carers following transfer. Data is presented from our review of 10 discharges to nursing homes.

Aims

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To identify if there are predictable /repeated issues causing distress in the transfer process.

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Whether continued involvement of a ‘familiar face’ would benefit a patient/carer in the transfer process.

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To work in partnership with nursing homes to reduce transitional anxiety.

Method

We reviewed 10 discharges from The Hospice of St Francis to 5 nursing homes (Aug ‘10 – March ‘11). Focusing on timeliness, carer/relative involvement and stage of illness at transfer.

Results

The hypothesis is:

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The greater the involvement of carer/relatives the longer the transfer process

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All of the patients/relatives expressed some level of anxiety with the process

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For some anxiety and feelings of abandonment intensified post transfer leading to a move within days to another care setting.

Discussion

The analysis of 10 discharges from the Hospice to nursing homes highlighted that both clinical and psychosocial issues contribute to transitional anxiety. Nursing home staff welcome support in addressing the psychosocial needs of people at the end of life.

Conclusion

Hospice care should not end once a person moves to a nursing home. We should focus more on reducing feelings of abandonment/loneliness for patients/carers transferred to nursing homes. The Hospice of St Francis Hospice will pilot a ‘transitional volunteer service’ for 12 months from May 2011 to May 2012.
Keep on going: providing a flexible blended learning end of life education programme
Authors: Willoughby Janet , Watson Lois , Gittins Samantha
Published: September 2011

Introduction

Nursing home staff want to provide end of life care that will maintain their residents dignity, comfort and best interests in the familiar surroundings of the nursing home. Education and support is a key part of this. The Hospice of St Francis provided a mentor education programme to two care homes to facilitate them in this care.

Aim

To enable the care staff to provide excellent end of life care for their residents encompassing all six steps described in the NHS National End of Life Care Programme.

Methods

Home 1 is a nursing home for people with learning difficulties, caring for their complex needs. Home 2 is a nursing home for people with dementia with multiple co-morbidities. A mentor is made available to support the staff through an end of life blended learning 6 module and follow-up workshop experience. An audit of patients notes before and after the programme plus staff confidence questionnaires enables evaluation of the programme.

Results

Both care homes have seen an increase in their confidence and competence in care.

Discussion

This project is innovative because of the flexibility of methods in delivering the support and training. Home 1 worked methodically through the blended learning. They were keen and ready to do the work shop and currently are gathering/developing tools to underpin this process. Home 2 were enthusiastic beginners but were unable to work through the programme. Now the staff have made time over 2 days to receive group face to face training before going on to gather the tools/action plan they need to achieve the relevant national quality markers. The mentor made herself available to work alongside the care staff, supporting, enabling and challenging their practice through the relationship of trust and support.

Conclusion

Blended learning using a mentor approach provides a flexible learner centred education programme.
Innovative pre and post bereavement work with children: unique ways with animals
Authors: Fernandes Jo , James Alex
Published: September 2011

Aims

Through the catalyst of ‘pony experience’ bereaved children and parents are facilitated into meaningful conversations with each other and supportive relationships with other families.

Method

Once a month bereaved children and families are invited to meet in the Hospice Woodland Walk for Pony Experience, including grooming and riding.

Results

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Commonalty of experience: participants meet other bereaved families, enabling them to share “their stories” should they wish and develop co -supportive relationships.

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Children gain confidence – “Life will go on even without their loved one”

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Observing other children confirms they are not alone, seeing others having fun gives permission for them to do likewise.

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Walking side by side feels less intense, enabling easy conversation and ability to explore and chat at differing levels.

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This informal bereavement group work is well attended with positive oral feedback. Formal evaluation underway- results pending.

Discussion

Benefits

Children feel more at ease when handling a pet or when being “carried” by a pony. They can use the animal as distraction from uncomfortable conversations to disclose intimacies/memories that may otherwise be difficult.

Challenges

Gaining insurance for the pony component proved challenging but possible. Health and safety issues require stringency.

Conclusion

Intrinsic to palliative care and bereavement support is focusing upon the little things that make a person feel respected and loved. We have launched a project that is simple in its theory, but complex and diverse in its positive outcomes.

Recommendations

We appeal to all Hospices to explore whether they could use pets in similar ways to support children requiring essential but difficult pre and post bereavement care. Oral presentation will include photos (consented)and interviews from users.
Documenting advance care planning in the hospice setting
Authors: Russell Sarah , Willoughby Janet
Published: September 2011

Introduction

The Hospice of St Francis piloted advance care planning (ACP) documentation (September 2010 – February 2011). The pilot was in four phases including a consultation group, agreement re documents to be used, staff training required, target areas and numbers (up to 10 patients per In Patient Unit, Day Care and Community Specialist Nursing team).

Aim

To establish whether there was a need for Hospice of St Francis specific ACP documentation.

Methods

Phases

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Multiprofessional working group to discuss, produce and pilot ACP documentation

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Evaluation of pilot and amend documents

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Implement amended documents over 6 months

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Evaluation and re-evaluate documentation.

Results

Documentation was implemented with two community and three day care patients.

Discussion

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Do the results reflect the need for more staff education or more confidence in using the skills and documents?

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Do the results relate to the voluntariness or fragility of patients in the advance care planning process or reticence of staff to use ACP documents?

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What is the impact of other ACP work in the hospice on this pilot (eg, ACP letters for patients with advanced respiratory and cardiac disease, ACP research interviews as part of a doctoral research programme).

Conclusion

The ACP document pilot shed light on the process and documentation of ACP. Further work has subsequently been done to look at an ACP education model for Beds and Herts as well as ACP resources for care homes. It is important not to make assumptions about the skills and confidence of hospice staff in ACP as well as looking at the context of the patient's voluntariness and fragility. The pilot helped us look at the education needs of our staff.
Investing in a weekly lottery – does it work?
Authors: Freeman Ruth
Published: September 2011

Investing in a weekly lottery can seem like a significant financial risk for a small to medium sized hospice and paying an external canvassing company to recruit members a step too far. In this time of economic insecurity, however, Lottery continues to be a very attractive and affordable fundraising proposition for a wide range of donors and is therefore worthy of significant consideration.

The Myton hospices ran a lottery recruitment campaign in 2009 using an external canvassing agency – the target was to recruit 12 000 new donors over 12 months, results outlined below

Year 1

Income; £ 574 080, Cost; £ 360 000, net income; £ 214 000

Year 2

Income; £ 505 191, Cost £ 165 000, net income; £340 191

Attrition

Year 1 = 8%, Year 2 = 12%

Predicted net income over 5 years = £ 1 450 000

In addition to the above the increase to the Donor database of 12 000 new names has resulted in over £ 50 000 in Raffle income and £13 000 in donations.

The secret to making a campaign work is as follows;

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Train the external canvassers in – house and to keep them up to date

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Negotiate the recruitment costs with the agency – ensuring that a 3 month “drop out “clause is built in

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Ensure that recruitment costs are phased over the expected life time value of the member / donor, that is, don't pay the full costs up front but make sure that there are anniversary reviews

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Build a solid business case and make sure the Trustees buy in to the campaign!
Service user evaluation of the benefits of complementary therapy in hospice care
Authors: Hunt John , Margaret Ayres
Published: September 2011

Complementary therapy (CT) is now a key component of care and support in hospice services and can be offered singly or in combination with other interventions, for example, emotional or bereavement support.

Service user evaluation is the best measure of effective outcome from care and support programmes.

The hospice offers Reflexology, Simple Massage and Reiki currently, in Day Hospice, Outpatient and Home settings.

The hospice introduced a self-completed user evaluation questionnaire in 2008 and has modified that to measure the benefits of combined therapies.

The questionnaire is offered to all CT service users after four completed therapy sessions.

The evaluation is structured to seek the user's views on overall benefits, length of effect and frequency of treatment to maximise quality of life.

Results

to-date (from 54 questionnaires offered and 44 returned; a response rate of of 81%) indicate that 43% of participants felt that the therapy had offered benefits in addition to having an effect on the problem that they had initially.

32% of service users stated that the benefit had lasted for longer than a day.

77% of respondents commented on the benefits of therapy; themes were increased relaxation (47%), reduced anxiety (44%) and improved sleep (26%).

59% of respondents had reflexology in courses of 4–6 treatments.

“It helps because I feel more relaxed; sleeping is improved and my pains are not so bad”

Additionally, 16 questionnaires have been offered to those receiving complementary therapy in direct combination with other interventions (‘Back to Back’ therapy). In this group, 10 individual returns is a response rate of 63%. All those offered ‘Back to Back’ treatments had complex needs. In commentaries, respondents remark on physical benefit, but also indicate emotional support and well-being.
Establishing a patient self-administration scheme for medicines in the hospice setting
Authors: Crowther Jeanette , Wanklyn Steven , Johnston Mel , Skinner Charles
Published: September 2011

Introduction

Self administration of medicines has been an area of nursing and pharmacy development. Literature reports have shown that it is feasible, provided appropriate checks are in place and that these happen on a regular basis. Implementation can maintain the patient's independence which is important in the respite setting. It also provides a valuable opportunity to explore adherence where this may be a problem and which could prevent unnecessary admission and the patient being denied the opportunity to be cared for in the place of their choice. Self-administration of high risk drugs such as opioids is an area where further work is required so that inclusion in self-administration schemes is risk-assured and possible.

Aims

To establish a framework that facilitates patient self-administration while minimising patient risk.

To further inform governance priorities for self-administration schemes particularly those involving high risk drugs.

Method

A multidisciplinary team was formed representing pharmacy, doctors and nurses in order to develop a clinical protocol. Incident surveillance data was used alongside consensus opinion to identify critical stages along the medicines trail and the appropriate control measures to risk manage them.

The protocol manages screening for patient eligibility, consent, monitoring and subsequent management of patients suitable for self-administration. Staff eligibility to undertake this protocol is granted following workshop attendance and completion of evidence-based competencies.

Results and discussion

In order to quality-assure the scheme protocol compliance will be audited on a regular basis, results of which will be assessed against incident surveillance data. This will provide ongoing risk management and identify areas for improvement.

Conclusion

Trinity hospice has approved this protocol. Staff eligible to undertake a role have been accredited to do so. Under the terms of the hospice's approval an audit of compliance and critical risk assessment will inform the further development of this medicine system.
A 3 month pilot of the distress thermometer within community specialist palliative care services
Authors: Thomas Andy
Published: September 2011

Introduction

The Distress Thermometer (DT) as a brief holistic screening and assessment tool has been introduced, validated and widely adopted within Oncology Services and cancer networks internationally. Supportive and palliative care guidance recommends the use of a screening tool to identify and signpost appropriate services.

Aim

To modify the existing distress thermometer to fit hospice and palliative care needs, and pilot within specialist community palliative care services.

Method

A working party of individuals providing nursing, emotional, psychological and spiritual support within the specialist palliative care service formed to amend the DT to fit the needs of community palliative patients. The tool was piloted by two community clinical nurse specialists (CCNS) and qualitative information collated regarding the tools appropriateness. Furthermore both qualitative patient and nurse experience was considered. Patient demographic and illness information was gathered as a possible variable influencing appropriateness of use. Finally DT training was delivered to all hospice inpatient health professionals and evaluations collected regarding the appropriateness of the DT's use with new inpatient admissions.

Results

Of the 63 new referrals to two CCNS, 21 completed the tool. No age / malignant versus Non-malignant difference in those able/willing to complete the tool were identified. Qualitative experiential information supported the use of the tool within the community setting. Difficulties with usability were identified from both perspectives. Training evaluations were favourable with inpatient staff recommending the DT's use as part of the hospice admission process.

Discussion

There are relative benefits and drawbacks of adopting this tool from both patient and nurse perspectives. However, the modified DT appeared to meet service needs. The training format and evaluations will be discussed in detail.

Conclusion

Both pilot and training feedback supports the use of the DT within this palliative care service.
The resilience programme for staff & volunteers
Authors: Clitherow Rebekah
Published: September 2011

This Hospice recognises the benefits of fostering resilience in its workforce so that we become more effective in delivering compassionate care on the journey towards the end of life.

The lead counsellor, responsible for co-ordinating staff and volunteer support and training in self care, took formal and informal opportunities to explore the concept of resilience with staff and volunteers. Ideas about resilience and factors within the organisation that undermine resilience were collated following focus group style sessions. This was combined with a review of the literature concerning resilience.

A model was developed together with a questionnaire and training programme that would enable staff and volunteers to explore and develop their levels of resilience. The model considers the emotional, psychological, physical and spiritual aspects of resilience and encourages individuals to explore how their identity, patterns of communication and personal values impact on resilience. The model holds different aspects of resilience in tension such as realism and hope. The training programme includes exercises that support the development of resilient responses to difficult situations. It considers communication and relationships.

4 cohorts of staff and volunteers, totalling 30 individuals, have now accessed the programme and evaluation has shown that they consider themselves better prepared to cope with the nature of their work and better prepared for the change and loss that might lie ahead in their own lives. They reported greater understanding of how they might foster resilience in the patients, carers and families that they work with.

We are keen to present a poster to share good practice in the area of staff support and personal development with other Hospices. Sharing our learning would also provide the opportunity to gain feedback from other Hospices, strengthening the model and programme.
An independent evaluation of a neonatal end of life care pathway
Authors: Crozier Kenda , Lindsay Bruce , Wray Jo , Leeson Janet , Andrews Luaren
Published: September 2011

Introduction

The neonatal end of life care pathway, implemented in 2008, provides a coordinated planning approach for rapid discharge of babies from Neonatal Intensive Care Unit (NICU) to hospice or home for end of life care.

Aims

The evaluation aimed to assess the effectiveness of the neonatal pathway from families' and staff perspectives.

Methods

To ensure the evaluation drew on a spread of voices, we recruited participants who had used and provided care pathway. Eight families, 10 internal and 10 external staff were interviewed using a guided conversation technique. Thematic analysis was undertaken and data was further clustered into subthemes.

Findings

42 babies have been referred on the pathway since 2008. Staff and parents expressed a supportive view of the pathway and demonstrated an appreciation for the underlying principles. There is a need for wider understanding of the pathway and care it offers. Bereavement support for families evaluated very well but needs of fathers could be further investigated. The impact on other aspects of hospice activity emerged.

Conclusion

The pathway is an innovative service, probably the first in the UK. It represents an increase in service activity of the hospice and contributes to the breadth of service on offer. The experiences of staff and parents outlined in this evaluation should be useful in contributing to the knowledge base about end of life care for very young babies. The knowledge and expertise of staff who have developed and worked with this pathway over the last 3 years should be acknowledged and the model disseminated widely.

Recommendations

More regular training opportunities for staff of all levels should focus on case studies rather than simply pathway documentation. Further consideration should be given to managing the demands of respite care when bereaved families are resident. Joint meetings should be used to anticipate and plan.
Creating a sustainable high quality hospicecare service
Authors: Ryan Alison
Published: September 2011

Introduction

Demographics, increased patient aspirations for choice of type of care and our potential funding base, mean our current monolithic service structure and business model, which we share with many other hospices, is not sustainable. The project is to create a coherent service and financial system which will deliver high quality care to all who need it and be affordable in an uncertain future.

Aims

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To understand what patient determined high quality outcomes are

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To reconfigure services to be able to deliver these outcomes

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To improve integrated working internally and with external agencies

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To be able to measure cost effectiveness in service delivery

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To increase our financial autonomy

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To develop new income streams.

Methods

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Researching patient determined quality outcomes

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Challenging assumptions about existing, and exploring alternative, service delivery systems

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Consultation with staff about the requirements of different systems

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Developing sharper costing mechanisms to allow measurement of effectiveness in service delivery

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Development of financial modelling and sensitivity analysis to allow differential decision- making about investment.

Results

A reconfigured integrated service delivery structure based on delivering the right person in the right place at the right time with the right skills to meet patients needs.

A business turnaround programme to create sustainable flows of income and expenditure into the future.

Discussion

The planned change involves structure, training development and financial remodelling but above all the cultural change required to put patient care and patient choice genuinely at the heart of service provision. The implementation has a 5 year timeline.

Conclusion

Many other hospices face the challenge of maintaining quality while facing rising demand and uncertain income streams. This presentation shows a possible way ahead and the issues which may arise.
Why carry a file or pick up a pen? All our records are paperless!
Authors: Higgs Joanna , Walford Carole
Published: September 2011

Our three services, inpatient, community and day care had separate notes and records for the same patients. We agreed to create a joint approach to assessment and an integrated record that could be viewed in real time at any site. Access over N3 enables us to interact with our GP practices, community hospitals and access records and imaging results in real time.

Aim

In late 2006 we set the goal to be paperless within 3 years.

Method

▶

Discussion with Crosscare and many meetings to gain mutual understanding of possible problems in implementation

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A pilot with the community team was started, for a year, to test the design

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Roll out across our service to follow within the next 6 months

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Close liaison and feedback on the project to Crosscare team enabled us to problem solve and keep to our timescale.

Results

▶

We are now paperless apart from electronic prescribing; this has taken slightly longer due to logistics

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We are now exploring connections with other healthcare agencies and partners in care.

Discussion

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Advantage of staff being able to see a patient record in real time and review it

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Uniform inputting by staff is quicker and more accurate

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We expect to develop better partnerships through closer interaction with GP practices and other community hospitals

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With access over N3 the expected norm is to easily see test results, imaging and consultants letters etc

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The audit trail tracks all alterations and so covers us for legal issues.

Conclusion

This work is imperative as the organisation looks to improve interdisciplinary communication and patient care. The organisation is currently reconfiguring and expanding to the North of Dorset. As such Crosscare will compliment the planned video conferencie facilities in North, Central and South Dorset.
Study of patients known to a hospice service: hospital versus home deaths
Authors: Parr Ann , Hodgson Aruna , Duddle Chris , Carby Jo
Published: September 2011

Background

It is well recognised that most patients state a preference to die at home, yet the majority die in hospital. If the proportion of home deaths is to be increased it is important to understand the reasons why this is not being achieved currently.

Aims

We sought to:

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Identify any differences between patients known to hospice services dying in hospital or at home

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Identify gaps in service provision

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Identify ‘predictors’ of hospital admission.

Method

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Comparison of 2 groups of 49 patients, one group dying in the local hospital and the other at home within the period October 2009 – April 2010

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Patients were identified from the Hospice database

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Data collected included demographic characteristics, services involved, family support, and knowledge of of the patients' preferred place of care

▶

Questionnaires were completed by the Hospice Palliative Care Nurse Specialists

▶

Hospital notes were checked

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Supplementary information was obtained from GP practices, the Primary Care Trust and Hospice records.

Results

▶

Most hospital admissions were precipitated by a sudden deterioration of an existing condition or an acute episode

▶

There were slight demographic differences between the two groups, with elderly females living alone being the most likely to die in hospital

▶

Hospice and community services seemed less actively involved with the patients who died in hospital.

Conclusions

▶

The majority of patients dying in hospital seemed to have a more rapid terminal decline, with a potentially treatable cause, than those dying at home.

▶

No factors were identified that could have prevented these admissions but timely access to Hospice beds could have prevented a few patients dying in hospital.
A care pathway to support extubation within a children's palliative care framework
Authors: McNamara Katrina
Published: September 2011

The need for this work was identified by a number of clinicians who asked ACT to develop a resource following an initial trawl for information about existing guidance and resources via the online global forum PaedPalCare.

This guidance on best practice for professionals in supporting families' decision making and the practical aspects of extubation, will lead to an improvement in the standards of care delivery and the choice offered to families. There is also an information leaflet for families which will help them reach an informed decision about the care they wish their child to receive.

The resource is appropriate for use in a variety of settings, including critical care, palliative care and community settings such as the child's home or a children's hospice. There are three sections to the resource

▶

Part One provides an introduction to children's palliative care and ACT's care pathway approach. It discusses the need for a dedicated pathway approach and outlines the principles that ACT recommends in adopting and delivering the care pathway to support extubation within a children's palliative care framework.

▶

Part Two takes the reader through the pathway to support extubation within a children's palliative care framework. There are three stages to the pathway: the journey towards a decision to withdraw life-sustaining ventilation; the practicalities of withdrawing life-sustaining ventilation; and care at the time of death. Each stage of the pathway includes sentinel standards: key goals and useful resources to support care.

▶

Part Three provides useful reference information, a glossary of terms and definitions and a directory of useful organisations.

While considering the need for the pathway, it became apparent that an additional resource of an information leaflet for families was required which will help them reach an informed decision about the care they wish their child to receive.
Sign on the dotted line: opioid agreements in patients with a history of substance misuse
Authors: Finnegan Clare , Brown Susannah , Coackley Alison
Published: September 2011

Introduction

The management of pain in palliative care patients with a history of substance misuse can be challenging. Patients may have a low pain threshold, feel ill at ease in unfamiliar clinical environments and consequently compliance can be poor. Doctors may feel ill at ease prescribing opioids due to fears of exacerbating the addiction or contributing to overdose. Following a regional audit of the management of this patients group, regional guidelines were developed recognising the importance of close working between disciplines and the use of opioid agreements. The development of opioid agreements with patients can improve compliance and quality of life.

Aims

A reflection on our experiences introducing verbal and written opioid agreements within the palliative care setting.

Methods

Opioid agreements were utilised with two patients with cancer pain and a coexistent history of substance misuse, in both inpatient and outpatient settings. Written and verbal contracts were used detailing expectations of the patient, role of healthcare physicians, and the plan of care.

Results

The staff observed improvement in compliance with medication, relationships with staff members and symptom control. The agreements facilitated communication between the hospice, primary care, community pharmacy, and the addiction team.

Conclusion

Introducing opioid contracts to this group of complex patients

▶

Set clear boundaries for the patient and staff involved in their care

▶

Improved compliance and consequently relationships between patients and staff

▶

Empowered patients to take responsibility for their own analgesic management

▶

Facilitated clear communication between the numerous healthcare professionals involved in the patients care.

We feel that the use of opioid agreements with patients with a history of substance misuse has improved the patient experience.
Risk register: an integrated governance approach
Authors: Haywood Chris , Coackley Alison
Published: September 2011

Introduction

While risk management is an integral component of high quality care it can be difficult to demonstrate effectiveness. A key aim of the Hospice Business Plan was to devise and develop a Risk Register that could incorporate Fundraising and Clinical activities as part of an Integrated Governance Framework.

Aims

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To produce a Risk Register to identify areas and work practices most at risk

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To implement a Risk Register to minimise risks that could affect the running of the Hospice

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To use a Risk Register to monitor effectiveness of actions/initiatives.

Methods

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Literature review

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Risk Matrix

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Risk scoring process

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Audit cycle.

Example

Risk Date Governance

Area Description of

Risk concern

(x,y,z) Potential Impact including current controls Risk Score

(Pre) Risk control processes to reduce or transfer risk

Date for completion Risk Score

(Post) Likelihood rating Impact rating RISK.

Clinical effectiveness

Administration of bisphosphonate infusions without adequate checks causing harm

Patient condition compromised

Develop hospice policy on bisphosphonate infusions with flow chart

Training and education for nursing and medical staff

Distribution of new regional audit guidelines

Audit to check on process

Results

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Organisational risks were identified and scored using likelihood and impact ratings

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Risks were categorised into seven key themes

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Potential impact including current controls were described

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Risk control processes to reduce/transfer risk were shown for each individual risk

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Following intervention 86% of high risks were significantly reduced within a 7 month period.

Conclusions

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Use of a Risk Register clearly demonstrates effectiveness

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Heightened awareness; risk is everyone's business

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Audit has shown improvements in identifying risks

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Strengthened communication across fundraising and clinical services.

Recommendations

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Understanding of Risk Register to be part of induction training

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Use of Register needs to be an ongoing process and should be regularly monitored and updated.
Memories, trajectories and bereavement
Authors: Mills Penny , Griffiths Frances , Munday Dan
Published: September 2011

Introduction

Much attention has been given in recent years to the concept of illness trajectories and their potential use in the planning of services provided to those with life limiting illnesses. This study examines how trajectories are experienced by bereaved individuals and whether the memories retained by the bereaved or the experience of grief differ according to the disease trajectory of the deceased.

Aims and methods

The aim is to investigate whether the trajectory of dying influences the experience of grief or the memories held by the bereaved of the death and prior biography of the deceased.

One to one unstructured in depth interviews have been conducted with bereaved relatives between 3 months and 2 years after the death, followed by thematic analysis of the narratives produced.

Preliminary results

While it is possible to identify key stages in the dying trajectory as experienced by the bereaved, there is little uniformity to trajectories and key events are often not related to the medical status of the deceased.

Considerable sacrifices are often made by the bereaved in order to achieve a’good death' as defined by the deceased and there appears to be a need to integrate the trajectory of dying with the memories of the deceased and their prior biography.

Discussion

There are a wide variety of experiences, with differences between the medical and the experienced trajectories of dying.

Research is ongoing, but it seems that the needs of the bereaved can be (willingly) overridden in the desire to provide an appropriate death and retain coherent memories of the deceased.

This may have future implications for the assessment of need and the provision of services and support of the bereaved both prior to and following the death.
South west region clinical incidents benchmarking project
Authors: Stevens Alison
Published: September 2011

The Hospice Nurse Managers in the South West have worked collaboratively to develop a tool to monitor clinical incidents within hospice Inpatient units. This tool forms the basis of a quarterly benchmarking exercise. The tool currently in use is based on the national nursing metrics system and consists of an excel spreadsheet detailing numbers of clinical incidents against 1000 bed days including falls, pressure ulcers and medical incidents (Drug errors). Each hospice Nurse manager has an electronic copy of the tool and is responsible for submitting quarterly returns to Dorothy House Hospice Care. The results are then collated and a regional average is produced. Results are shared at SW regional Nurse Manager meetings and possible reasons for variation discussed and good practice examples highlighted. Each hospice has the option to share their individual results and the regional average with their local commissioners or other interested parties.

Challenges in setting up the benchmarking system have included ensuring consistency in reporting and the variation in database systems currently in use for data collection/analysis.

Benefits have included the opportunity to benchmark against other hospices rather than acute or community providers, the routine of regular discussion with colleagues on how improvements may be made to reduce incidents and demonstration to the Care Quality Commission of a proactive approach to managing clinical incidents.

South West Region Forum for Hospice Nurse Managers. March 2011.
Measuring clinical outcomes for hospices
Authors: Roberts Michelle , Stott Lisa
Published: September 2011

In 2009 the West Midlands hospice group worked with Help the Hospices to establish a set of measures that would demonstrate the value of the work of hospices to healthcare commissioners.

An important domain of this work was to accurately measure the outcomes of the care that hospices give through the eyes of those receiving the service – patients and carers. It was felt that the only true measure of a satisfactory outcome is in the eyes of the service receiver so we used that basis to devise an accurate measure of the outcomes of hospice work. We decided to do this by asking patients and carers what they thought the hospice had achieved using a methodology which could be statistically validated.

The DMH worked with other hospices to formulate questions which would most accurately reflect the user's views on the outcomes of hospice treatments as against their goals and expectations. The work was then used to run a series of pilot surveys which helped to test the validity of the questions used and the methodology for calculation of the outcome results and scores. The result was a complete suite of surveys carefully designed to accurately measure service outcomes in hospice care. After some further testing and amendment the surveys were launched in autumn 2010.

These outcome measures are calculated from the results of the surveys and cover both patients and carers for the following services:

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In Patient Unit

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Day Hospice

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Community Clinical Nurse Specialist service

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Hospice at Home

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Bereavement Services.

Results

of the first full surveys are now available and there are plans to benchmark with other hospices in future. This will enable us to use the results to continue to work towards improving the quality of the services we deliver.