bluuebunny/crossref_metadata_2025_split huggingface dataset:
POST DISCHARGE TELEPHONE CALL TO PALLIATIVE PATIENTS
Authors: Reeve Ursula , Gale Sue 
Published: February 2014

BackgroundThe transition home for Specialist Palliative Care (SPC) patients is often complex; requiring multiple medications, equipment, healthcare agency support. Many patients go home to die which causes additional stress for patients/carers. Nationally, discharges are frequently unsatisfactory; a telephone survey of local outcomes was undertaken.AimTo identify any concerns/problems arising and improve the patient experience by providing SPC post-discharge support/advice.MethodsA pro-forma comprising 11 questions was designed for call handling. All patients were called within 3 days of their discharge home. All patients were known to the experienced SPC nurses making the calls. Over an 8 weeks period 14 out of 45 discharges was audited.Results79% (11/14) were called within the timeframe. Respondents were patients (7), family (4), other (3). Two patients had died. All knew what their medications were for, how to take them and what their side effects were. Eleven had enough medications until they could arrange a repeat prescription, one had three days supply; pending dosset box. Thirteen (93%) were given the SPC 24-hour advice line number. District Nurses (DN) and personal carers had attended as arranged (21% and 57% respectively) and equipment supplied (29%); the remainder reporting that these were “not applicable”. Two ‘concerns’ were identified: one DN unaware injection required and another had taken patient's discharge summary.DiscussionIt is not known why a DN took the discharge summary or why another was unaware of the injection; this information had been sent to them. Most SPC patients have at least one DNs, professional carers and/or equipment therefore the response ‘not applicable’ may have occurred because the call was made before their arrive; this needs further exploration.ConclusionPatients were followed up in a timely manner and few concerns arose; those that did were resolved. The need for subsequent follow-up call/s is under review.
IMPROVING END OF LIFE CARE FOR PATIENTS WITH COPD AN EVALUATION OF A SERVICE INNOVATION USING THE “WOULD YOU BE SURPRISED? QUESTION
Authors: Quibell Rachel , McAleer Nina 
Published: February 2014

BackgroundThe National End of Life Strategy initiative “would you be surprised if this person died within the next 6–12 months?”1formed basis of a protocol to identify COPD patients with a prognosis of <12 months using a modified BODE score and clinical experience. GPs were notified to place patients on GP Palliative Care Registers. Discussions with patients were supported by communication prompts.MethodPatients identified in a 14 month period had case note review. GPs were asked via letter about palliative care register and patient benefit.Results14 patients, 9 had died at the time of evaluation. 8 died in hospital, 1 at home. GP notification to death 2–16 months median 7 months, Mean 7 months. 8/9 had died within 12 months of notification.5 patients alive had a range of 4–13 months since notification, mean 7 months, median 5 months.Only (14%) patients had remained or remain alive for >12 months.Admission rate pre and post notification remained the sameGP Responses71% GPs responded100% practices have GP Palliative Care Register100% agreed information from secondary care helpful.8/10 patients had been placed on GP register.3/8 on register had been put on by GP prior to CHEST team notificationGP free text response was extremely positive.“Anything that helps initiate the discussion is most welcome”“Allows them to be discussed monthly so they are in our minds. Helpful”With a simple protocol, decision aid (modified BODE) and communication prompts the CHEST team have developed a proactive approach to improving EOLC for patients with COPDPrognostication was good. Fears concerning patient distress, lack of GP engagement and patients not receiving hospital care during exacerbations have not been borne out. GP comments suggest better community support. These numbers are very small, further work is necessary to identify more patients.
DEVELOPMENT OF AN INTEGRATED END OF LIFE CARE PATHWAY FOR PATIENTS WITH COPD
Authors: Berry Pauline , Jackson Christopher , Saba Tarek , Au GIllian , Martin Michelle , Bennie Marion , Tymon Lorraine , Whitfield Andrea 
Published: February 2014

IntroductionChronic Obstructive Pulmonary Disease (COPD) is a progressive disease ultimately resulting in death, usually in a secondary care setting. Historically, many of these patients have never had the opportunity to discuss their End of Life (EoL) preferences, resulting in unexpected deaths that neither patient nor family are prepared for.ProblemPatients with COPD are not prepared for the progressive nature of the disease and are dying without identifying their Preferred Place of Care.AimWhilst developing a COPD pathway, an identifiable gap was evident relating to discussing EoL care. National guidelines recommended asking the Surprise Question to accompany the GSF prognostic indicators. However no local assessment tools were available to prompt EoL care discussion and planning for patients with COPD reaching their last year of life. The aim was to have a unified approach to this across primary and secondary care.MethodA working group developed the Blackpool Teaching Hospital (BTH) End Stage COPD Assessment tool incorporating nationally recognised guidelines. This allows the initiation of a BTH Respiratory EoL Care Bundle at an appropriate stage in the disease trajectory and is closely linked to the time line of the North West EoL Care Model.ResultsThe Respiratory team are now utilizing these documents to initiate early conversations, maximising treatment options and Advance Care Planning in a systematic manner. This information crosses the interface between primary and secondary care. Early results from the introduction of the COPD Assessment Tool will be presented.ConclusionThe BTH End Stage COPD Assessment tool prompts clinicians to identify the last year of life for patients with COPD. Used as part of the integrated acute and community COPD pathway this will ensure that this important phase of the patient's illness is considered and will improve communication of their priorities for care across all care settings.
INTEGRATED PALLIATIVE CARE/ADVANCED RESPIRATORY DISEASE (ARD) CLINICS – A MULTI-CENTRE PILOT PROJECT
Authors: Curtis Claire , Challand Simon , Harrison Susan , Turner Marion , Bevan-Smith Elaine 
Published: February 2014

BackgroundThe symptom burden of ARD is similar to that of cancer, however patients with COPD are less likely to access Specialist Palliative Care (SPC) Services, and less likely to die at home. In Worcestershire there is a comprehensive COPD service providing an ARD pathway, but there exists a group of patients with ARD, who are too unwell to attend the pulmonary rehabilitation and fit to breathe groups, who need a differing level of support, but who are reluctant to attend generic hospice day care.AimsThe monthly joint out-patient clinics aim to enhance end of life care for patients with ARD and their carers by:▸ Providing specialist medical and nursing input from Respiratory and Palliative Medicine consultants, COPD CNS, and SPC day hospice team to minimise symptoms, and maximise activity and function.▸ Improving joint working and increasing accessibility and acceptability of SPC services.▸ Challenging and changing the culture and aims of care for ARD patients.▸ Reducing un-planned hospital admissions.▸ Offering ACPResultsMonthly clinics were set up at two hospice sites, and have been running for 18 months.Approx 50 patients have attended.Unplanned hospital admissions have reduced, deaths at home have increased.Patient and Carer satisfaction survey, HADS and distress thermometer have been used.ACP has been undertaken using the Worcestershire advance statement document.ConclusionsThe clinics have evolved over the 18 months and benefits have occurred beyond just the scope of the patients who actually attend in person. There exists the ability to offer another treatment pathway, with culture change occurring because of this extra option for care. Teams have been empowered to engage in ACP, there has been enhanced carer support and improved joint working.
END OF LIFE CARE IN NEURODEGENERATIVE CONDITIONS: EVALUATION OF A SPECIALIST NEUROLOGY PALLIATIVE CARE SERVICE
Authors: Hussain Jamilla , Adams Debi , Campbell Colin 
Published: February 2014

BackgroundThe last year of life for people with advanced neurodegenerative conditions (ANC) is often unsatisfactory, characterised by multiple unplanned hospital admissions. Despite this few patients with ANC access palliative care services, with limited evidence of effective service models and when such individuals should be referred to palliative care.Aims1. To evaluate the Scarborough Palliative Neurology Service (PNS) model, led by specialist palliative neurology nurses, against the National End of Life Care Programme (NEoLCP) ANC recommendations. 2. To evaluate the validity of the seven NEOLCP triggers for palliative care referral.MethodRetrospective observational study of 62 consecutive patients under a PNS. Principle component analysis (PCA) was performed to examine the relationship between triggers and survival.ResultsAll patients had a key-worker who coordinated care. Capacity was assessed in 95% of cases, for who advance care planning and best interest decisions were documented in 95%. The terminal-phase was recognised in 72.6% and 100% of carers were offered bereavement support.The median follow-up under the PNS was 336 days. The mean number of hospital admissions was 0.9 in the last year of life (compared to 3.5 nationally across diagnoses). Pneumonia was the cause of death in 56.5%. Thirty-one percent of patients died at home (nationally 14% of ANC patients die at home), 26% in hospital (46% nationally) and 24% in hospices (0.03% nationally).Frequency of triggers increased as patients approached death. PCA found 4 components in combination explained 76.8% of the variance in survival. These representedrapid physical decline;significant complex symptoms-including pain; infection with cognitive impairment;andrisk of aspiration.ConclusionA model of service provision investing in specialist palliative neurology nurses is an effective model in delivering palliative care to this vulnerable patient group. The triggers for referral require further validation, although the derived PCA components do have face-validity.
BEREAVED GROUPWORK PILOT WITH CHILDREN AGED 7 TO 8 YEARS OLD
Authors: Jan Emma , Stafford Lynne , Holland Mary 
Published: February 2014

CancerCare is a charity dedicated to helping local people whose lives are affected by cancer and other life limiting conditions. Services are free to anyone in North Lancashire and South Lakeland.The Children and Young People's Service (CYPS) support 3 to18 year olds. In February 2013, CancerCare decided to undertake a pilot study to assess the feasibility of providing a therapeutic group for all bereaved children, not just cancer-related. The aims included:▸Normalising the children's experience of bereavement▸Decreasing their sense of isolation▸Allowing them to communicate their feelings around grief▸Sharing their experience of bereavement with others▸Receiving peer support▸Building emotional resilience▸Recognising support in their environments▸Working creatively and expressively to process their feelings around loss▸The pilot study was for children aged 7 to 8 years old.Change was measured using feedback questionnaires and a pre/post intervention outcome tool, the Strengths and Difficulties Questionnaire completed by parents at the beginning and end of the groupwork. Children, who had high impact scores, indicating bereavement was greatly affecting their lives, showed a decrease in their scores at the end of the group; a shift towards greater emotional health. One child moved to a higher score at the end of the group; signifying an ‘unlocking’ of some aspects of grief the child was holding. The child was offered an onward referral for 1–2–1 therapy within CancerCare, following the end of groupwork.In conclusion, the results demonstrate both children, and parents, found the group helpful and transformative. The pilot study identified a correlation between the original aims, and the outcomes experienced by children and parents.The vision of Cancer Care is to build upon the success of the pilot study, offering further therapeutic bereavement groups to children in years 5–6 in the Autumn term followed by secondary schools in 2014.
AN AUDIT INTO ADVANCED CARE PLANNING FOR END OF LIFE CARE PATIENTS AT KINGSTON HOSPITAL
Authors: Merrick Sophie , Guilhem Emily , Kreeger Lulu 
Published: February 2014

BackgroundThe End-of-Life Care (EoLC) Strategy 2008 highlighted the importance of early identification of potential for dying and Advanced Care Planning (ACP).1 2 3Early awareness of poor prognosis helps patients and their relatives to understand their illness and make informed choices about their care; for instance whether to decline aggressive intervention and hospitalisation if it is unlikely to improve their quality of life.Aims and ObjectivesTo prompt early communication within the MDT and with patients and their relatives about ACP for those deemed to be in their last year of life.MethodData from 40 discharged patients, who had been identified as likely being in their last year of life, was collected in each audit cycle.Cycle 1 was a retrospective case notes analysis from one Care-of-the-Eldery (CoE) ward. Five key areas of ACP were reviewed: resuscitation status, prognosis, ceiling of care, readmission plans, patient/family awareness of condition and prognosis.Prior to cycle 2, an ACP Summary proforma was implemented where discussions around the five key areas could be summarised. It was introduced at a CoE department meeting and teaching sessions were held for junior doctors.ResultsTables 1 and 2 illustrate our findings.Table 1Documentation in Medical NotesTargetCycle 1Cycle 2Resuscitation Status100%82%97%Prognosis95%55%95%Ceiling of Care95%41%100%Readmission Plans95%14%100%Patient/family awareness95%77%100%Table 2Discharge DocumentationTargetCycle 1Cycle 2Resucitation Status100%6%89%Ceiling of Care100%56%100%Readmission Plans100%33%100%Patient/family awareness100%59%100%Cycle 1Documentation regarding prognosis and ceiling of care (escalation plans) was poor; often it was very difficult to find in the medical notes. On call teams had to make escalations plans for 4 patients. Patients and relatives were not always informed in a timely fashion leading to 3 complaints.Cycle 2Re-audit results following the implementation of the ACP Summary showed an improvement in all 5 key areas.ConclusionThe ACP Summary ensured easily accessible information and prompted early discussions with patients, relatives and within the MDT. It improved communication with GPs on discharge.
AUDIT OF AVERAGE LENGTH OF STAY IN MARIE CURIE HOSPICE BELFAST
Authors: McCann Mary-Ann , Regan Joan , Doherty Jenny 
Published: February 2014

BackgroundAverage Length of stay (ALOS) is a widely used indicator of hospital and hospice performance and commonly viewed as a measure of efficiency. The standard for ALOS of patients in Marie Curie Hospice Belfast is ≤14 days.Aims of this audit were(1) to assess how often we meet the standard for ALOS in Marie Curie Hospice Belfast, (2) to identify the ALOS of patients admitted in a 6 month period and (3) the reasons why some patients stay is >14 days.Results48.3 % of patients had an ALOS ≤14 days. The ALOS between February and July 2012 was 19 days. 59.5% of patients died and 40.5% were discharged. The ALOS of patients who died was 18.9 days and for those who were discharged, it was 19.2 days. Patients with ALOS >14 days were older, more of them lived alone and fewer of them had a package of care in place. Symptom control was the commonest reasons for an ALOS >14 days, with an average symptom control admission lasting 35 days. Patients with brain tumours and prostate carcinoma had the longest ALOS at 47.5 days and 37.1 days respectively.ConclusionsSymptom control was the most common reason for increased stay possibly reflecting the fragility and complexity of these inpatients and the potential for their condition to change. Identifying patients who may have a more complex discharge and beginning the discharge process at an earlier stage may help reduce the ALOS. The ALOS of patients who eventually died in hospice was 18.9 days. ALOS is a crude measurement of patient stay and occupancy and offers no information on quality of patient outcomes. One area for improvement is the development of a tool which incorporates ALOS, complexity and quality of care for patients.
VALE, VOLUNTEERS AT LIFE'S END: THE LOROS CARE HOMES PROJECT
Authors: Faull Christina , Faulkner Shani , Kavanagh Jo 
Published: February 2014

BackgroundSupporting people in the last hours of their life has a particular importance: a human presence may reduce fear, and agitation and promote a peaceful dying; provision of a ‘sacred space’ performing rituals or an environment of valuing of the person's way of life and beliefs may be a consideration; and witnessing the passing from life to death.AimLOROS developed a novel pilot service recruiting and training volunteers to work with care homes to compliment their care of dying residents. The aim was to explore the feasibility and evaluate its added value.Service developmentA three day training programme was developed for 9 volunteers : learning hand massage; a focus on common features of dying; features of dementia; and discussing the role and potential impacts on the volunteer. Volunteers developed ‘comfort packs’ containing readings, music, massage oil and religious icons. A regular support structure was developed.Four care homes developed operational frameworks for contacting and integrating volunteers in to their team. Leaflets provided information to service users and processes were developed to discuss the service with residents and relatives.OutcomesOver seven months three of the four care homes utilized volunteers with 10 residents. Most residents who died did not need the additional support of a volunteer and some volunteers were not utilized. Where volunteers did provide support it was highly valued by staff and by relatives. Volunteers enjoyed the work and despite being needed infrequently there was no attrition.Application to practiceHospice trained and supported volunteers are welcomed by care homes as part of their care team for dying patients. The need for their service is infrequent and unpredictable and when it does occur it is immediate and intensive. These practical factors make it difficult service to provide.
MANAGEMENT OF DIABETES IN PALLIATIVE CARE
Authors: Dampetla Srilatha , Pawlak Tadeusz , Johnson Miriam , smrity smrity 
Published: February 2014

BackgroundOf the half a million people who die in the United Kingdom each year, approximately 6–9% will have Diabetes Mellitus (DM). The 2011 position statement regarding diabetes management at the end of life released by the Association of British Clinical Diabetologists (ABCD) highlighted: avoidance of symptomatic hypo or hyperglycaemia; minimal blood glucose monitoring; review of oral hypoglycaemic agents; involvement of specialist diabetes team. Subsequent guidelines from the Joint British Diabetes Societies were published in July 2012.AimTo audit the diabetic care of patients with DM who died in a district hospital using ABCD statement as the audit standard.MethodA retrospective case note audit of deaths between August 2011 and February 2012. The coding/ audit department identified patients coded to have DM at the time of death and/or DM was on the death certificate (parts I or II).ResultsRecords were available 61/67 patients (mean age 82, range 42–97; men 31). Type 2 DM was present in 54 (89%) and co morbidities were common: cancer (33%); other serious medical problems (66%), most commonly cardiovascular conditions and infections.The diabetes team saw 13% and 31% were placed on an integrated care pathway for dying although 51 (80%) patients had DNAR forms.ABCD guidance adherenceMedication was reviewed/stopped in 25 (41%); blood glucose monitoring was stopped in 21 (34%) of those on the ICP for the dying. A total of 223 episodes of hypoglycaemic episodes were recorded of which only 33 episodes led to a change of medication.ConclusionSpecial attention should be paid towards end of life in diabetic patients. We demonstrated significant inadequate adherence to ABCD guidance. Particular issues that need urgent attention include: recognition of dying; hypoglycaemic episodes with inadequate response; involvement by specialist diabetes teams. A re-audit will be conducted following targeted education of clinical staff.
TRANSFORMING END OF LIFE CARE THROUGH CLINICAL TEMPLATE DESIGN AND TRAINING
Authors: Faull Christina , Prasad Rish , Griffiths Adam , Pearson Wendy , Wong Richard , Gray Sarah-Jane , Feathers Luke , Brown Jayne 
Published: February 2014

National evidence suggests that whilst up to 67% patients wish to die in their own home, only 21% of patients actually do so. Recent Leicester City data reviewing emergency admissions and mortality suggests that recognising those patients who are not going to recover is inadequate in both primary and secondary care. Current systems and skills appear to be failing dying patients and their families, with local financial modelling also suggesting significant savings if appropriate care arrangements had been anticipated and implemented.To improve care for this vulnerable patient group, a local enhanced service (LES) was commissioned and an innovative three strand approach developed in conjunction with local providers and experts.Firstly, a clinical template for an Emergency Health Care Plan (EHCP) was created, using unique macros developed collaboratively with palliative care physicians, geriatricians and IT experts. This SystemOne template allows care plans for pre-defined conditions to be completed quickly and efficiently, providing outline plans for core clinical event scenarios which can be used to aid both completion and provide depth and breadth to the EHCP which is generated by the template. Secondly, locality mentors and practice end of life care champions were appointed with a training programme developed with the local Consultants in palliative medicine. Thirdly, extensive evaluation of the impact of the project on both patient and clinician needs, with baseline, peri- and end-point analysis planned and costed from the outset.This abstract seeks to demonstrate the collaborative work behind the template, and the benefits of its use to practising clinicians, as already evidenced by its recent expansion to neighbouring CCGs.