bluuebunny/crossref_metadata_2025_split huggingface dataset:
NUTRITIONAL ASSESSMENT AND MANAGEMENT — AN AUDIT OF CURRENT PRACTICE
Authors: Longford Emma , Powell Paula , Horlick Clare , Kendall Margaret , Royles Elen , Hamill Elaine , Cliff Catherine , Young Alison 
Published: February 2014

BackgroundUndernutrition affects up to 97% of patients with cancer and is strongly associated with poor outcome. Eating is an important quality-of-life issue with many social activities centring on dining. Assessment of patients' nutritional status and appropriate support is fundamental to palliative care at all stages. An audit was undertaken of current practice with regards to nutritional assessment and management within Merseyside & Cheshire Cancer Network (MCCN), the results of which are presented.MethodThe audit consisted of three parts a) telephone survey of nutrition resources within specialist palliative care services (SPCS), b) web-based survey determining healthcare professionals (HCPs) perceptions of practice c) supplementary web-based survey focusing on key issues.ResultsThe majority of SPCS inpatient units do not have a nutrition policy or lead. None of the SPCS units had access to educational information regarding nutrition in palliative care.110 HCPs completed the initial survey, 60 HCP's completed the follow-up survey. 90% routinely discuss nutrition with their patients. The majority (64%) do not use any form of nutritional screening assessment; however within most MDT's (69%) there is access to specialist nutritional advice. Within all hospital settings there is a well adhered to protected mealtime policy, however only 58% of those working in SPCS inpatient units are aware of a protected mealtime policy. 64% of respondents advise prescription of oral nutritional supplements regularly. All respondents suggest prescription of dexamethasone for appetite stimulation ‘sometimes’ or ‘often’, whilst only 59% suggest prescription of megestrol ‘sometimes’. 44% of respondents had received no nutritional training.ConclusionsThere is paucity of nutritional guidance within SPCS, although in most cases there is access to appropriate specialist advice. Training needs to be improved to increase confidence in management of nutritional issues. MCCN guidelines for assessment and provision nutritional care have subsequently been published.
A SERVICE EVALUATION OF A SPECIALIST COMMUNITY PALLIATIVE CARE OCCUPATIONAL THERAPY (OT) SERVICE
Authors: Phipps Kerrie , Cooper Jan 
Published: February 2014

BackgroundPalliative care OT is an integral part of comprehensive end of life care, maximising patients' independence and maintaining independent living. However studies have highlighted that professionals often have an inadequate understanding of OT interventions, and as a result patients are not referred. This has led to a concern that some patients, who are experiencing functional difficulties in line with disease progression, may not receive the OT support they require.AimThis project took place in 2012 and was a service evaluation of an existing Specialist Community Palliative Care OT Service. It aimed to evaluate the service from a professional users' perspective to identify areas of good practice and those requiring further development/improvement.MethodsTwo data collection methods were selected to collect evaluative data:An online questionnaire to 100 core Gold Standard Framework (GSF) professional group members who had referred to the service in the past 12 months.Two focus groups of GSF group members to expand on the emergent themes identified in the analysis of the questionnaire results.Results58 out of 100 (58%) online questionnaires were completed and a total of 26 professionals attended the focus group meetings.Results of the evaluation demonstratedSpecialist Community Palliative Care OT has a significant impact on: maintaining patient's independence; comfort, and quality of life.Professionals associated the service with supporting patients' preferred place of care; improved patient outcomes, and valued it in terms of its ability to support them in addressing the needs of their patients.Factors in ensuring patients receive timely and appropriate OT interventions were: clear communication pathways and education and information strategies regarding the role of the community palliative care OTConclusionThe results of this service evaluation demonstrate the importance/contribution of specialist palliative care OT in comprehensive end of life care. However the results also demonstrated the need for education of the role of OT in palliative care, ensuring all patients receive this specialist support.
YOUR ONE PERCENT?
Authors: Bunce Claire , Edwards James 
Published: February 2014

Aims and ObjectivesTo investigate if readily identifiable patients with a life expectancy of less than twelve months are being identified at the Practice to allow them to gain the benefits of palliative care on the Gold Standards Framework (GSF).Content of PresentationObjectives are: to explain what the audit involved, use of Karnofsky Performance Scale (KPS), the results and implications for practice.Relevance/ImpactThe Living and Dying Well Campaign aims to encourage General Practitioners to recognise the predictable deaths in the 1% of their patients who will die every year. This allows patients to make informed decisions, GPs to improve co-ordination and delivery of care and reduces the burden on acute services.OutcomesOnly 25% of the sample were on the GSF register, another 43% were eligible based on KPS and clinical judgement. The Practice is not identifying the 1% of its patients for inclusion on the GSF Register and could consider utilising the strategies suggested to reach this threshold.DiscussionUse of the Karnofsky Performance Scale to aid GPs in deciding who to list on the register by including all patients with a KPS <50% and having disease specific palliative care meetings could help to identify the predictable deaths at each GP Surgery.
HOW DO CLINICAL STAFF PERCEIVE THE LIVERPOOL CARE PATHWAY?
Authors: Srivastava Leena , Ting Ruth ,   Members of LCP working group
Published: February 2014

BackgroundOver the last year, concerns have been raised about the care of patients on the Liverpool Care Pathway (LCP). In July 2013 an Independent Review recommended that the LCP should be phased out and replaced by an individual end of life care plan. It is crucial we have an understanding of how clinical staff perceive the LCP to develop robust training around end of life care.AimTo evaluate clinical staff's perceptions regarding the LCP.MethodTwo wards in Gateshead Health NHS Foundation Trust were randomly chosen. In June 2013, all their staff were invited to complete an anonymous survey.ResultsGeneral Views47% of clinical staff responded. 57% thought the LCP should only be used in the last 48 hours of life. 94% felt the LCP ensures patients are treated with respect. Only 1 staff member felt that the LCP speeds up dying.Care whilst on LCP71% of clinical staff felt that they would consider treatments depending on the clinical situation. 80% would regularly monitor patients with 94% checking for signs of improvement. 86% would stop the LCP if the patient recovered.LimitationsOur results are based on less than 50% response to the survey and may therefore not represent the full views of all staff.Discussion57% of staff can recognise when to commence the LCP. Once in use, a majority of staff are able to decide on treatments and monitoring. Confusion can however arise if all are not clear of the application of the LCP. This can lead to some of the issues raised in the Independent Review.ConclusionThis survey has shown that clinical staff know when and how to apply the LCP. End of life training needs to continue to support staff in this.
COMPARING THE ACCURACY OF AN ONLINE PROGNOSTICATION TOOL WITH CLINICAL TEAM PROGNOSTICATION
Authors: Forrest Sarah , Holmes Ann , Lew Eva 
Published: February 2014

BackgroundMedical Teams regularly formulate a prognosis for patients to allow appropriate plans to be made and to help patients and families prepare for end of life.Research shows that clinicians are over-optimistic in prognosis formulation to a degree of up to 5 times the actual time to death.1The ‘Prognosis in Palliative Care Study’ (PiPS) online prognostication tool allows clinicians to input data and receive a prognosis in days, weeks or months, and has been found to be at least as accurate when compared with physician estimate alone.2 3AimTo compare the PiPS-A online prognostication tool with Clinician estimate of prognosis and the actual time to death for all advanced cancer patients admitted to the IPU over three months.To assess whether using PiPS-A improves the accuracy of prognostication in our patient group compared with the team's estimate, and whether using it adds to our practice.Results33 PiPs-A forms were completed on 32 patients over 3 months from April–July 2012.Clinician prognostications were at least as accurate as PiPs-A supported prognostication. For patients who had an actual prognosis of weeks or months, the clinician (54%/55%)was markedly more accurate than the PiPs-A (30%/31%). PiPs-A was as good as a clinician in predicting days (80% vs 78%).DiscussionDoctors find prognostication difficult, yet it is central to assessment and management of patient and in planning for changing care needs. PiPs-A may be useful in prognostication of patients in whom prognosis may be short and the efficacy of interventional treatments is questioned.Junior doctors have little experience of formulating an accurate prognosis; PiPS has a role as a teaching aid for juniors to enable them to develop this skill.
THE INSERTION OF LONG-TERM PERITONEAL DRAINS IN PATIENTS WITH RECURRENT MALIGNANT ASCITES
Authors: Brown Anna , Drake Alexandra , Gibson Matthew , Bhattacharyya Madhumita , Clarke Lisa , Mckeogh Maeve 
Published: February 2014

BackgroundRecurrent malignant ascites poses a significant burden to oncology patients approaching the final phase of life. This is, in part, due to recurrent hospital admissions for intermittent paracentesis. In March 2012, the National Institute for Clinical Excellence approved the insertion of indwelling, long-term, peritoneal drains for recurrent malignant ascites. Guidance concluded clinical efficacy, low complication rates, cost efficiency (estimated saving £679 per patient) and improvement in patient quality of life.AimsThe Royal Berkshire Hospital had no long-term drain provision. The intention was to implement a trust-wide protocol for the insertion of long-term peritoneal drains in patients with recurrent malignant ascites.MethodsA pilot group was established with members from Oncology, Palliative Care and Radiology. A protocol was developed, presented and accepted at Clinical Governance by all relevant departments. The protocol was instituted via the trust intranet. Education regarding the process and the practicalities of the drains was provided at departmental level. Data was collected on patient experience.ResultsSince introduction, eight months ago, twelve long-term drains have been placed. Malignant sites include ovarian (5), endometrial (3), urological (2), breast (1) and colorectal (1). Average drain duration is 37.5 days (range 2–215 to date). Placement of long-term drains enabled two patients to consider hospice care and two patients to die at home in their preferred place of care. Seven patients remain at home with ongoing community management of their ascites. Complication rates have been low with no insertion complications. In one case, two drains had to be inserted due to pocketed ascites. A further case displayed localised cellulitis at the insertion site but was not associated with systemic illness.ConclusionThe implementation of a trust-wide protocol has allowed the insertion of twelve long-term drains with optimisation of patient's quality of life, maximised time out of hospital and an estimated trust saving of £8,148.
ANTICIPATORY PRESCRIBING AT THE END-OF-LIFE IN SOUTH EDINBURGH CARE HOMES
Authors: Finucane Anne M. , McArthur Dorothy , Gardner Hilary , Murray Scott A. 
Published: February 2014

BackgroundCommon symptoms at the end-of-life include pain, breathlessness, anxiety, respiratory secretions, and nausea. National end-of-life care strategies advocate anticipatory prescribing to manage these symptoms, enhance patient care and reduce unnecessary hospital admissions. NHS Lothian palliative care guidelines have drawn on this advice and recommend that four classes of “as required” medicines are prescribed and available for all patients in the last days of life. These are analgesics, anxiolytics, and anti-secretory and anti-emetic medication.AimsThis study explored the extent to which residents in eight South Edinburgh care homes had anticipatory medications prescribed prior to death.ResultsData was collected as part of a larger project to improve palliative care in these care homes. Each care home was asked to provide data on anticipatory prescribing for the last ten residents who had died. Data on 77 residents was received, 71 of whom died in the care homes (6 died in hospital). Of the 71 who died in the care homes, 59% had some anticipatory planning medications in place: morphine for analgesia (52%); midazolam for anxiety and distress (38%); hyoscine butylbromide for respiratory secretions (21%); and levomepromazine or haloperidol for nausea (23%). Overall, 41% no anticipatory medications prescribed in the last days of life. Only 15% had prescriptions for all four medications.ConclusionsMany care home residents do not have the recommended anticipatory medications in place in the last days of life and thus may experience inadequate symptom control. Barriers to anticipatory prescribing in care homes include difficulties diagnosing dying, lack of knowledge about the guidelines, costs concerns relating to wastage of medicines and barriers around individual prescribing systems and storage. Research that explores these issues is required. In the meantime, interventions that build the skills and confidence of care home staff to diagnose dying and facilitate such prescribing are recommended.
IMPROVING COMMUNICATION CONCERNING USE OF POTENTIALLY SEDATIVE INJECTABLE MEDICATIONS AT END OF LIFE
Authors: Richardson Kathryn , Hiscock Ruth , Midgley Corinna 
Published: February 2014

AimsTo explore use of potentially sedative injectable medicines at end of life in a hospice inpatient population, and ensure good quality of communication surrounding the use of such drugs. A retrospective case notes audit of people who had recently died in the hospice was developed. Frequency and dose range of injectable sedatives used in the last week of life were noted, also range of symptoms recorded, documentation of intent for those medications. and that discussion with patient/family concerning intent/potentially sedating side effect had been achieved, with the plan of care agreed.Results46/50 notes were analysed (sequential deaths — 4 not found). 42 were on an end of life care pathway when they died. Use of medicines which could potentially sedate was high: medicines reviewed were midazolam, levomepromazine and phenobarbitone. Only 3 were on no such medication. 40/46 were receiving medicine via an infusion. Midazolam and levomepromazine median/mode doses were low. Intention was better documented than in a previous audit but there were clear gaps in documentation concerning discussion with patient, family and team. In the 5 for whom the intent was sedation there was good documentation concerning discussion with a senior doctor - but poor documentation of discussion with patient/family/team.ConclusionsThe audit identified improvement since intention/counselling had become part of syringe driver policy, but unclear patient, family and team engagement in the plan of care. A policy on use of potentially sedative medications has now been developed to better support good communication concerning such drugs. MDT teaching has engaged staff in the importance of such communication. Key recommendations for use of sedation in palliative care (based on the European Association for Palliative Care, 2007) are now included. The policy has been positively received by staff (feedback included in this review) and is now in use.
THE DEVELOPMENT OF AN ELECTRONIC REPORTING MECHANISM TO SUPPORT THE USE OF EPACCS IN CLINICAL PRACTICE
Authors: Henry Karen , Kite Suzanne , McDermott Sarah , Penn Naomi , Paul Westerman 
Published: February 2014

BackgroundLeeds was one of the sites for the DH EPaCCS pilots 2009–11 (Ipsos-Mori 2011) and implementation across the city has been ongoing since 2011. Bespoke templates have been developed to collect patient information specified in the 1SB1580 standard from within existing clinical systems of the healthcare provider organisations to support the elicitation, recording and sharing of people's key preferences about their care.Whilst implementing EPaCCS in Leeds it became apparent that reports could assist clinicians in identifying which patients might be suitable for EPaCCS, help streamline palliative care/GSF meetings and support organisational reporting requirements. The team therefore developed the reports outlined below.AimsUse electronic coding of patient information to develop reports to: highlight those patients with a palliative code in their record for consideration by clinicians for EPaCCS streamline palliative care/Gold Standard Framework meetings by focusing on patients preferences enable GP practices and healthcare organisations to meet their reporting requirements and monitor care outcomes.ResultsEPaCCS reports have been developed within the SystmOne clinical IT system populated by GP's, specialist palliative care and community nurses. Since clinicians started using the EPaCCS reports there has been a significant increase in the numbers of patients identified as having palliative care needs and who have subsequently been included on EPaCCS. Clinicians report that GSF/palliative care meetings are more streamlined and effective. Practices are also able to evidence QOF requirements of a palliative care register and meeting; similarly other healthcare organisations can meet their reporting requirements using EPaCCS.ConclusionsThe introduction of reports into the Leeds Systmone EPaCCS has been beneficial to patients and clinicians in terms of more patients being identified and highlighting gaps in preferences being recorded. and clinicians are enabled to be more productive and proactive in their decision making and reporting requirements.
DEVELOPING AN ELECTRONIC PALLIATIVE CARE COORDINATION SYSTEM (EPACCS) WITHIN A LARGE CITY WITH MULTIPLE CLINICAL IT SYSTEMS
Authors: Henry Karen , Sarah McDermott , Kite Suzanne , Penn Naomi , Westerman Paul 
Published: February 2014

BackgroundThe DH End of Life Care (EoLC) Strategy (2008) identified EPaCCS as an enabler of greater co-ordination of patient care through supporting the elicitation, recording and sharing of people's key preferences about their care and enabling these preferences to be met across a wide variety of teams and organisations. A variety of approaches to the design of EPaCCS have been adopted across England (Ipsos-Mori 2011). In Leeds the emphasis has been on hosting EPaCCS within the current clinical IT systems that span the city, in response to the stakeholder priorities of accessibility in clinical practice and minimal duplication of record entry.AimTo design and implement an EPaCCS IT solution that maintained clinical intuitiveness across a multitude of clinical IT systems ie ‘one click’ from the organisational clinical record.ResultsThree clinical IT systems predominate. SystmOne is the platform for 66% of GP's, community nursing, OOH's and the two hospices, and EMIS is predominantly used by the remaining GPs. The acute Trust had a myriad of systems currently being amalgamated into a single Clinical Portal. Bespoke templates have been developed with clinicians and implemented to collect the patient information specified in the 1SB1580 standard within the existing clinical systems of the healthcare provider organisations. Interoperability between the IT systems to permit sharing of the EoLC plan is being pursued via the Leeds Care Record which will facilitate sharing of information between different clinical systems and is the first of its kind in the country.ConclusionsThe “one click away” approach to EPaCCS is a challenging one, and a lengthy process. However, the benefits of supporting clinicians to build a record of patient preferences and wishes for end of life care within their own clinical system are now being realised.
IS THE SPECIALIST PALLIATIVE CARE MULTIDISCIPLINARY TEAM (MDT) ABLE TO PROVIDE MORE ACCURATE PROGNOSTICATION THAN NON-SPECIALIST MEDICAL PROFESSIONALS?
Authors: McManus William , Khodabukus Andrew , Hayle Catherine , Ahmad Fawad , Lewis-Jones Catherine 
Published: February 2014

BackgroundPrognostic estimates are used to support decision-making in advance care planning. NICE Quality Standards (2011) advocate that ‘people approaching the end of life are identified in a timely way’. Estimations are often inaccurate, with non-specialist medical professionals being accurate only 20% of the time.1 2Prognostication scores exist to help inform estimations, but most medical professionals use a combination of personal experience, the patient's disease burden and momentum of functional decline.AimTo determine prognostic accuracy of a specialist palliative care multi-disciplinary team (MDT).MethodsPrognostic estimates were recorded by a specialist palliative care MDT bi-weekly for hospice inpatients over a six month period. Patients were placed in to one of four prognostic categories: ‘last six months’, ‘last six weeks’, last two weeks', and ‘last 48 hours’. Data was collected retrospectively.Results182 prognostic estimates were recorded for 122 patients over six months. 96.8% of patients had a diagnosis of malignant disease. In the ‘last six months’ category, median survival was 42 days, with a prognostic accuracy of 48.6% (i.e. 48.6% of patients in this category died within six months and survived longer than six weeks). In the ‘last six weeks’ category, median survival was 21 days, with an accuracy of 43%. In the ‘last two weeks’ category, median survival was 8 days, with an accuracy of 50%. In the ‘last 48 hours’ category, median survival was 60 hours, with an accuracy of 52%.ConclusionsThe specialist palliative care MDT is more accurate at estimating prognosis than non-specialist medical professionals, with an average accuracy over all prognostic categories of 48.4%. Accuracy improves the closer the patient is to death. Overestimation of prognosis is the more common error, contrary to media reports that suggest medical professionals can underestimate prognosis and deny patients treatment towards the end of life.