bluuebunny/crossref_metadata_2025 huggingface dataset:
Establishing a nurse led specialist palliative care satellite clinic
Authors: Gibson Vanessa , Grint Tracey , Campbell Heather
Published: September 2011

Introduction

Increasing referral numbers within a rural location have prompted us to explore new ways of working to not only increase timely access to specialist palliative care services but also to also ensure that these services, when deployed, function effectively and meet the changing needs of patients and families.

A Specialist Palliative Care nurse led satellite clinic based within a rural general practice offers scheduled appointments to appropriate patients,

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Facilitating enhanced communication with primary healthcare colleagues

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Expediating effective symptom control by facilitating multidisciplinary team working

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Promoting continuity and seamless care.

The project is important because it challenges traditional ways of working and standard community nurse specialist role.

Aims

To increase access to specialist palliative care services within a rural location

To expediate symptom control

To evaluate the patients experience of new models of service provision- this will inform future service development.

Methods

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A literature review was undertaken

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A potential pilot site and CNS caseload was identified

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Service user consultation was undertaken by one to one discussions

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Comparable services were benchmarked

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An audit strategy including a service user satisfaction survey, 360 degree review and use of recognised outcome measurement tools has been planned

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Key stakeholder support was secured and a pilot agreed.

Results

Interim data suggests:

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Initial service user reluctance

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Improved team working with primary healthcare colleagues

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Increased user choice

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Reduced travelling time for CNS.

Discussion

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The satellite clinic is now established within a supportive GP practice

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A small number of patients are currently accessing the clinic

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Multidisciplinary team working with primary healthcare colleagues has been markedly enhanced

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The CNS's educational activity within the host practice is increased.
Keeping medicines management on the radar!
Authors: Schrikker Tara
Published: September 2011

Introduction

A trend identified that drug errors were happening due to complacency and a shortfall in nurses' capabilities in Medicines Management. The potentially serious consequences of this led to the introduction of a rolling medicines management programme.

Aim

To create an effective Medicines Management system containing structure and guidance in order to ensure patients' safety and minimise the occurrence of drug errors.

Method

Introduction of a yearly medicine management programme which includes:

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Training sessions – responsibility and accountabilities, update on drug calculation skills

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Annual drug calculation test

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Annual drug administration competency

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Annual syringe driver assessment

A scoring system for medication errors was implemented to ensure consistency in assessing the severity of the drug errors and determining the appropriate action to take.

Results

The Medicines Management Policy and Procedure has been amended and awareness of good medicine management is embedded in the daily routine. The hospice encourages a supportive culture, involving staff in the process of investigation and the implementation of new ways of working. Medication errors and near misses are managed in a fair and supportive manner.

All staff successfully achieved the pass rate of 95% for their Drug Calculation Test. The number of incidences of drug errors has fallen by 50% within the last 12 month period.

The focus on this area has enabled trends to be identified, both general and individual, and remedial action taken to improve practice. Measures have also been taken to minimise risk.

Conclusion

Awareness, communication, education and support are the main drivers for the reduction in drug errors. Staff feel more confident as their competencies have increased.

The implementation of an annual programme keeps medicine management on the radar and the programme is an effective and efficient investment to enhance patient safety.
Role of a hospice education unit in leading the development of an end of life care model of service
Authors: Jeynes Salli , Challinor Annamarie
Published: September 2011

Key concepts

This innovation has been developed and led by a palliative care education centre supported by two hospices. It illustrates how hospices can lead, innovate and influence the quality and strategic direction of end of life care (eolc) within their community. The key to this is a passion to lead and work collaboratively with multiple care settings and staff groups. The strategic engagement of the eolc commissioner has been instrumental to its success.

Background

Achieving quality eolc across a myriad of care settings in which disparate groups of professionals work and where the culture of care is varied and inconsistent, represents an enormous challenge. In response to this challenge a new model of service has been developed to facilitate end of life care in a co-ordinated and unified way across Central and Eastern Cheshire.

Aims and outcomes

The structure of this model enables sharing of best practice and innovations across professional and organisational boundaries to promote a whole systems approach. The approaches and ethos of this model are improving the experiences of patients, families and care workers with evidence that care is becoming better co-ordinated. Through this, obstacles and barriers within the patient pathway are being identified and overcome. Care sectors are encouraged to share good ideas and best practice with communication between professional groups and different organisations becoming more streamlined.

The model is led by two Macmillan eolc post holders and three co-leaders who work across care sectors. The team, within the model, engage directly with champion groups from a variety of care settings who are made up of different professionals caring for patients and families. They are inspired and developed by the model team to change and enhance their practice in ways that enable patients and families to live and die where they prefer with dignity.
Reaching out to care homes: a new specialist practitioner service
Authors: Skilton Carolyn
Published: September 2011

Introduction

The End of Life Care (EoLC) Strategy (2008) recognises that most people in care homes consider it to be their main residence, and the place where most would choose to die yet deaths in care homes represent 16% of all deaths.

Aim

To provide:

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Support for patients and staff in care homes to access medications and expertise in palliative care to prevent hospital admissions

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An opportunity for patients /families to express their wishes for preferred priorities of care to prevent them dying in unfamiliar surroundings.

Method

All new referrals for residents in care homes (not known to community palliative care services) were taken by the Specialist Nurse Practitioner and further clinical information obtained from the GP or hospital.

An assessment visit was organised, and the data on referrals and interventions were recorded.

Results

64 patients were supported:

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81% died in the care home

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4% were either still alive or place of death was unknown

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4% died in hospital and 1% in the hospice

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25 prescriptions were issued for anticipatory drugs

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24 prescriptions were amended

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7 homes requested, and were provided with, training in EoLC.

Discussion

Patients were able to receive support at the end of life and to remain in their own environment, without trained nurses on the premises. The need for increased training in EoLC, highlighted by staff, was also met.

Conclusion

This innovative service achieved the vision of both the EoLC Strategy and the hospice's objective of reaching patients and staff in care homes to reduce hospital deaths and to meet training needs. It empowered the carers in the home by giving them the confidence to comply with residents' wishes knowing that appropriate support was available.
Developing the assistant practitioner role for palliative and end of life care
Authors: Arkwright Sharan , Hewitt Carole , Bass Madeline
Published: September 2011

In 2009 Foundation Degree Forward and Help the Hospices encouraged member hospices to collaborate in developing a Foundation Degree in Palliative and End of Life Care. The objective was to provide a nationally recognised qualification for palliative care professionals, who traditionally, have not engaged in career development through academic achievement. A uniformity of approach would provide consistency and transferability across sectors. Within palliative care, this ‘new’ role would assist the delivery of future workforce planning, through cost effective and flexible skill mix enrichment.

Three pilot initiatives emerged from across the UK; St. Ann's Hospice Manchester, St. Margaret's Hospice, Somerset and St Nicholas Hospice, Bury St Edmonds.

A steering group was formed with representation from relevant provider organisations including Strategic Health Authorities, educational providers, Social Services, community providers and hospices. A scoping exercise ascertained how the Assistant Practitioner role could be integrated into existing services. Job descriptions were subsequently written encompassing the Palliative Care and End of Life module. Recruitment to the degree programme commenced in 2010.

Pilot implementation

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St Ann's Hospice in partnership with NHS North West and NHS Bolton: 15 Trainee Assistant Practitioners (TAP's) commenced Foundation Degree programme in January 2011 (University of Bolton as the Education provider)

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St Margaret's Hospice in partnership with Strode College commenced a level 5 Diploma for TAP's in 2011

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St Nicholas Hospice in partnership with a local HEI have a Foundation Degree starting in 2011 with 2 candidates to date.

Future steps

Evaluation of the foundation degree programme throughout training and 12 months post qualification. Evaluation will include perceptions of course participants on course content, delivery and relevance to role, followed by observational activity analysis post qualification and delivery of Assistant Practitioner role.
Day services partnership working
Authors: Johnson Wendy , Sinclair Jane , Reeder Sally
Published: September 2011

St. John's Hospice - Lancaster, serves patients within its Community for palliative and end of life care. Despite not being set up specifically for cancer patients, the hospice services are predominantly accessed by cancer patients.

The Day hospice services have recently undertaken a number of initiatives to try to encourage wider access by long term conditions patients. The first success was a 'One Stop Multi-disciplinary Clinic' for motor neuron disease patients. Here patients are able to see members of the Multi-disciplinary team and the Nurse Specialist at a single hospice based clinic.

Following this success the team were keen to extend the services to other long term condition groups. Initiated by a a meeting with the Parkinson's Disease Society – including some of their patients – it was agreed to host their support group which would include a weekly gentle exercise group. This commenced following a launch day.

The Day Hospice more recently piloted a Chronic Obstructive Pulmonary Disease (COPD) programme. The aim being to empower patients and help them gain control of their situation as they experienced disease progression. The programme which was done in partnership with the COPD specialist acute team and the hospice team set out a 6 week programme where patients were offered information, time and support. They dealt with issues such as fatigue, breathing exercises and discussed concerns around Preferred Priorities of Care and Advanced Care Planning using a multi-disciplinary approach.

All the initiatives were matched against the QIPP agenda. Following the COPD programme five of the nine patients have accessed the day hospice. The staff and volunteers within the hospice have gained education from the specialists involved and each of the stakeholders/partners have had positive feedback from the users of the services. Moreover patients are also being introduced to other services within the hospice.
Trains boats and planes
Authors: Henderson Barbara , Steven Anne
Published: September 2011

Introduction

Children's Hospice Association Scotland (CHAS) is a charity that is the sole provider of children's hospice services in Scotland for children and young people with life limiting conditions. CHAS at Home was developed to support families, across Scotland, at home in times of crisis, at end of life, and to support families who live in rural and remote areas. The journey to one of CHAS's two children's hospices can become impossible due to the child or young person's condition, or the distance making the journey impractical.

Aims

CHAS aims to offer families a choice in their place of care, no matter where they live in Scotland; including the north, the islands; Orkney, Shetland and Hebrides. Scotland is 31 510 sq miles in area, it is 274 miles long and has 130 inhabited islands.

Discussion

For families who live a distance from their nearest hospice the journey can be traumatic for the child or young person especially as their condition deteriorates and their care needs increase. Imagine a 10 h journey, involving a ferry crossing, that includes administering medications, gastrostomy feeds, suctioning, personal care and more. All this can make the journey impractical and intolerable for the whole family. CHAS can relieve this by offering to take the ethos and care from the hospice to their home. A key to the success of this model of care is working in partnership with the local community teams. For the team providing this service it can mean a trip by train, boat or plane and nights away from home, however the team consider it a privilege to be able to support families in this way.

Conclusion

CHAS is committed to providing a service to families wherever they live in Scotland no matter how remote. The families say “just to know that CHAS is there for us is amazing”
Poetry and creative writing in palliative care: an alternative approach to communication
Authors: Haraldsottir Erna
Published: September 2011

Aim of project

To explore whether participating in poetry reading and/or creative writing sessions within a hospice has a positive impact on patients.

Method

Funding from the Scottish Art Council enabled a Hospice to work with two poets facilitating five poetry reading sessions and seven creative writing sessions. All sessions were co-facilitated by a clinical nurse specialist in palliative care. The poetry reading sessions included a poet reading a wide range of poetry, including requests from patients. After each poem space was created for patients to respond to the poems and discussion was encouraged. The creative writing sessions were facilitated by a poet who assisted patients with writing their own poems through providing a prompt and structure for the writing. A specific focus was chosen for each session, for example ‘places we know’, ‘houses we have lived in, and ‘favourite objects’. Each session lasted for one and a half hours. The sessions were evaluated by staff and patients.

Results

25 patients attended one or more than one session with staff members attending poetry reading sessions.

Patients' and staffs' comments on the sessions were themed into: positive occupation, bringing back memories, sharing of stories and fostering dialogue.

Conclusion

Creative writing and poetry within palliative care provides an alternative approach to communication that facilitates social interaction and ‘sharing of stories’ that may otherwise not occur. This alternative approach to communication provides common ground and a unique way for the patients to connect with each other.
Learning at your fingertips
Authors: Scott Ros
Published: September 2011

Introduction

CHAS is Scotland's only children's hospice organisation and has three hospice services: Rachel House in Kinross, Robin House in Balloch, and CHAS at Home which operates from both hospices and has a small base in Inverness. With 235 staff across 11 sites and 900 volunteers throughout Scotland, access to consistent high quality learning opportunities can be a challenge, regardless of role.

Aims

The aim of the project was initially to meet our statutory/mandatory training needs and to develop a structured and accessible blended learning approach. One key component of this was the development of online learning modules for all statutory/mandatory areas.

Methods

Research was undertaken to find the best platform for CHAS to use which would be easy to create and upload module materials, and straightforward for staff and volunteers to use. It was also important for the learning to be validated through short assessments.

Results

Initially eight modules were developed and rolled out to all staff, including topics such as Fire Safety, Infection Control, Moving and Handling Objects and Display Screen Regulations. After initial apprehension staff quickly began to see the benefits and some even described the process as ‘addictive’! Staff began to see the possibilities for supporting other professional learning through on-line learning, and have prepared new modules.

Conclusion

The results of our work with online learning far surpassed our initial expectations. Staff are really engaged with the process both of completing modules and with many new ideas for topics. It has also encouraged greater use of electronic communication in CHAS. Currently there are 14 modules available to staff: topics as Lone Working and Bereavement have been added. We are also about to begin the process of rolling out statutory/mandatory modules to volunteers.
Providing a seven day community clinical nurse specialist service: a 6 month pilot
Authors: Grady Anna , Milton Elisabeth
Published: September 2011

Introduction

In response to the challenges faced by patients and carers out of hours, the service provided by the Community Clinical Nurse Specialist (CNS) team in an inner city hospice in Scotland was extended to cover 7 days per week. While this was recommended by NICE in 2004, there is little published information around the implementation and evaluation of this service development.

Aim of the pilot

To examine the need for and benefits of an enhanced 7 day service by the Community CNS team.

Method

The team of 6.5 WTE staff piloted 7 day working for 6 months. Activity data was collected on planned and unplanned urgent contacts. Acceptability of the service to both staff and patients and families was sought.

Results

There was an average of 5.3 urgent contacts per weekend (range 0–12). 36% of these contacts were unplanned, with the majority of these (68%) being made by a family member.

Key benefits were seen to be: specialist symptom management 7 days per week, supporting patient choice in place of care, emotional support to patients and families and improved team working.

Discussion

Successful management of change is dependent on a number of key factors. With these in place, resistance to change was overcome and staff were both enthusiastic and willing to embrace a new way of working. To support this service development an additional 0.5 WTE member of staff was recruited.

Initially data was only gathered around the “unplanned urgent” contacts. The team recognised that they could also incorporate appropriate routine activity, negotiated with the patient and family.

Conclusion

The pilot demonstrated need, was highly acceptable to staff, patients and families and its delivery was sustainable in our team. Seven day working is now established in the delivery of our Clinical Nurse Specialist service.
A review of translation and interpretation services provided by children's hospices in the UK, March
Authors: Gandhi-Rhodes Kalyani
Published: September 2011

Introduction

The review was commissioned by the Children's Hospices UK Diversity Reference Group to take forward the work of the Diversity Toolkit (2009) that was developed in collaboration with Help the Hospices.

The purpose of the review was to provide data on provision of Translation and Interpretation services (T.I.S) by children's hospice services and indicate what actions are needed to improve future services. The central aim was to gather views from children's hospice staff and diverse service user families. This would influence the provision and development of existing and future services to diverse communities.

The findings would provide recommendations that could be adopted by Children's Hospices UK in supporting member hospices in further developing their T.I.S provision.

Methods

The review was carried out to include the provision of T.I.S services by all 44 children hospices in the UK. The review collected data by three principal means: an electronic survey questionnaire, telephone interviews and focus groups.

Findings

The review identified some significant gaps in the provision of T.I.S services but also identified a great deal of good practice to incorporate into policy and guidance that can inform the development of locally appropriate provision. The findings stress the need for language and communication support provision to be an integral tool when conveying information between staff and families.

Conclusion

The findings describe significant barriers that deter access to services as well as compromise the quality of care and support provided to families using services. The recommendations seek to address the challenges by enabling children's hospices to review their existing policy and provision and develop a range of mechanisms that will provide localised support to a diverse range of families.
Collaboration in education to meet the QIPP agenda: an innovative consortium approach
Authors: Walford Carole , Hewitt Carole , Gibbons Liz
Published: September 2011

In early 2011 three established hospices in the South West went beyond the rhetoric. They agreed to work in formal collaboration to address the education needs of their own, and external, clinical and non-clinical staff. A discussion paper was written drawing from the literature of both industry and education. A meeting of key stakeholders in March 2011 agreed a 6–12 month lead in time to the formation of an education consortium.

Aim

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To establish a gold standard for equitable and transferrable EOLC education for clinical and non-clinical staff

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To meet the QIPP agenda with economies of scale

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To remove the element of competition and enable a united approach to future income generation.

Method

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Initial honest transparent discussion to consider four functional areas of the consortium: ownership, leadership, membership and partnership

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This informed the governance structure and roles and functions of the staff

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A letter of intent was signed by each stakeholder organisation

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It was agreed that the consortium would be seen as part of each organisation and not an external entity

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A work plan was agreed.

The mapping process has begun to look at resources in each stakeholder organisation: business development expertise, IT resources and systems, human resources and their capacity as well as the existing education programmes and their current delivery format.

The work of the consortium is in its infancy. In all senses it is a learning organisation as we explore this new approach to sustainable delivery of appropriate End of Life education. The outcome and discussion will be rich by September 2011 and will focus on both the joys and challenges of this work.
Enterprise initiatives: to boldly go…….
Authors: Nickinson Caroline , Walford Carole
Published: September 2011

The role of enterprise in the charity sector is increasingly that of entrepreneur. As the down turn in the economic climate reached the high street so did the realisation that traditional routes of income generation could no longer sustain current patient care provision, nor give scope for future planning and direction.

It was agreed that this was not purely a challenge to the enterprise and income generation team. As an organisation we needed to prioritised time to work together to find fresh ground for innovative and creative income generating opportunities.

An enterprise committee was set up to report to the Board. This is chaired by Chairman of the Trust and consists of Trustees, Fundraising and Retail Directors and income generation staff. The outcome from this united approach is still unfolding.

Key new ideas that the income generation team have taken forward to date include:

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Sourcing sponsorship for our web pages

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A sponsored DVD about the hospice running in our charity shops

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Local businesses being approached to include us on their on- line sales as a charity of choice for their customers at a suggested donation of £1 per transaction.

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Major investment of time to sell items on Ebay.

A further outcome from this work is a series of dedicated ‘blue sky’ thinking events. Benefits have included a further integration of the various work strands in the organisation and sense of unity as we “boldly go…….” into the forecasted austerity ahead.

This paper will give an honest presentation of the challenges we have faced and share some of the successes and lessons learned along this journey.
Evaluating an adapted mindfulness meditation course for use in palliative care setting
Authors: Baines Elizabeth
Published: September 2011

Introduction

Mindfulness Meditation involves paying attention to our mind and body moment by moment, being aware of what arises without judgement.

Experience and evaluation demonstrated that some patients receiving one to one mindfulness meditation failed to achieve their identified goals due to difficulty in committing to regular meditation practice when at home. They felt the traditional framework of the 8 week course would be to onerous.

Aim

To ascertain patient / carer experiences of attending a 4 week course of 1 h structured, group mindfulness meditation sessions.

Method

Patients and their carers referred for meditation practice were invited to attend four 1 h weekly structured group mindfulness meditation sessions. Each attendee was requested to complete a Measure Yourself Concerns and Wellbeing questionnaire prior to first attendance and again following the final session.

Results

2 groups, each consisting of 3 patients and their carers attended. Regular attendance and goals were achieved, as was regular and committed practice at home. They valued the mutual support from other attendees, the positive sharing of experiences – including the challenges of practice.

Discussion

The results demonstrate that the 4 session course fulfilled patient identified outcomes and was felt by attendees not to be too onerous.

Conclusion

Running a course over a number of weeks which requires regular attendance by patients can be a challenge in palliative care settings. My experience suggests that it is possible to cover the essence of Mindfulness Meditation in 4 sessions.

Future studies could compare outcomes of an 8 week and 4 week course.

Future practice could consider: introductory Mindfulness Meditation days; and regular meditation drop-in sessions to support regular home practice.

Knowing of sessions for patients enhances staff awareness and interest in the process of Mindfulness Meditation.
e- ELCA, from the beginning
Authors: Owens Sarah
Published: September 2011

The purpose of the presentation is to highlight innovation in practice with regards how the end of life care for all e-learning programme was implemented and integrated within a hospice. Key concepts include the introduction of e- learning to the clinical staff as a way of learning. How then could this programme be integrated into the working day and how best to monitor the progress of that integration.

The issues were around availability of facilities, such as IT equipment. The varying levels of ability of the staff using the computers, and how those who were less confident could be supported. The ability of staff being released from clinical practice to complete sessions, and which of the sessions available were the most pertinent to each staff group.

Staff were introduced to the programme and its concepts. Extra IT equipment was ordered with two rooms being made into e-learning suites. While this was occuring i accessed the modules and mapped out which modules each staff group would be required to complete. This would ensure that staff completed modules which were most pertinent to their role. Each staff member was given their own folders and workbooks, with step by step guidance of how to negotiate the site. Managers allocated specific time away from the clinical environment and time was spent with staff who felt less confident with e-learning as a way of learning.

Staff continue to learn on a rolling programme, and some have completed all of the necessary modules. Staff report that they find this way of learning flexible and are able to utilise the knowledge back in practice. That they value the time away from clinical practice and the relevance of the topic areas to the delivery palliative and end of life care.
The multiprofessional toolkit – improving communication about patient choices for care
Authors: Tapley Michael , Cerdeira Marcia , Cardoso Anna , Vallantine Karen
Published: September 2011

Quality patient care and family support depends on sharing information between patients and healthcare professionals. However, the number of settings where palliative care is provided may form a barrier to effective communication.

Technologically advanced countries have been developing electronic patient records to enable access to information by all healthcare providers. I.T. is expensive, relying on professionals to keep records up to date and ensure confidentiality.

Our patients living with life limiting illnesses could not wait for the development of databases.

A paper booklet called the Multiprofessional Toolkit was designed so that patients take ownership of their health information. They ask any healthcare workers they meet to make entries in their booklet to keep it up to date. It enables problems to be managed according to the patient's wishes.

Methodology

A coordinator interviewed patients and professionals from the hospice, the hospital, the primary care trust and macmillan nurses. The pilot survey guided the design of the booklet, its content and user friendly design.

Results

The coordinator developed the toolkit. This formed a patient held record, which as a communication tool helps staff dicuss life limiting illnesses with patients and families. Patients relate the story of their illness and record it in their toolkit, reassured that professionals may understand more clearly what their priorities of care might be.

It includes relevant medical information. Patients find this makes consultations easier as information does not have to be remembered burt simply read from the toolkit. Patients record changes in their views whenever they wish.

Samples of the toolkit were distributed among user groups, with a feedback questionnaire. Data collected demonstrated approval for the project.

It has now been printed and staff training undertaken.

Conclusions

Audit demonstrated very quickly, cheaply and effectively improved communication. It could be adapted for other countries too.
Developing an end of life care community forum
Authors: Haywood Chris , Littlewood Clare
Published: September 2011

Introduction

Embedding end of life care in nursing homes is not sustainable on education packages alone. Evidence shows us that ongoing clinical support needs to be provided if change is to be sustained. The development of a dedicated End of Life Care Community Forum was felt to be a model that could address this issue.

Aims

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To enable networking and opportunity for care homes to meet for support with end of life care issues

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To improve end of life care delivery in care homes and assist people to die in the place of their choice reducing hospital admissions at the end of life

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To establish End of Life Care Champions.

Methods

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Scoping exercise

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Senior staff at the Hospice Chair and co-ordinate meetings

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Engagement with Advance Care Planning Teams (Community)

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Funding at Network Level to support roll out.

Results

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Care of residents and staff morale increased

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Reduced admissions to hospital for end of life care

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Heightened awareness of End of Life Care Strategy with an increase in the use of end of life tools

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Electronic communication systems and links to 24/7 telephone advice have been enhanced.

Conclusions

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Has provided opportunity for improvements in the patients pathway with shared learning between nursing home and specialist palliative care services

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Staff are empowered to utilise end of life care tools in supporting patients to die in their preferred place of care

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Requires commitment from all service providers and a level of funding from the local ICN.

Recommendations

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All nursing homes providing end of life care become active members of the Forum as part of any contracts via Commissioners in line with Quality Markers

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Consider widening the remit to other service providers where end of life care is offered.
Reducing treatment dose errors with low molecular weight heparins
Authors: Campbell Colin , Coackley Alison , Thompson Anthony
Published: September 2011

Cancer patients have a 1 in 200 risk of a venous thromboembolic event, which is five times higher than the general population. Low molecular weight heparins are used in the treatment of venous thrombo-embolism but a patient weight calculation is required to determine the correct dose. Incorrect weight estimations can lead to serious adverse effects. In general hospices do not have ways of accurately assessing patient weight.

Recent guidance from the National Patient Safety Agency has specified guidelines on treatment.

Aim

To assess hospice compliance with recommendations from the NPSA.

To initiate appropriate changes in clinical practice relating to prescribing of LMWH.

Method

Retrospective audit of clinical records of patients who were on treatment for venous thrombo-embolic disease.

Results

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5/6 patients with venous thrombo-embolic disease were anticoagulated

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0 patients were weighed prior to treatment

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Limited use of biochemical screening prior to treatment

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Incomplete documentation/communication to other healthcare professionals.

Conclusion

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If weighing equipment not available other methods of assessing patient weight are required

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Essential information should be documented and communicated when patient care transferred to another setting

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Discussion of the pros and cons of anticoagulation should be part of routine care for all patients.

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Need for education for all hospice staff

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Review of documentation used

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Need for reaudit within 6 months.
Demonstrating quality through advanced care planning
Authors: Gallini Andrew , Reddish Melissa , Martin Tori , Barnes Steve
Published: September 2011

The National End of Life Strategy set out a particular focus on the care planning of patients at the end of life and with one of the key 10 objectives that individual needs will be documented, reviewed and acted upon in relation to advanced care plans. Specific quality markers and measures for end of life care were published by the department of health in 2009. In relation to advanced care planning these identified a requirement that people approaching the end of life are offered a care plan and that individuals' preferences and choices, when they wish to express them, are documented and communicated to the appropriate professionals.

Significant work has gone on over the past 18 months by the community specialist palliative care team at St John's Hospice to develop policy and guidance, patient documentation and information, and a dedicated database to record whether discussions around patient plans and preference have taken place. This has enabled the team to be in a position to report this as one of three key commissioning for quality and innovation (CQUINS) targets, set jointly with commissioners, which enables quality to be recognised and linked to additional funding. Results for the first full year have been very positive in demonstrating over 85% of patients have had opportunities to discuss and document their advance care plans.

This presentation will explore the challenges in seeking to implement advanced care planning for patients. The need to quantify advanced care planning with patients for commissioners is a particular challenge to be meaningful, informative and transparent. The work by the community specialist team in recording a number of items related to patient preferences may be seen as a precursor to end of life registers that the team are currently involved in as part of both a local and national pilot.
Whose job is it anyway? Meeting the spiritual needs of people at the end of life
Authors: Noble Agnes
Published: September 2011

Introduction

Spiritual care is a key element of palliative care. In the UK, NICE guidelines state that spiritual care should be offered as an integral part of care. Patients should have opportunities for their spiritual needs to be assessed and it is important for those assessing need to be highly attuned to the spiritual dimension of care. However, the results from the National Care of the Dying Audit (Round 2) in the UK show that this spiritual need is still not being met. Spiritual needs can be more urgent at the end of life.

Aim

The aim of this study was to explore oncology nurses' understanding of spirituality, in anticipation of a greater understanding of this elusive area.

Method

Using a qualitative cross-sectional design, inspired by a grounded theory approach, a non-probability purposive sample of seven nursing staff took part in a focus group and individual semi-structured interviews. The participants varied in age, grade and years of oncology experience.

Results

The main findings showed the majority of nurses cited lack of time and not knowing what to say as significant barriers to giving spiritual care. The emotional impact on the nurse providing spiritual care was also identified as a burden, causing stress and feelings of inadequacy. Lack of education and training produced fear and anxiety. However, spiritual care was seen as a collective responsibility. The nurses wished to raise spiritual awareness and to deepen their own awareness in this important area.

Conclusion

Results suggest that despite the recognition of the importance of care in this area, nurses find difficulty in providing spiritual care to patients. Recommendations arising from the study include an education programme for nurses to increase the skills and confidence in undertaking spiritual assessment and enabling them to provide spiritual care.
Systematic review: to what extent are end-of-life patient medical treatment preferences respected?
Authors: Satherley Philip
Published: September 2011

Background

End-of-life medical treatment preference tools are documents for guiding end-of-life practice and are commonly known as Advance Decisions, advance directives or living wills. To date, most published research on these tools has focused on their uptake and how they are understood by the general public and healthcare professionals. Less research has been published which examines whether such tools have been acted upon and the patient has received the level of care they requested.

Review question

In response to this, a systematic review was conducted which examined to what extent are the medical treatment wishes laid out in preference tools respected? Out of approximately 3500 references located, eight were included in the final systematic review.

Findings

All studies were from the USA and, as a body of evidence, indicated that the tools worked at ensuring patients' documented wishes were acted upon. These studies also demonstrated that the success of preference tools is as much about the context of care, sophistication of care models and buy-in from staff as the tool itself. Crucially, in all studies, patients' treatment wishes are recorded in an appropriate system. Implications for practice Based on the findings of the systematic review I will make suggestions for changes in the organisation of Advance Decisions in the UK and where further research is needed. Given proposed changes to the organisation of the NHS, and the increasing emphasis on patients being able to die in the place of their choice, systematic and cultural changes are needed to ensure wishes expressed in Advance Decisions can be respected whether a patient dies in hospice, at home, or in a hospital and how they are managed between settings.
Is a triage system of referrals to a community palliative care nurse specialist team workable?
Authors: Coldicott Roz , Campbell Mary , Rowlands Sue
Published: September 2011

Aim

To provide an insight into the workability of a triage system for patient referrals to a team of Community Palliative Care Clinical Nurse Specialists (CPCT).

Background

The community team were concerned about delays in responding to patients referred to their service. Patients are referred to a specialist service for specialist advice for complex symptom management / psychological support. Any delay in responding to the referral impedes the management of their symptoms or support and can lead to further distress.

Methods

Triage was introduced as a 6 month pilot in an attempt to improve the response time in line with local and national initiatives. An audit was then carried out using questionnaires to district nurses, GPs, and the CPCT with the aim of providing the team with evidence of the feasibility of triage as a long term working commitment.

Results

Triage has provided the team with a workable practice which enables prompt response to both the patient and the referrer. Due to the process of triage the team has also ensured an accurate recording of the number of referrals, as well as a uniformed and structured response. Triage also allows for; The gathering of detailed information, by a CNS, on day of referral and provides an outcome for speed of response. Same day assessment and treatment of symptoms and if necessary referral to other disciplines, Education for referrers, patients and carers about symptom control, Provides patients and carers with telephone numbers straight away for them to access our service and 24 h helpline.

Conclusion

Triage is a team initiative which has directly benefited patients and carers; opened communication with referrers; ensured we achieve local and national standards; standardised the referral process; improved data collection; provided a tool for audit.
Putting patients in control
Authors: Dickinson Carole , Tydeman Julie
Published: September 2011

Background

The Nightingale Macmillan Unit is a purpose built 20 bed specialist palliative care unit within an acute hospital. Staff identified that patients with impaired upper limb function had difficulty or were unable to summon assistance of staff on the ward. In addition, some patients who had environmental controls at home reported to feel extremely vulnerable and dependant during respite admissions, as there were no such facilities at the unit. During respite admissions we wish to maintain the patients function and condition to ensure that they can return home with the pre-existing care package and equipment.

Methods

Having identified the problem, discussions were had with patients from the respite list as to what equipment they used at home, and what was most important to them. A number of different staff groups then worked together to obtain a range of non-standard nurse call switches and an environmental control system to facilitate control of electrical appliances.

Results

Patients with impaired upper limb function can now use the nurse call system to summon assistance when they need it. Patients now also have control over lighting, TV, radio and a fan.

Discussion

These improvements have enabled patients with impaired upper limb function to feel more empowered during their respite admissions. The non-standard nurse call switches have allowed patients to summon assistance when they need it. Therefore patient's privacy and dignity are greater and demands on nursing staff time are reduced. “When I wake up in the night, I can now turn on the light instead of being stuck in the dark” Gordon (patient). It has been both a positive and rewarding experience for staff to be able to use technology to promote patient independence and quality of life.
End of life care for people with dementia: the challenge for specialist palliative care
Authors: Alsop Anne
Published: September 2011

Introduction

There are 613 661 people with dementia in England, rising to over a million by 2030, an increase of 72%. They should have the same access to palliative care as others but many are not receiving it. Specialist palliative care (SPC) should consider how it can help to achieve a ‘good death’ for them.

Aims

To examine the end of life care needs of people with dementia; to identify gaps in the provision of care and to develop a hospice strategy.

Methods

A literature search identified issues in the care of people dying with dementia. Consultation with providers of care confirmed these findings. A focus group of bereaved carers provided insight into the experience of caring for someone dying of dementia. Models of care from other hospices were explored to generate ideas. Hospice teams were encouraged to share experience of caring for these patients.

Results

Emerging issues were the risks associated with hospital admission; symptom burden; the emotional impact of decision making on families and uncertainty about the role of SPC. Effective communication; advance care planning; symptom assessment; recognition of dying and support for families were identified as essential for improving care.

Discussion

A hospice strategy was developed, based on different levels of SPC. Most people with dementia need generalist palliative care, with SPC providing education and consultancy for professional carers. A practice development role with partnership working between the hospice and care providers is being explored. The hospice should also create a dementia friendly environment for people requiring its services.

Conclusion

The increasing incidence of dementia and the inadequacy of palliative care provision challenges SPC to find innovative approaches to improve the experience of dying. This project makes a start in meeting the challenge.