bluuebunny/crossref_metadata_2025_split huggingface dataset:
MEDICINES RECONCILIATION FOR PAEDIATRIC PATIENTS ON ADMISSION AND DISCHARGE
Authors: Moss Maria , Bilbul Celine , Crook Jo 
Published: August 2016

IntroductionNational guidance from National Institute for Health and Clinical Excellence (NICE), National Patient Safety Agency (NPSA), World Health Organization and the Royal Pharmaceutical Society has long highlighted the importance of accurate and timely medicines reconciliation (MR) in reducing medication errors for patients upon transfer of care setting.1
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4 Current guidance for MR excludes children <16 years of age, where widespread use of off-label and unlicensed formulations puts this group of patients at a higher risk.AimTo quantitatively assess the level of MR for paediatric inpatients on admission and discharge and to ascertain whether Discharge Summary (DSUM) information is sent to the GP in a timely manner.Method▸ Data was collected retrospectively over a two week period for paediatric take home prescriptions.▸ An electronic prescribing system was used to complete a data collection form, documenting their MR process and timeframe on admission and discharge.▸ The information was recorded onto an online template of the data collection form using Qualtrics software to prepare a Microsoft Excel file for data analysis.Results65 paediatric patients on four wards were audited.▸ Standard 1: 32/65 (49.2%) of patients had their drug history (DH) documented within 24 hrs of admission.▸ Standard 2: 39/65 (60.0%) of patients had their medicines reconciled by a pharmacist within 72 hrs of admission.▸ Standard 3: 46/65 (70.8%) of patients had their medicines reconciled by a pharmacist and/or doctor at discharge.▸ Standard 4: 57/65 (87.7%) of patients had their DSUM sent to the GP within 24 hrs of discharge.ConclusionNone of the four standards were met, emphasising the need to develop better MR practice. The following conclusions were identified:▸ A need for more MMTs at ward level to conduct accurate DHs within a timely manner.▸ MR on admission and discharge suffers out-of-hours (OOH), thus supporting plans for seven-day working.▸ A combined effort between different members of the multidisciplinary team is paramount to ensure accurate MR.▸ Doctors need to have the resources available OOH to allow them to prioritise completion of DSUMs in a timely manner to optimise accurate MR communication with GPs.▸ It is evident that anecdotally MR is done to a higher level; however a possible lack of pharmacist understanding on the MR process and its documentation may have contributed to this audit's standards not being met.
DOES MORE SPECIALIST PHARMACIST TIME IN A CLINICAL AREA EQUAL MORE ACTIVITY?
Authors: Isaac Rhian , Gerrard Astrid , Bazaz Kevin 
Published: August 2016

BackgroundFollowing a medication safety initiative proposed by the PICU Safety Strategy group a pilot was set up to extend the presence of a PICU trained pharmacist in the clinical area.One of the main safety initiatives was to assess whether increased pharmacist exposure decreased drug omission of time critical medicines, which was highlighted from incident reporting patterns on PICU.AimTo assess what impact extending a pharmacist with specific PICU training would have on the medicines management of the PICU patients.MethodThe pilot involved attendance on the afternoon ward round, review of all new admissions and follow up of priority patients as highlighted by the “day” PICU pharmacists. The pilot “late” PICU pharmacist was resident in the hospital, on PICU, for an hour longer than the pharmacy opening hours. A rota ofA basic data collection form was set up on Microsoft Excel. Data collected included start and finish times of the ward round, time leaving PICU, clinical interventions made, queries by staff on PICU and outside of PICU, supplies made, drug omissions prevented, number of times the presence on the unit prevented need to call in the on call pharmacist and interpretation of drug assays reported after pharmacy hours. Follow up of specific medicines management issues highlighted by the “day” pharmacists as requiring action prior to following day pharmacy visit were recorded.ResultsDuring the 74 days data were collected there was 395 drug related queries by PICU staff (252 by nursing staff, 143 by prescribers). The “late” PICU pharmacist was contacted for advice regarding non-PICU patients by the on call or dispensary pharmacist on 7 occasions and 11 times from clinical staff outside of PICU.The “late” pharmacist intervened on 412 prescriptions, some of the interventions arose from the 260 follow up reviews requested by the “day” pharmacists. Of the 236 drug assays reported after pharmacy hours, 126 required intervention by pharmacist.Omission of time critical medicines was prevented on 17 occasions following 79 supplies of non-stock medicines. Calling out the on-call pharmacist was circumvented 11 times.ConclusionThe Safety Strategy teams’ request for increased access to a “late” PICU pharmacist resulted in a number of clinical interventions, appropriate dosing advice on late-in-day reported drugs assays and prevention of delays in medicines, including time critical drugs. Benefits of the specialist pharmacist being on-site to the pharmacy service included less need to access the on call pharmacist for either advice or supplies of medicines. During a pharmacy 7 day working review these data were used to secure the increased clinical pharmacy service to PICU.
USE OF PILL GLIDE TO ENCOURAGE TRANSITION FROM LIQUID TO SOLID DOSAGE FORMULATIONS
Authors: Gaskell Ceri 
Published: August 2016

SituationPatient I is a 15 year old female with ornithine transcarbamylase deficiency prescribed L-arginine 1.5 g three times daily and sodium benzoate 4.2 g three times daily. By taking her medication and controlling her diet she is able to lead a normal life and does well at school. However she struggles with the palatability of her medication and has not been able to transition to solid dosage forms. She has therefore been stabilised on an unlicensed sodium benzoate liquid and has L-arginine capsules which she takes by opening and dispersing the contents in water. This creates problems for the patient because the volume of sodium benzoate liquid that she needs is very large. This means it has been difficult to come to collect supplies from our pharmacy due to the volume that needs to be carried and transported in one go, and also makes going away on holiday difficult. In addition, the liquid version is more expensive than other options so being able to convert to tablets would be a cost saving measure.BackgroundPrevious attempts to encourage her to take tablets and alternative options such as licensed sodium phenylbutyrate granules have failed. A recommendation was therefore made by the pharmacist to try using Pill Glide swallowing spray as an aid to help her learn to swallow sodium benzoate tablets, in conjunction with nurse-led teaching. Pill Glide is a flavoured spray that helps patients swallow tablets and capsules more easily. It comes in a number of flavours that patients can choose from and can be used for as long as it is beneficial.OutcomePatient I found the spray useful in helping her to swallow sodium benzoate tablets and swallow her L-arginine capsules whole and has now successfully transitioned from using sodium benzoate liquid. This has benefitted the patient by reducing the need collect and transport large volumes of liquid, and by helping her to transition to adulthood. Importantly it has also enabled a significant cost saving, with a saving of £367/month by switching her from liquid sodium benzoate to sodium benzoate tablets and Pill Glide.Lessons learnedPill Glide is a useful potential option to help patients who struggle to take solid dosage forms. Liquid medicines are usually much more expensive than tablets and capsules, and therefore helping children with chronic conditions to transition to taking tablets and capsules could be an important cost-saving measure. In addition it could improve compliance in taking medicines where there is no liquid form available or where patients find liquid forms unpalatable. The option of Pill Glide has now been rolled out to other specialties such as renal and respiratory patients where there may also be cost savings and patient benefits for those who find transitioning to solid dosage forms difficult.
Heart failure care or palliative care? Patients want and need both
Authors: Brice Mary , Martin Amanda , Hansford Penny , Richardson Heather , George Rob , Murtagh Fliss 
Published: August 2016

IntroductionPeople with advanced heart failure have significant symptom/disease burden. Optimal models of care have not yet been widely tested and evaluated. We aimed to test a novel combined heart failure palliative care service model.MethodA mixed-method feasibility study, including comparison with an age- and gender-matched cohort receiving specialist palliative care.Results27 male and 13 female patients (mean age 84 years, range 60–99) were recruited. Integrated Palliative care Outcome Scale scores, compared with an age- gender- matched specialist palliative care population, demonstrated significantly higher levels of fatigue (mean score 2.6 v 1.9, p = 0.01), poor mobility (2.75 v 1.6, p = 0.00), drowsiness (2.03 v 0.6, p = 0.00), breathlessness (2.2 v 0.9 , p = 0.00), sore/dry mouth (1.4 v 0.6, p = 0.004), depression (1.4 v 0.5, p = 0.002) and not feeling at peace (1.6 v 0.9, p = 0.02). 67% (95% CI: 49–79%) were severely/overwhelmingly affected by poor mobility and 50% (95% CI: 34–65%) were affected by weakness/fatigue in the previous week. In qualitative interviews (8 patients, 6 carers and 2 joint), patients sought heart failure care critical for optimal symptom control, and whilst realistic about the limitations of therapies, wanted parallel support to prepare for and manage future deterioration.ConclusionPeople with advanced heart failure have considerably greater needs than an age-matched palliative care population. They have realistic expectations about interventions available but identify practical support and appropriately skilled healthcare teams as important to their care. Professionals skilled in both heart failure and palliative care interventions in an integrated service model are needed.ReferencesHogg KJ, Jenkins SMM. Prognostication or identification of palliative needs in advanced heart failure: where should the focus lie?BMJ2012;98(7):523524Nordgrena L, Soerensen S. Symptoms experienced in the last six months of life in patients with end-stage heart failure.Eur J Cardiovasc Nurs2003;2(1):213217Pattenden JF, Mason AR, Lewin RJP. Collaborative palliative care for advanced heart failure: outcomes and costs from the ‘Better Together’ pilot study.BMJ Support Palliat Care2013;3(1):69–76Selman L, Harding R, Beynon T,et al. Modelling services to meet the palliative care needs of chronic heart failure patients and their patients: current practice in the UK.Palliat Med2007;21(5):385–390
Supporting adults bereaved through advanced illness: development of a core outcome set (COS)
Authors: Cowie Luke , Nelson Annmarie , Morgan Fiona , Byrne Anthony , Pickett Sara , Sivell Stephanie , Fitzgibbon Jim , Harrop Emily 
Published: August 2016

BackgroundA lack of evidence-based guidance on bereavement support (Hudsonet al., 2012) and of consistency in the measures used in clinical practice and research to assess bereavement outcomes (Forteet al., 2004) have been identified. The heterogeneity in outcome measures makes it difficult to assess and benchmark clinical services. It is also challenging to combine and compare research results, and draw robust conclusions on effectiveness to inform clinical practice and service delivery. One step to resolving this situation is to develop a core outcome set (COS). This represents the ‘minimum that should be measured and reported in all clinical trials of a specific condition’ (www.comet-initiative.org).AimThis project, funded by Marie Curie, aims to develop a COS that is specific to bereavement in adults following advanced, progressive illness.MethodsThe COS will be developed through a series of distinct methodologies. First, outcomes utilised in the studies identified by systematic review will be mapped into different domains. Second, an expert consensus day will be convened with up to 30 stakeholders to identify any further outcomes and engage in a consensus methodology (Gallagheret al., 1993) designed to identify the most important. Finally, the list of core outcomes will be further refined through an online Delphi survey with items rated over two rounds to reach consensus on which items should be included in the COS.Results/conclusionsThe COS will allow research results to be compared, contrasted and combined, and will have additional benefits for clinical practice and the commissioning of services.ReferencesHudson P, Remedios C, Zordan R,et al. Guidelines for the psychosocial and bereavement support of family caregivers of palliative care.J Palliat Med2012;15(6):696–702Forte A, Hill M, Pazder R, Feudtner C. Bereavement care interventions: a systematic review.BMC Palliat Care2004;3(1):3Gallagher M, Hares T, Spencer J, Bradshaw C, Webb I. The nominal group technique: a research tool for general practice?Fam Pract1993;10(1):76–81
What support do people with cirrhosis need from liver healthcare professionals in a liver transplant centre?
Authors: Davis Sarah , Low Joseph , Greenslade Lynda , Marshall Aileen , Thorburn Doug , Jones Louise 
Published: August 2016

Background and aimsThe incidence of liver disease is increasing in the UK; it is now the 3rdcommonest cause of death in those aged under 65. People with cirrhosis often have complex physical problems that require regular comprehensive management. Limited evidence exists on the ways that people with cirrhosis cope with the disease. We aimed to explore their experience to ascertain whether current levels of healthcare support were sufficient.MethodsTen people with cirrhosis were recruited from hepatology clinics in one liver transplant centre. In semi-structured qualitative interviews, we explored their understanding of their disease and prognosis; healthcare services received; specific problems encountered; concerns for the future. Interviews were audio-taped and transcribed verbatim. Data were analysed using a Framework approach.ResultsOur sample was 50% male: 5 were on the liver transplant list. Everyone said that the healthcare they received from the hospital was good; staff continuity and relationships with clinicians were seen as important. However, people lacked understanding of their diagnosis, health status and symptoms and wanted more management advice and psychological support. Contacting a member of the clinical team was difficult if problems developed at home, leading to A+E attendance. Limited discussions were held about disease progression and future care if treatment failed.ConclusionsSymptom burden in people with cirrhosis is high and needs are complex. Active communication from professionals about current disease status and likely progression may enable better understanding and encourage involvement in plans for their future care.ReferencesPoonja Z, Brisebois A, van Zanten SV,et al. Patients with cirrhosis and denied liver transplants rarely receive adequate palliative care or appropriate management.Clin Gastroenterol Hepatol2014;12(4):692–698Kimbell B, Boyd K, Kendall M, Iredale J, Murray SA. Managing uncertainty in advanced liver disease: a qualitative, multi-perspective, serial interview study.BMJ Open2015;e009241. doi:10.1136/bmjopen-2015-009241
Facilitating successful implementation of the carer support needs assessment tool (CSNAT) intervention within palliative care
Authors: Diffin Janet , Ewing Gail , Grande Gunn 
Published: August 2016

BackgroundThe Carer Support Needs Assessment Tool (CSNAT) intervention identifies and addresses family carer support needs towards end of life.1–3This person-centred approach involves a change in practice from a practitioner- to carer-led assessment process. Numerous policies recommend carers’ needs should be addressed yet there is little guidance on how to achieve this within palliative care. To address this gap and assist a change to a carer-led process, an implementation strategy for the CSNAT intervention was developed, of which facilitation is key.Aimsinvestigate components of facilitation associated with successful implementation of the CSNAT intervention across 36 palliative care services.MethodsQualitative: Interviews three and six months post-CSNAT implementation with 38 practitioners acting as CSNAT ‘champion’ (internal facilitation) in 32 services. Researcher field notes collected from teleconference support sessions with ‘champions’ (external facilitation).ResultsSuccessful implementation of the CSNAT intervention was associated with: a teamwork approach to facilitation; the ‘lead champion’ having a leadership role in the service e.g. team manager; presenting a clear rationale why a change in practice was needed; reviewing progress and making changes to overcome identified barriers; ‘champions’ having good communication skills and authority to make changes. Aspects of context which constrained facilitation included the need to establish a new carer record, and organisational changes e.g. budget cuts, and a culture focused on the patient. Management support assisted with facilitation efforts.ConclusionsEstablishing a team of practitioners to lead facilitation of the CSNAT intervention and regularly review implementation progress, is recommended to help ensure implementation success.ReferencesEwing G, Brundle C, Payne S, Grande G. The Carer Support Needs Assessment Tool (CSNAT) for use in palliative and end-of-life care at home: A validation study.J Pain Symptom Manage2013;46(3):395–405Ewing G, Grande G. Development of a Carer Support Needs Assessment Tool (CSNAT) for end-of-life care practice at home: A qualitative study.Palliat Med2013;27(3):244–256Ewing G, Austin L, Diffin J, Grande G. The Carer Support Needs Assessment Tool: A person centred approach to carer assessment and support.Br J Community Nurs2015;20(12):580–584
How current UK research addresses out of hours palliative care
Authors: Fordham Florence Todd , McMillan Stevie , Best Sabine , Candy Bridget , Thakrar Sanjay , Noble Bill 
Published: August 2016

IntroductionIn 2015 the Palliative and end of life care Priority Setting Partnership (PeolcPSP), facilitated by the James Lind Alliance, published a top-ten list of unanswered questions relating to palliative and end-of-life care research. These were ranked in accordance with responses from people in the last years of life, current/bereaved carers and professionals working with people at the end-of-life.The highest ranked question was: “What are the best ways of providing palliative care outside of working hours to avoid crises and help patients stay in their place of choice? This includes symptom management, counselling and advice, GP visits and 24-hour support, for patients, carers and families.”AimThis project presents how current research in the UK is addressing this question.MethodsThrough a grant mapping process, links have been identified between the PSP questions and current research, using the UK Clinical Research Collaboration’s (UKCRC) Health Research Classification System dataset, providing a snapshot of 2014 data. These links have been coded from weak to interventional.ResultsThis grant mapping process highlights that although out of hours care is ranked most important by carers and health care professionals, it receives very little research attention. In 2014, no current research proposed an intervention to address the question, and only four grants representing 0.03% of health research spend directly addressed out of hours palliative care. They were funded by the Department of Health and Marie Curie.ConclusionThis work highlights the need for future research funding to focus on out of hours palliative care.
Enabling successful hospital discharge to home at end of life: can a carer support needs assessment tool (CSNAT) help improve support for family carers?
Authors: Ewing Gail , Austin Lynn , Gibson Debra , Grande Gunn 
Published: August 2016

IntroductionSuccessful hospital discharge and prevention of readmission often depend on carers’ ability to support patients.AimTo investigate how carers are supported during patient discharge from acute care towards end of life (EOL) and suitability of using a Carer Support Needs Assessment Tool (CSNAT) to improve this support.MethodsQualitative design: focus groups (FGs) with 40 practitioners supporting patient discharge from three English acute hospital trusts; interviews with 22 carers of patients discharged. 14 practitioners and 5 carers joined two final workshops. FGs/interviews/workshops explored current discharge processes and potential value of using CSNAT. Thematic framework analysis was conducted.ResultsBoth practitioners and carers viewed CSNAT as highly relevant in supporting carers at discharge. Discharge processes were heavily focussed on patients: carers were consulted but about patients’ needs; there was no systematic approach to supporting carers. CSNAT was identified as a means of facilitating much needed EOL conversations which often were absent, enabling carers to articulate concerns, and managing carers’ expectations of their caregiving role at EOL and support available (or not) in the community. However, palliative care discharges were complex: from many different wards involving different practitioners. No single professional group was identified as best placed to support carers. Feasibility issues included skills, confidence and time for carer assessment and support. A two stage process using CSNAT earlier in hospital admission, then as a carer-held record to manage transition to home were seen as ways forward.ConclusionCSNAT shows good potential to enhance carer support at hospital discharge and play a role in preventing readmissions towards EOL.ReferencesEwing G, Brundle C, Payne S, Grande G. The Carer Support Needs Assessment Tool (CSNAT) for use in palliative and end-of-life care at home: A validation study.J Pain Symptom Manage2013;46:395–405Ewing G, Grande GE. Development of a Carer Support Needs Assessment Tool (CSNAT) for end of life care practice at home: a qualitative study.Palliat Med2013;27:244–256