bluuebunny/crossref_metadata_2025_split huggingface dataset:
020 “Do patients with end-stage chronic obstructive pulmonary disease (COPD) on maximal pharmacological therapy with specialist respiratory care benefit from Pharmacy Technician led medication review?”
Authors: Wall-Hayes Lisa , Seager Louise , Bartlett Joanne 
Published: October 2013

IntroductionJohn Taylor Hospice runs a 9 weekFatigue,Anxiety &Breathlessness (F. A. B.) programme for patients with end-stage COPD. All patients recruited to the programme were on maximal pharmacological therapy1with regular input from both community and hospital specialist respiratory teams.Aim and ObjectivesTo ascertain if Pharmacy Technician led medication reviews would be a valuable addition to the programme.MethodOf the 11 patients recruited to the programme 6 were randomly selected for a domiciliary medication review by the Pharmacy Technician. Issues identified by the review were dealt with either at time of review or if necessary escalated to the appropriate professional for follow up. Interventions were categorised and recorded. Evaluation forms were completed by those receiving a review and a questionnaire was completed by those who had not.Results6 medication reviews were completed, 4 of which were in a domiciliary setting, whilst 2 took place at the hospice.30 interventions were identified of which 13 were dealt with at the time of review, the remaining 17 were escalated.Main categories of intervention were: Adherence/counselling and prescription issues.Patient evaluation results: 100% of patients stated that the medication review was helpful, 100% also stated they now felt more confident managing their medication.Patient feedback questionnaire results: 100% of patients who did not receive a medication review stated they would have found it useful.Drug cost savings demonstrated: approximately £5602over 6 months.ConclusionPatients with end-stage COPD on maximal pharmacological therapy with regular respiratory team involvement, still benefit from a Pharmacy Technician led medication review.
021 Advance care planning - development of a group intervention for people with newly diagnosed dementia and their families
Authors: Madsen Emily , Grey Lorna , Horne Gillian 
Published: October 2013

BackgroundRowcroft Hospice’s strategic aim is ‘taking care further’. This includes providing greater access to services and end of life care for people with non-cancer diagnoses. Working with Devon Partnership NHS Trust an intervention was developed to offer people post diagnosis with dementia, and their families/carers in South Devon. The ‘Planning Ahead’ session is delivered as part of a ‘Memory Matters’ course.Aim4 weekly 2 hour sessions for those recently diagnosed with dementia and carers.Informal introduction to advance care planning - focus on changing ability to communicate and make decisions in the future.Provision of information about the legal framework and support tools.Promote choice – place of care, preferences, hopes and wishes, nature of medical intervention etc.Provide a supportive and safe group to explore these issues.ApproachAn informal psycho-education group. The use of group discussion enables individuals to talk about personal experiences/concerns. This facilitates the sharing of information and literature specific to planning ahead. We used mixed media including: video clips, hand-outs, power point, local and national booklets.OutcomesInitial evaluation by participants:Improved understanding about decision making in the event of changes in communication/capacity.These conversations are difficult to have/or start in families without support.Peer support/normalising effect of the group has been helpful.Observations of facilitator:Shared opportunity to start difficult conversations.Carers empowered to consider their own preferences and wishes – the universal relevance of planning ahead for all.Individuals with dementia who attend need support to participate and encouragement to be involved.Carers/family members can dominate.ApplicationAdvance Care Planning is a cornerstone of Specialist Palliative Care. Developing bespoke ways to meet the varying needs of different patient groups and their families is essential.
022 Hospice-based multi-disciplinary clinic for end-stage renal failure improves quality of care and reduces hospital admission
Authors: Wilderspin Nicola , Turner Marian , Ferring Martin , Garside Jenny , Blaine Felix , Westwood Debbie 
Published: October 2013

Background/contextPatients opting for conservative management of end-stage renal failure in South Worcestershire frequently died in hospital and struggled to attend acute hospital outpatient appointments.AimsTo improve quality of life through a new hospice-based model of care for conservative management of end-stage renal failure, and provide opportunities for advanced care planning and increased choice in end of life care.ApproachPatients and carers attend a flexible afternoon day hospice ‘clinic’ which begins with lunch and offers assessments with:An acute hospital nephrologist to proactively manage renal complications such as anaemia and fluid balance.A palliative care CNS/consultant for symptom control, carer assessment and advanced care planning.Complementary therapies and informal chaplaincy support are also provided. Details of advance care plans are communicated to primary and secondary care, and inclusion on GP end of life care registers recommended.Evaluation included satisfaction surveys of patient/carers and monitoring planning for,and place of, end of life care. Excellent satisfaction scores were reported with very positive qualitative feedback. 69 patients were referred between 2010-13, with median age 83 (range 49-97 years) and high co-morbidity scores. Carer assessments enabled significant unmet supportive care needs to be addressed. Referrals to other community-based services were arranged as needed. Of the 52 patients who have died (75%), the majority (46, 88.5%) have died in community settings, with only 6 (11.5%) dying in hospital. Collaboration with renal services also facilitated transfer/community referral of other hospital patients dying with renal failure who would not previously have been identified for hospice care.ApplicationIncreased quality of care and cost savings (from unscheduled care) have enabled on-going clinical commissioning group (CCG) funding. This accessible multi-disciplinary clinic may offer a new model of end of life care for the frail elderly, leading to CCG funding to pilot multi-disciplinary clinics for patients with other chronic diseases in partnership with the acute hospital trust.
P1 Improving End of Life Care (EoLC) in care homes: An action learning and education development programme for care home leaders
Authors: Booth Michele , Nash Sue 
Published: October 2013

In the last decade there has been considerable investment in end of life teaching to the care home sector with particular reference to the Gold Standards Framework and Six Steps to Success North West Care Home Programme. These two successful programmes are continuing to gather momentum and our project was not to compete with these, our dual aim was to develop care home managers in terms of their leadership and management and increase theirEnd of Life Care (EoLC) knowledge and skills.We believe that the sum of the two would be greater than the separate parts. The use of anaction learning setwas purposeful, hoping to develop a sustainable supportive local network of managers.Action learningis sometimes referred to as group coaching; the premise is that real life problems would be brought to the “set” for discussion. The problems shared related either to EoLC or to people management. Within each of the ten days there was a dedicated slot, typically 90 minutes to teach on a particular EoLC topic.Scammellet al2012 in their service evaluation of our project concluded “This evaluation provides compelling evidence that an action learning approach to EoLC education can be used to empower middle managers to have positive impacts on EoLC provision through not only increasing specialist knowledge but also enhancing their capability to engage in a confident and informed manner with a diverse range of stakeholders”Many hospices engage in delivering education to care homes. Care homes often operate in a competitive market but in our project we witnessed action learning sets breaking down any potential barriers. This is very important since creating supportive networks could increase retention of middle managers, high turnover of this group arguably impacts on moving forward with good EoLC initiative’s such as advance care planning.
P2 Making the Difference: An Alternative Care Home End of Life Education Approach
Authors: Russell Sarah , Loney Jo , Miller Helen , Nicell Claire , Willoughby Janet 
Published: October 2013

Society is aging and we are living longer. By 2035, deaths in the over 85’s will represent 50% of all deaths in the UK and older members of our society will be more likely to die in a hospital or care home (Calanzani et al 2013).The NHS Health East of England ABC blended learning programme consists of 7 modules (face to face, e-learning or both), follow up workshops, resources, DVD’s, mentor support, audit materials and Train the Trainer project (http://www.endoflifecarelearning.co.uk/)A recent evaluation comparing the ABC care home programme in Hertfordshire vs 2 national equivalents in Suffolk, Bedfordshire, Peterborough and Luton concluded:Well-evaluated education, sustaining learners in practice resulting in athe most cost effective programme with highest completion rates (97%) and reduced hospital admissions.Recomended education programme‘Several features that have made the ABC Training Programme more accessible to nursing homes. These include the flexibility about when the training commences, and the fact that staff are able to complete modules within their own timeframe and at their own pace. This blended learning approach also combined the e-learning with visits to the nursing home where the trainers were able to provide additional support and encouragement to staff to complete the training’ (Pyper et al 2013).‘It is recommended that as currently nursing homes staff turn-over is very high, EoLC standards are more likely to be maintained by commissioning the trainers to continue their relationships with the nursing homes and offer infrequent on-going support sessions as required.’ (Pyper et al 2013).The ABC programme is now validated as an alternative end of life education programme making a difference combining learning with mentorship and site visits. This education model is recommended particularly for struggling care homes.
P3 Making a difference in care homes
Authors: Andrews Wendy 
Published: October 2013

IntroductionThe Hospice undertook a project with 10 local care homes which had the highest rate of admissions to an acute hospital where the patient had died. The inital results in 2012 led to a further 12 months of funding with 10 more homes.AimsReduce inappropriate hospital admissions from care homes for end of life patientsPromote the use of end of life caretoolsMethodsRegistered Nurse led project with multi-disciplinary steering groupBaseline data:After death analysis (ADA) – last 5 deaths prior to project commencementCare home training needs analysis (TNA)Project period:Training programme based on TNA delivered and evaluatedOngoing ADAsYear end:Collation of ADA informationReviewed whether new skills and knowledge embedded.ResultsYear 1– 19% of nursing home patients and 57% of residential home patients died in an acute setting. Uptake of EOLC tools rose dramatically. 140 staff received EOLC training.Year 2– Post-training, 19% of patients died in an acute setting and the ADAs suggested only 5% might have been avoided if end of life needs had been correctly identified. Uptake of EOLC tools increased with 90% of those who died having some form of ACP and nearly 80% having a valid DNACPR form. 157 staff received EOLC trainingDiscussionThe uptake of EOLC tools was the most obvious achievement and qualitative data indicated increased staff confidence as a major factor. The ability to measure a reduction in inappropriate hospital admissions was more difficult due to interventions from other in-reach projects. The importance of good engagement with GP practices was identified early on, but was outside the scope of this project.ConclusionThis project demonstrated the value of EOLC training, tailored to care home staff needs. Hospices can increase opportunities for good end of life care in the community, without the need for specific patient intervention from specialist palliative care providers.
P4 VALE: Volunteers at life’s end, the LOROS care homes project
Authors: Kavanagh Jo , Faulkner Shani , Faull Christina 
Published: October 2013

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 (1);provision of a ‘sacred space’ (2) 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 patients. The aim was to explore the feasibility and evaluate its added value.Approach usedA 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 utilised volunteers with 10 residents. Most residents who died did not need the additional support of a volunteer and some volunteers were not utilised. 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 hospice 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.
P5 The South Edinburgh care homes project: A community nurse specialist-led intervention to improve palliative care
Authors: Gardner Hilary , Finucane Anne , Stevenson Barbara , Muir Lynn , Oxenham David , Montgomery Emily , Gibson Hilary , Murray Scott A 
Published: October 2013

ContextApproximately 20% of people die in long term care settings.(1)National and international policies call for care homes to provide reliably good end-of-life care. Hospices are well placed to support care homes to deliver palliative care to residents who would benefit. This project builds on two previous projects aimed at better meeting the needs of care home residents.(2,3)AimTo improve the delivery of palliative care to care home residents using a hospice-led model of care home support.Approach usedNineteen South Edinburgh care homes were approached by two Community Palliative Care Clinical Nurse Specialists (CNS) to take part in the project. All care homes agreed. Care homes were divided into two geographically defined clusters. The intervention is currently being delivered to the first cluster.Key components of the intervention include: support from a dedicated Community Palliative Care CNS; identification of two palliative care lead nurses in each care home; a study day and three workshops based on the Macmillan Foundations in Palliative Care programme; implementation of key processes such as multidisciplinary palliative care review meetings, and support to use tools to help identify residents who may be approaching end of life.OutcomesThe primary outcome is the proportion of residents who die in the care home. Other outcomes include the proportion of deceased residents who had an anticipatory care plan in place; DNACPR documentation in place; appropriate anticipatory prescribing and who died on the Liverpool Care Pathway. Outcome data is being collected before, during and after the intervention period.Application to hospice practiceThis project will show the extent to which a hospice based model of care home support enables care home staff to improve the delivery of palliative care to their residents. This would allow hospices to greatly extend their influence to reach non-malignant patients.
P6 One Step at a Time: Introducing an End-of-Life Care programme to a critical mass of local care homes
Authors: Godfrey Cathy , Stevenson Alex , Barber Bernie , Cath Baldry , Groves Karen 
Published: October 2013

AimsThe Six Steps to Success programme was launched in the UK (North West) to support the delivery of end of life care in care homes. 36 (1162 beds) of the 109 nursing and residential homes (3,600 beds) in our locality (Southport, Formby and West Lancashire) have undertaken the programme and this poster demonstrates the impact of the programme upon the knowledge, skills and confidence of care home staff.DesignThe programme, delivered from the Hospice Hub by end of life care facilitators, includes:A pre and post course self-assessment of knowledge skills and confidencePost workshop evaluationsAn end of programme questionnaireThis poster describes the analysis of these.ResultsThe programme met the needs and expectations of 100% of participants. 100% found the education clear and felt well supported by the EOlc facilitators. Evidence shows that each cohort improved in knowledge, skills and confidence across all topics when measured on a 5-point self-assessment scale. Qualitative analysis of feedback indicates that the care homes are working as a team to utilise end of life care tools and improve patient experience approaching end of life.ConclusionThe Six Steps to Success Programme has enabled care homes to bring about organisational change and develop frameworks to improve End of Life Care in their place of work. By working together, sharing experiences and ideas, supported by their facilitators and the local hospice (Queenscourt Hospice), care homes have developed comprehensive end of life care policies which have enhanced delivery of high quality care. By rolling out the programme to a large number of care homes over a 12 month period we are creating a ground swell of enthusiastic motivated care home staff with a desire to collaborate with those working in other health and social care settings to improve the experiences of their residents and relatives.
P7 Red Envelope Scheme
Authors: Young Shirley , Hickey Deb 
Published: October 2013

Ambulance crews reported lack of information with regards to patient care & wishes, meaning their default position was Hospital admission as they could not ‘waste time’ looking for relevant documentation eg Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) forms, ‘hidden’ in copious patient records.AimsTo give crews readily accessible Patient information, enabling them to make decisions about best care, recognising patient choice.To prevent unnecessary or unwanted hospital/hospice admissions for palliative patients. A form was designed which included Information regarding patients’ Preferred Priority of Care, DNACPR, medications and contact details of relevant Health Professionals. This was agreed by the Ambulance Service.An A5 Red envelope labelled ‘FOR AMBULANCE CREW ONLY’ held the completed form, to be The Scheme was piloted for 3 months from April – July 2012During the trial 24 forms were completed and held by the patient and familyThe checklist was described as ‘Directional Documentation’ by the Ambulance service. The contact numbers and information gave crews the opportunity to call and discuss the situation with other professionals.Subsequent improved communication between services has resulted in Ambulance crews anecdotally describing a change in practice and increased confidence in making decisions to support patients to remain at home.DiscussionIn the absence of Electronic Registers within our locality, the intermediate solution was to introduce the Red Envelope Scheme which gave Ambulance crews the right information at the right time. However despite the large catchment area of the Hospice the Scheme reaches a small percentage of patients with palliative care needs.ConclusionCrews now look for a red envelope in the patient’s home. It gives support to crews to make the right clinical decisions and the opportunity to influence the patient journey in a more positive way.
03 Volunteers – sustaining hospices?
Authors: Scott Ros 
Published: October 2013

Volunteers have historically played a vital role in the founding and on-going development of independent hospices. The governance of these voluntary organisations is also the responsibility of volunteer trustees, however, it is not clear whether volunteering is considered as strategic resource. This study aimed to explore how volunteering perceived strategically in independent hospices throughout the UK.Purpose of the ResearchThe purpose of this research was to study the link between volunteering and hospice sustainability by:Exploring how volunteering is understood by UK hospice senior staff, volunteers and trustees.Considering the influence of volunteers on four key UK hospice sustainability factors: governance; service delivery; hospice economy; and community engagement.Explore whether there is a link between volunteering and hospice sustainability.MethodsUsing a mixed methods approach a self-administered online survey which was sent to hospices across the UK. The questionnaire included both Likert Scale and free text questions. As this study sought to the strategic context of volunteering, the views of senior staff, trustees and volunteers were sought. Thirty one hospices took part with responses from 58 senior staff 56 trustees and 181 volunteers.FindingsNo recognition of the role of volunteers in governance.Volunteers viewed as a strategic resource but not engaged in strategy development.Lack of planning for volunteer involvement.Volunteers are important to income generation, the quality and range of services offered and community engagement.Hospice sustainability is highly dependent on volunteers, howeverCurrent volunteering models may not be sustainable.ImplicationsThis area is the first study of its kind to establish evidence about the dependence of hospices on volunteers. It identifies opportunities for practice development in planning and approach. A toolkit is being developed to enable organisations to identify areas for development.