bluuebunny/crossref_metadata_2025_split huggingface dataset:
AUDIT OF A SPECIALIST PALLIATIVE CARE TRIAGE ADVICE LINE WITHIN SOUTH TEES
Authors: Sealy Trish , Perry Fiona , Stockdale Stacey 
Published: February 2014

BackgroundSouth Tees Community Specialist Palliative Care Team (SPCT) provides Specialist Palliative Care support to a diverse population across the Middlesbrough and Redcar/Cleveland areas. Data collection in recent years has shown increasing pressures of telephone calls from generalist professionals requesting clinical advice/discussion. In 2011 an advice line was created using an office-based Clinical Nurse Specialist during working hours to co-ordinate and deal with telephone work. Alongside implementation of the System1 computerised patient record system within the team and across the locality it was felt this would provide a more controlled and consistent environment for the provision of timely and reliable advice with immediate access to written confirmation and a more readily available governance trail.AimsAn audit was carried out with the intention of providing feedback to support the maintenance and development of the service. Questionnaires were sent to every user of the service who consented during a defined period with responses returned anonymously to the audit department within the trust.Results21 responses were included in the analysis of which 19 were fully completed with a range of 12 different professional roles across health and social care represented. 19/19 were satisfied with the response time and 17/17 whose enquiry regarded direct patient management felt that the advice received helped them to manage that patient more effectively. 8/19 felt that without advice the patient may have required admission to the acute hospital and 5/19 resulted in subsequent referral to the SPCT for further input. Qualitative comments were generally favourable.ConclusionsThis audit provides evidence to support the continuing need for a robust telephone advice service across South Tees. It highlighted possible areas for future development which include extension of available hours and dedicated telephone number.
SURVEY OF POTENTIAL DRUG INTERACTIONS IN ACUTE HOSPITAL INPATIENTS RECEIVING SPECIALIST PALLIATIVE CARE (SPC)
Authors: Daniel Sunitha , Hurlow Adam , Hicks Fiona 
Published: February 2014

AimPolypharmacy is common in palliative care and is associated with an increased risk of potentially harmful drug interactions. In order to identify common interactions and explore the SPC approach to polypharmacy we surveyed hospital inpatients receiving input from an SPC advisory service.MethodologyThe notes and drug charts of 50 consecutive patients referred to the SPC team between May and August 2012 were retrospectively reviewed. Potential interactions were identified and classified according to their clinical significance as minor, moderate or major using the website http://www.drugs.com/ResultsThe median number(range) of medications per patient at the time of initial assessment was 12 (5–23). In total, there were 628 potential interactions, 53 major, 505 moderate and 70 minor. Potential interactions were seen in 90% of patients and 62% had a major potential interaction. The median number (range) of major, moderate, and total potential interactions per patient was 1 (0–5), 8 (0–28), and 11 (0–32) respectively. There was a positive correlation between the number of medications and the number of potential interactions (p<0.0001). Common interactions in the major group were: QT interval prolongation (26%), enhanced serotonergic activity (18%), cytochrome P450 inhibition (16%), increased bleeding risk (12%), and reduced seizure threshold (5%). Common drugs implicated include haloperidol, cyclizine, levomepromazine, metoclopramide, opioids, benzodiazepines and ondansetron. Although at risk, none of the patients included in the study had evidence of major or moderate adverse events due to drug interactions. In only 14% (5/37) of patients taking potentially unhelpful medication, like antihypertensive, antiplatelet, and cholesterol lowering agents had SPC advised the medicines to be stopped.ConclusionThis study demonstrates that majority of acute hospital inpatients receiving SPC are at risk of clinically significant drug interaction although the clinical importance is less clear. The study highlights the need for SPC teams to be vigilant for common interactions and to minimise polypharmacy by stopping medications of little benefit.
MY NEEDS NOW—OUTCOMES OF INNOVATIVE COUNTY-WIDE COMMUNITY NEURO-PALLIATIVE COORDINATOR POST
Authors: Scholes Carol , Garrood Liz 
Published: February 2014

IntroductionFollowing 4 years of community neuro-palliative multidisciplinary teams in Hertfordshire, the gap of a community co-ordinator for newly diagnosed patients with rapidly progressive neurological conditions emerged as a priority.MND71HD30PSP22MSA12CBD4AimsTo assess the impact of an innovative co-ordinator role assessing community neurology and palliative care needs at diagnosis of five rapidly progressive neurological conditions. To examine impact on patient experience, non-elective hospital admissions and place of death.MethodA pathway was developed direct from neurological diagnosis of five rare conditions-Motor Neurone Disease(MND), Progressive Supranuclear Palsy (PSP), Huntingtons Disease (HD), Cortico-basal degeneration (CBD), Multisystem atrophy (MSA). The community co-ordinator assessed their neuro-palliative needs soon after diagnosis, gave information, referred to appropriate community services, and then acted in a clinical consultancy role to staff and patients.ResultsTotal number of patients referred and assessed during January 2012 – May 2013=139The most frequent onward referral was to specialist palliative care=75 (54%).31 (22%) have died, 27 (87%) in their preferred place.Eastern Region Public Health Observatory data showed reduction in elective and non-elective hospital admissions for people with these diagnoses by over 50% in 1 year. Cost of the co-ordinator post and administrative support is 60k per annum.Patient experience –a baseline questionnaire revealed gaps in current service. Comparison after 1 year of the service will be presented. Anecdotally it has made huge improvements to many patients' lives and improved knowledge and skills of community staff, which can be applied in managing patients outside this project.ConclusionsThe model appears to have been successful providing improved quality of co-ordinated community clinical care while reducing hospital costs. It is cost-effective and provides timely specialist support, working through existing workforce. It could be a model for managing other rare long term conditions, and to increase access to palliative care for other non-malignant conditions.
LAST YEAR OF LIFE PROJECT: BRADFORD TEACHING HOSPITALS FOUNDATION TRUST
Authors: Holmes Sarah , Price Elizabeth 
Published: February 2014

Aimto improve care of patients identified in their last year of life by increasing the number of patients identified in their last year of life; recording patients' Preferred Place of Death (PPoD); improving transfer and documentation of advance care planning decisions between primary and secondary care, and reducing inappropriate readmissions and length of stay at the end of life.MethodPiloted on two acute medical wards, four workstreams were established to plan, implement and evaluate the project. Using a marginal gains approach, where multiple small changes produce a significant result, the team have: implemented the AMBER care bundle and linked with the Locality End of Life Register; established an End of Life Information Hub to facilitate sharing of information across boundaries; delivered an education package including multiprofessional communication skills training, role modelling on ward rounds and e-learning; improved facilities for carers of dying patients, including the provision of recliner chairs and Bradford Bags containing items to make relatives' stay more comfortable.Results179 patients have been entered on the End of Life Register. Of these, recording of Preferred Place of Death has increased from 4% to 88%, with 64% of those who died achieving their preference. There has been a significant reduction in number of admissions, length of stay and occupied bed days for patients in their last year of life. The speed of fast-track discharges has improved from 60% within 48 hours to 80%. An increased number of advance care planning discussions are taking place and feedback from staff at 3 months shows a sustained increase in confidence in having end-of-life conversations.ConclusionAlthough numbers are small, initial evidence demonstrates a positive impact on care for patients in their last year of life. Roll out of the project and sustainability remain challenging.
EVALUATION OF THE DOVE CENTRE, PHYLLIS TUCKWELL HOSPICE, MULTIDISCIPLINARY TEAM MEETING FOR PATIENTS WITH NEURODEGENERATIVE CONDITIONS
Authors: Dando Nicholas , Brinkworth Helen , Hawkins Helen 
Published: February 2014

BackgroundA collaborative, cross boundary multidisciplinary team (MDT) was established in January 2012. The purpose of the meeting was to support best care for patients living with neurodegenerative disease by enhancing partnership working across the different services. The aim of this evaluation was to review the activity and impact of the meeting over the first year to identify what was going well and where the meeting could be improved.MethodsThe evaluation involved: 1)retrospective analysis of the MDT documentation including plans for nutritional and respiratory support and advance care planning, 2) review of patient deaths including preferred and actual place of death, 3) a questionnaire survey of the MDT members to quantitatively measure views on a range of statements relating to the operation of the MDT, with space for free text comments.Results22 patients were discussed over 10 meetings. Following discussion, plans for nutritional and respiratory support were in place for 86% and 77% of patients respectively. Plan for advance care plan was recorded in 55% of patients. 8 patients died during the year. Preferred place of care was recorded for 4 patients. 6 patients died at home or in the hospice. 9 multidisciplinary team members completed feedback questionnaires. Feedback was positive and suggested that the key goals of the MDT were being met. Improved multidisciplinary communication enhanced delivery of patient care by expediting management plans and interventions. There also appeared to be professional development by sharing experience.ConclusionA multidisciplinary team meeting for patients with neurodegenerative disease provides an important forum for communication and information sharing. The meeting enhances patient care by generating and expediting clinical management plans and provides a written record which is shared with key professionals. There is scope for improvement in exploration and documentation of preferred place of death and advance care planning.
AUDIT OF END OF LIFE DISCUSSIONS IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Authors: Arnold David , Cheaveau Matthew , Beard Charlie , Reid Colette 
Published: February 2014

BackgroundThe NHS End of Life Care Council advises that end of life (EoL) discussions should be offered to patients with chronic obstructive pulmonary disease (COPD) who have certain poor prognostic markers. EoL conversations with advanced care planning can reduce a patient's anxiety during an exacerbation, allow informed decisions about what treatment they would (or would not) like to receive in the future, reduce unnecessary or unwanted hospital admissions, and enable patients to die in their preferred place.AimsTo assess whether patients who are admitted to a respiratory ward with exacerbations of COPD, who fulfill the criteria, have been offered the opportunity to have such discussions. Secondary aims included (i) patient engagement, (ii) communication of outcomes (iii) communication of DNACPR orders.MethodsAudit of all patients admitted to a respiratory ward with an exacerbation of COPD, within a 3 month period. Specifically looking for evidence of EoL conversations during the current admission, previous admission or clinic appointments.ResultsOf 48 patients admitted with an exacerbation of COPD, 20 fulfilled the criteria to be offered EoL conversations. The 3 month mortality of these 20 patients was 25%. Three patients (15%) had documented EoL conversations. One lead to the formation of an advance directive not to return to hospital, one described a patient's wish to have no further non-invasive ventilation, and one where a patient wanted full treatment escaltion in the future. Seventeen of the 20 patients were made DNACPR, however, only 4 had this communicated to the GP.RecommendationsIdentify patients on hospital board rounds that may be suitable for end of life discussions. If patients engage with EoL discussions this should be documented in the medical notes as well as the discharge summary. Further use of an existing “Poor prognostic indicators” letter, which is sent to the GP, noting engagement in EoL discussions and decisions around DNACPR orders.
Can the Palliative Care Outcome Scale be used to measure the positive impact of a hospital based palliative care liaison team?
Authors: Whitehurst Jane , Michaels Katherine , Montacute Nicola , Williams Sue , Ward Brenda , Gillett Janet 
Published: February 2014

BackgroundThe Palliative Care Outcome Scale (POS) is a holistic, validated, Patient Reported Outcome Measure (PROM). PROMs can enable evaluation of patient care, helping to improve service quality.AimsTo assess POS as a tool for patient assessment and clinical audit in a nurse-led hospital liaison palliative care team (HPCT).MethodsWe used POS and POS-S (symptoms) at initial, weekly and last consultations in 30 patients and evaluated the HPCT experience of this.We used the following Minimal Clinically Important Difference in scores to determine PCT effectiveness80% percent achieving a one-point reduction in pain scoreStatistically significant reductions in grouped POS and POS-S scores (Wilcoxon signed rank test)ResultsThe HPCT saw 57 patients to collect 30 patients' data. (23 clinically unsuitable, 4 missed). Follow-up questionnaires were available in 19 patients for POS, 15 for POS-S (7 patients seen once, 1 data set destroyed, remainder missed).A one-point reduction in pain score occurred in 74% patients (14 out of 19 with follow-up POS data).Both POS and POS-S median scores improved. POS median score: initial consultation 17, last consultation 6 (p=0.002) POS-S median score: initial consultation 17, last consultation 8.5 (p=0.04).▸ The HPCT felt that POS was useful to:▸Establish the patient's agenda▸Enable early discussion of psychosocial concerns▸Reduce the risk of missing significant needsConcerns were:▸The staff time required to complete POS▸That patients found repeated questionnaires burdensomeThat POS data may underestimate HPCT effectiveness as sometimes advice was disregarded and patients were discharged before a final assessmentConclusionsThe HPCT significantly improved patient well-being. However, repeat use of POS was burdensome and low inclusion and follow-up rates suggest POS is not a suitable audit tool to measure our HPCT effectiveness at this time. Using POS and POS-S at the initial consultation usefully established the patients' baseline status and needs. The HPCT will continue to use it in this manner.
THE DEVELOPMENT OF THREE INDIVIDUALISED CARE PLANS TO GUIDE NURSING STAFF WHEN CARING FOR PATIENTS IN THE LAST MONTHS OF LIFE
Authors: Rees Elizabeth , Henderson Amanda , Stothard Chris , Gibson Kathryn 
Published: February 2014

BackgroundImplementation of the National End of Life Care Programmes ‘Transforming End of Life Care (EOLC) in Acute Hospitals’ has involved teaching and guiding ward based staff to make changes to patient care to improve the quality of care patients and their families receive. We were asked to advise on the EOLC section of the Trusts nursing specialist assessment (NSA) which is completed for all patients on admission. The EOLC section was rarely completed.AimsTo develop written guidance to support and prompt staff about essential aspects of care for patients approaching the end of their life.MethodsNSA changed to identify patients who are:1. In the last months of life2. Acutely unwell with uncertain recovery and expected to die within the next 1–2 months3. DyingPrompts were written to commence one of 3 care plans produced for each category – palliative care plans 1, 2 and 3.Three care plans were written in Trust format, following consultation with ward nurses, Drs and community teams with prompts for staff to follow both for patients and their families while in hospital and also with discharge advice.ResultsThe three care plans have been piloted within oncology, respiratory and elderly care.Excellent feedback stating that the nurses have found the care plans extremely helpful in guiding and formalising the goals and aspects of care required.Request from Trusts Chief Nurse to roll out the care plans ASAP to fill the gap the withdrawal of LCP has left.ConclusionsNursing staff work well with written guidance in the form of care plans to plan, deliver and evaluate patient care.We are hoping that following Trust wide implementation of the care plans we will notice measurable improvements in the quality of care patients and their families receive at the end of life.
TRANSFORMING END OF LIFE CARE IN ACUTE HOSPITALS – HOW TO SET UP A TRUST WIDE PROJECT WITH BOARD LEVEL SUPPORT
Authors: Rees Elizabeth , Kite Suzanne , Henry Karen , Larder Melanie 
Published: February 2014

BackgroundThe Leeds Teaching Hospitals NHS Trust (LTHT) is a flagship Trust for the NHSIQ ‘Transforming End of Life Care (EoLC) in Acute Hospitals programme’ .Previous EoLC initiatives had been led by the specialist palliative care team (SPCT) within existing resource supplemented by some non- recurrently funded projects. However, a step change in improved EoLC in this 2000-bedded acute trust required implementation at scale and a corporate approach to sustainability.AimsTo develop a service improvement programme across the organisation to ensure that all patients at LTHT approaching the end of their life are identified and receive the best quality of care with their needs and the needs of their families met appropriately, within available resources.MethodAn approach was piloted within two specialties for six months, led by a triumvirate of senior manager, and SPCT lead nurses and clinician. The learning gained from the pilot informed a successful bid to the Care Pathways Programme Board for a corporate EoLC Service Improvement Project, with dedicated project manager support and Trust Board leadership (Medical Director)ResultsStakeholders identified 4 workstreams (Education, Metrics, Interface with community, and Patients and Public Information Needs).EoLC Project Board formed with senior representatives from across the trust, and with clear communication and accountability back to the Board.Linkage made with other EoLC initiatives including the engagement of EOLC champions across the Trust.EOLC process mapping sessions informed the work.ConclusionIn order to implement measurable changes across a large Trust, dedicated project management skills and time are required to ensure momentum and connectivity between inter-related workstreams; to coordinate clinicians across specialties and general practice, and to link into trustwide structures which have the necessary authority and recognition to effect change.A leadership triumvirate of manager, lead clinician and senior nurse works well.
OPIOID CONVERSION CHART : INTRODUCTION OF A USER-FRIENDLY VERSION
Authors: George Mariam , Wilkins Clare , Garner Idaliza , Powell Barbara 
Published: February 2014

BackgroundOpioid dose conversion is an integral part of palliative care services. Though several such conversion charts exist, they generally lack simplicity and uniformity in their ease of use across the spectrum of palliative care professionals.AimTo develop a simple, easily understandable and user-friendly opiate conversion chart.MethodUsing a common conversion chart template, we modified diagrammatic representations to include simple, clear-cut formulae. The chart represents a ‘sun’ with 9 ‘sunbeams’. The oral morphine (mg/day) is the ‘sun’ at the centre of the chart, encouraging the conversion between different opiates to start with morphine equivalent doses. All conversions complied with Palliative Care Formulary (3rdedition), Leicestershire/Northamptonshire/Rutland cancer network ‘Guide to prescribing for patients with Advanced malignancy’ and the Oxford handbook of pain management guidelines. Laminated pocket-sized versions were produced to make it portable to enable rapid and easy dose conversions by the bedside. Feedback questionnaires were distributed among healthcare professionals in different roles working across hospice, hospital and community.ResultsTwenty-two feedback forms were returned. 95% (21/22) of professionals found it useful, with 68% (15/22) utilising it ‘often’/‘always'. All those who used it confirmed that it was a practical, simple and convenient tool. The chart empowered hospice-based nurses and community clinical nurse specialists to feel confident about the accuracy of dose conversions. It was also useful as a teaching aid, enabled appropriate dosage of transdermal opioids and served as a benchmark for provision of advice to other services. Specialist doctors and trainee doctors in other specialties who have rotated through hospice posts found it useful. Indirect positive feedback was reflected by an increase in the use of the chart across clinical professionals in Leicestershire.ConclusionThis adapted user-friendly conversion chart has the potential to simplify and make uniform the use of opiates across the palliative care community.
THE ROLE OF NURSES IN PROVIDING PALLIATIVE CARE FOR DYING CANCER PATIENTS: A META-ETHNOGRAPHIC SYNTHESIS
Authors: Husaini Asmah 
Published: February 2014

BackgroundPalliative care is a well-established approach to maintaining quality of life in people with advanced cancer. There is limited research exploring qualified nurses' role when providing palliative care for dying cancer patients. Much of it is qualitative and so findings cannot be generalised to other care settings.AimTo synthesis evidence from published qualitative studies the explored the role of the nurses when providing palliative care to dying cancer patients.MethodA meta-ethnographic approach (Noblit & Hare 1998) was employed. Studies were included if they were undertaken between 1990–2012, data collection consisted of in-depth interviews and participants were registered nurses who provided palliative care to advanced cancer patients. Continuous comparative analysis was performed and metaphors were translated using reciprocal translation.ResultsThe role of nurses in the provision of palliative care can be divided into two overarching themes; direct patient care and indirect patient care. Direct patient care includes assessment, care towards the family and providing physical and psychosocial care. Indirect patient care involves multidisciplinary team working and the practice of specialist and management skills to meet patients' needs. Care is seen as a continuous ‘process’ that consists of providing tangible and intangible aspects of palliative nursing care. The ‘tangible’ aspect of care is care carried out by nurses regardless of the context that they are in, and ‘intangible’ care is defined as nursing actions that can be changed/adapted according to the contextual or cultural circumstances of a particular setting.ConclusionThis meta-ethnography has identified key components of palliative care nursing for dying cancer patients, regardless of the context of the care. This will permit cross-cultural comparison of palliative care provision to be undertaken in future research.