bluuebunny/crossref_metadata_2025_split huggingface dataset:
P121 How implementing deciding right in Cumbria supports good practice in Advanced care planning (ACP): a case study
Authors: Chaddock Becky , Bradley Carol , Laycock Mel 
Published: October 2013

IntroductionDeciding Right (DR) is an integrated approach to making decisions about future care. It draws together statute and good practice for ACP with children, young people and adults across all sectors of health and social care, and embeds this through shared documentation. It starts with a conversation between the professional and patient about their right to make care decisions in advance. The project is jointly hosted by three of the independent hospices in Cumbria, and is strategically linked with the 1% GP palliative care registers campaign.Case StudyWe will present a case study of Betty, 76yrs, with end stage COPD and multiple co-morbidities. This is a complex case featuring repeated hospital admissions and fluctuating capacity around end of life care. Through exploring this case history we will show how DR made a real difference to choice, control and sense of self for Betty, and to the health and social care management of her care. We will demonstrate how DR was important in facilitating multi-disciplinary working and critically, cross agency information sharing at end of life.DiscussionEstablishing DR shared documentation across the whole of health and social care has been crucial in rolling out ACP conversations and this approach is effecting change in organisational culture. Training and education for professionals builds capacity within the existing workforce to change current practice, and engagement with students helps to future-proof the principles of DR in Cumbria.Learning pointsMaking ACP conversations the responsibility of all professionals is key to ensuring that conversations happen early enough in people’s journey for them to be well thought through and meaningful.Agreeing and adopting shared documentation for Health, Social Care and 3rd Sector organizations is fundamental to ensuring that ACP conversations held are recorded appropriately and in a meaningful format for all concerned.
P122 Death, dying and dementia: Diminishing dilemmas and distress
Authors: Cowan Margaret Mary , Jenner Jo , Bankole Abdul 
Published: October 2013

Background/contextThere are currently 750,000 patients living with dementia in United Kingdom ( Alzheimer’s Society, 2011) with evidence of inappropriate hospital admission of patients with advanced dementia (Pace,et al, 2011). NICE, (2013) suggest a palliative care approach from diagnosis till death. Following a critical reflection relating to the end-of-life care of patient with dementia, the local hospice collaborated with local advanced dementia unit to hold bi-monthly meetings to improve planning care.AimAs a result of this collaboration patients are supported to receive their end-of-life care in familiar surroundings resulting in equality of care to those who are cognitively intact.Approach usedBi-monthly meetings assess newly admitted patients and identify patients approaching end-of-life. Discussions are documented in case notes with particular significance to DNACPR, preferred place of care/death and communication with relatives.OutcomesAs a result of this collaboration the outcomes are fourfoldPatients can expect an agreed care plan at end of life, with coordination of specialist dementia and palliative care services.Carers can expect increased support, are involved in advanced care planning, have access to newly formed carers group and access to bereavement care.Dementia unit staff have increased expertise, improved their uptake of education on end of life issues, have received bespoke communication training and have rapid access to specialist palliative care advice.Hospice staff have improved recognition of needs of advanced dementia patients and allows them an opportunity to seek advice on control of symptoms of other dementia patientsApplication to hospice practiceThis collaboration allows both units to transfer their skills to benefit an increasingly ageing population. It allows the hospice to plan ahead for the increase in future referrals of dementia patients in line with predictions.
P123 Improving end of life care on inpatient dementia wards
Authors: Campbell Carolyn , Hope Suzy , Stevens Deborah , Morris Alison 
Published: October 2013

IntroductionThis audit and service review looks at a collaborative approach to improving the end of life care for people with dementia on inpatient wards in Cornwall. It has prevented many inpatients resident on the inpatient dementia ward being transferred to the acute hospital for symptom control or terminal care.BackgroundPeople with dementia over 65 years of age are using up to one quarter of hospital beds at any one time and it is estimated that that the majority of the 100,000 people who die with dementia are in hospital. Multiple initiatives have set out to improve the end of life care of these patients. Despite this, there is evidence that suggests that end of life care for people with dementia is significantly poorer than for people without dementia.MethodsAn inreach service to the dementia wards was provided by the hospice nursing and medical staff. The three key aspects were:Guidance - specific end of life care guidelines were written collaboratively, taking into account the complexities of setting, staffing and patient group.Confidence buliding - Dementia unit staff were educated in palliative care principles & skills, with hospice nursing staff & doctors providing peer education and support.Support - the dementia units were given 24/7 access to the hospice advice line with availability of consultant review withing 24 hours when needed.ResultsTransfers of patients to the acute trust were reduced and end of life transfers eliminated in patients with contact with the inreach service. Staff confidence and expertise was developed to a high standard. Options for extending the service to nursing home settings are being explored.
P124 Improving End of life care for patients with Dementia
Authors: Parkes Nicola , Cross Gillian , Whitfield Andrea 
Published: October 2013

IntroductionDementia is predominantly a disease of later life but there are at least 15 000 people under 65yrs who have the illness. Symptom relief is often missed as these patients are unable to communicate effectively.Aims of the ProjectImprove the quality of End of life Care for people who are diagnosed with dementia admitted to hospitalIncrease the awareness of staff caring for these patientsPromote advance care planning for people with dementiaSupport families of people suffering from dementia with decision makingMethodsA flow chart was designed and coloured to reflect the local End of Life Care Model. There was close liaison with trust staff about developments in dementia care within the acute setting and teaching materials were developed to train staff on caring for patients with dementia in their last days of life.ResultsThe Trust collated results from the dementia screening tool used to asses every patient over 75yrs; it demonstrated an Increase in knowledge for staff in trust to recognise dementia as a terminal disease.DiscussionThe project aimed to support patients with dementia from diagnosis to bereavement. The work was a collaboration between the Acute Trust and local hospice services. Work streams were formed to develop care pathways, integrated working and shared learning. The trust adopted the butterfly scheme which the CNS team promoted when visiting patients with dementia and raise awareness of importance of advanced care planning for these patients.ConclusionImproving the knowledge of staff around caring for patients that are dying who have dementia improves their ability to effectively observe and manage symptoms, improves the quality of care and job satisfaction whilst improving outcomes and relieving distress for patients and families.
P125 Piloting the design and delivery of a five-day course on End of Life Care for people with dementia. A joint venture
Authors: Myers Laura , Mahoney Mary 
Published: October 2013

The drivers for this project included National guidance and policy, such as the Prime Minister’s Challenge (Department of Health (DH) 2012) and "Living Well with Dementia (DH, 2009) and the National end of life care strategy (DH, 2008), Regional influences were Dementia Local Implementation Groups (DLIG) and "Dementia-friendly communities". The development of the course was funded through the Regional Innovation Fund (RIF). The hospice is revising the organisational strategy, with a view to reaching more people who are dying and their families, through enhanced joint working.The aim was to bring professionals together, sharing their specialist expertise to develop and deliver a five-day course to a wide variety of health and social care providers.Initial work centred on accessing appropriate health and social care providers to help to design and deliver the course.. The group met regularly (over a period of six months), initially to establish the framework of the course and, subsequently, to design and agree the course content, intending to use facilitators from a range of disciplines.A pilot five-day course was delivered in the Spring of 2013, attended by a diverse group of participants, including staff from mental health, learning disability, hospices, care homes, and community settings as well as a care commissioner. The course was facilitated by specialists from mental health, social care training, Alzheimer’s society, specialist palliative care, care home setting, palliative medicine and hospice education, as well as a person with dementia. An assortment of teaching and learning techniques were used to encourage shared learning. Electronic evaluation has provided evidence of participants’ learning.This course has the potential to enable care providers to learn more about end of life care for people with dementia, reaching more people in all settings, in line with National, regional and organisational strategy.
P126 Respite Care Reframed - A Palliative Care Service For The Future
Authors: Laverty Diane 
Published: October 2013

Respite care is currently disregarded as an essential component of palliative care despite interest on the part of Government and others to support home based end of life care and to increase access for people with chronic degenerative conditions.During the last 2 years an East London hospice has delivered an updated model of respite care that recognises and responds to new emerging groups of users and seeks to enable more people to remain at home during their illness.A new, nurse led service, headed by a nurse consultant, has been established which delivers planned respite care. The service proactively seeks to support people with non malignant conditions including young adults undergoing transition from children to adult services.This shift results in time being given to a multi professional review of the patient and carer’s needs as a basis for establishing an updated care plan, designed to enrich the patient’s life and maintain their function and wellbeing. Access to other hospice services is also made available. It is particularly effective when the patient is admitted in a relatively stable state and can consider / negotiate different approaches to care in a safe environment. Seven beds are now open to provide this care. Development of this new model has required a different culture of care, development of staff skills and new working relationships within and outwith the hospice.The service has been well used (average occupancy 80%). Review of activity data reveals a higher than average use of these beds by people with non cancer conditions (47%) and increasing utilization of young people undergoing transition (12 episodes). User satisfaction is high and the impact of care, measured through SKIPP is positive. Carer feedback, via focus groups indicates that the service is a vital one & suggestions about improvements will help inform service development plans.
015 Collaborative leadership - working in partnership to improve the design and delivery of palliative and end of life care across East London
Authors: Bradley Ruth , Farag Dan 
Published: October 2013

BackgroundIn 2012, St Joseph’s Hospice and Marie Curie proactively formed a strategic partnership. Unified by the shared goal of enabling more people to achieve choice at the end of life, the partnership provides the required leadership, to facilitate change and develop across EoLC services.AimThe partnership aims to:improve performance across the East London EoLC system;develop a stronger EoLC voice locally through reforms across health and social care.Meet the complex and growing demand for services through collaboration, innovation, and community engagement.Approaches usedThe partnership identified a number of themes that collaborative leadership could benefit from: Urgent Care; Care in the last days of life; Support for Families and Carers; Coordination of Care.The partnership has been driving change and stimulating innovative solutions through:Bringing together stakeholders from across health and social care, commissioning teams and service users to develop a shared commitment for change.Designing new services to better meet local need with multi-borough, multi-disciplinary teams.Developing robust business cases to support and inform commissioning.OutcomesOutcomes of the partnership :Raising the profile of EoLC across East London, and placing the hospice at the centre of developments.Design of an ambitious EoLC Coordination Centre.Undertaking detailed baseline mapping of the support available for families and carers.Hosting stakeholder and community events to raise an understanding of needs of families and carers, laying the foundations for change and development.Application to Hospice practiceThe value of partnership work to support hospice development :The importance of hospices taking a pro-active leadership role in forming networks across East London.The value of sharing resources, expertise, learning, and networks to make improvements and facilitate the redesign of care.The recognition of the contribution that palliative and end of life care can make to the wider health economy.
P128 Does respite care address the needs of palliative care service users and carers?
Authors: Anna Wolkowski , Carr Susan 
Published: October 2013

Research aimsTo explore the perspectives and experience of respite care of married or bereaved palliative care service users and carers and to establish in what ways respite care addresses their needs. The research is located in a professional doctorate study.BackgroundThere are clear indications that over the coming years, as more people live longer into old age and die as a consequence of chronic disease, an increasing amount of support for carers of patients with palliative care needs will be required. In UK policy and guidance, respite care is frequently mentioned as a key factor in supporting carers. However, little is known about respite care for people in this group and the study addresses this gap in knowledge.MethodsThe approach was qualitative, the methodology was interpretive and the method used was constructivist Grounded Theory. Data collection was carried out by unstructured informal interview with couples who had experienced hospice respite care. Social network circle activity was undertaken as part of theoretical sampling.ResultsRespite care is valued by palliative care service users and carers although there are some fundamental tensions in service models which limit its potential. A theory of vulnerability and resilience was developed which accommodated issues of needs and acceptance, choice and risk, loss and gains.ConclusionsThe articulation of respite care needs and the insights gained in this study have the potential to influence hospice practice and provide a platform for innovative service development and improvement which is sensitive to the needs and capacity of local communities.Application to hospice practiceA reframing of respite care as an empathic response within a new palliative care approach is proposed. Within this the centrality of the relationship is reinforced and the need for support over a potentially long and more uncertain trajectory is acknowledged.
P129 Equitable allocation in needs-led care: developing an assessment tool for respite allocation in a hospice for young adults
Authors: Ebeling Sophie , Cowee Deborah 
Published: October 2013

BackgroundThe hospice provides support for young people with life-limiting illnesses, central to which is respite care. It is recognised that decisions about respite care provision are of fundamental importance to patients and their families. The referrals team invests time, clinical judgment and combined knowledge to assess each case and agree an allocation of respite care.A project was undertaken to develop a tool for allocation of respite care. This tool would structure the allocation of respite according to a matrix, allowing the team to provide evidence of equitable allocations, allow direct comparisons between cases and potentially improve time efficiency.AimsThe aim was to develop and validate a simple scoring matrix which could be used to assess each patient’s need for respite and ensure an appropriate allocation of nights.ApproachThe tool was developed through a grounded theory approach, refining and developing the tool through testing until an accurate version was created.OutcomesThis project has successfully captured, and defined, the collective knowledge and experience of the referrals panel. This collaborative decision-making process, that has historically relied heavily on personal and professional knowledge, combined with a holistic understanding of the complex lives and needs of patients and their families, has been explored. These tacit aspects have been articulated, defined and quantified in the assessment tool produced.ApplicationThis project represents a step forward, in response to current national agendas that call for hospices to demonstrate quality and equity ahead of GP Commissioning.Adopting the tool will ensure that allocation continues to be a transparent and equitable process, which is able to be articulated and justified to patients, families and wider colleagues, allowing the organisation to demonstrate accountability and good governance.
P130 Progress for providers: End of Life - checking your organisation’s progress in delivering personalised support
Authors: Ball Philip , Sanderson Helen , Meyerhoff Tracy , Monks Nichola , Torkington Anne 
Published: October 2013

IntroductionThe hospice movement often uses the term ‘holistic care’ to describe what it provides, with it being applied differently depending on the care setting. Personalisation could be considered another version of holistic care. Based on this we took the opportunity of bringing both holistic care and personalisation together, to explore what this means in practice for end of life care.Progress for Providers is a recognised series of self-assessments, to enable providers to see how they are doing in delivering personalisation. There’s not something of this nature already available to hospice managers. Personalisation has primarily been a term used by social care, with government plans to integrate health and social care by 2018, its key we start to embed personalisation to hospice care now.AimsThe aim is to enable hospice managers, and anyone involved in supporting people at end of life, to know what personalisation looks like in practice and to introduce person-centred thinking tools that can add to the way that hospices can deliver truly personalised services.Approach usedThe authors met to produce the self-assessment tool using their knowledge, key reports and other sources of information to inform the statements of each area of assessment. The tool will be sent out for comment, refined and tested during the summer of 2013, to be launched in October.Outcomes and applications to hospice practiceThe use of Progress for Providers: End of Life offers an opportunity to critically examine local practice with a view to taking personalisation further.While the future of hospices has been considered by the Commission, making progress in personalisation is another way to look at service provision to ensure it meets the needs of the people we support.
P131 Garden house hospice admission response criteria
Authors: Ebiredelu Augustina 
Published: October 2013

IntroductionReferrals for admissions are received from health care professionals in the community and acute trust with GP’s knowledge. Requests are assessed by the admission co-ordinator and a member of the Hospice Medical team on an individual basis, without discrimination and in accordance with the admission policy.A tool has been adapted from Luton Community Service Palliative care response criteria. It is based on RED/AMBER/GREEN (RAG) category model.AimThe aim is to ensure a responsive service based on patient needs. It provides clinicians with a user-friendly tool to support decision making when prioritising request for admission to the Hospice.MethodAn audit on the use of the tool was undertaken.RAG tool covers 3 categories; End of life care, symptom management and Psychological/social support.RED – Death expected within hours/days, Symptom control and Carer breakdown. Admission/bed offered within 24 hoursAMBER – Death expected within days/weeks, symptoms assessed but remain unresolved, Psychological support requiring regular observation. Patient is admitted within 3 days.GREEN – Death expected within weeks/months. Respite for family. Admission offered if no red or amber patients are waiting.The tool is used in conjunction with a list of questions when dealing with request for admission.Using the criteria, admission was prioritised according to RAG tool and response time documented.ResultsDuring a 12months period, 202 patients were admitted to the IPU from home or from hospital. 140 of these admissions were considered to be RED requests, 47 were AMBER and 15 were GREEN.Admission between 2–24hrs = 140Admission between 24hrs – 36hrs = 47Admission between 36hrs and over = 15SummaryThe RAG tool was found to be successful in prioritising request for admission. Streamlining the process of admission meant that patients requiring urgent admission were prioritised therefore preventing possible hospital admission and achieving their Preferred Place of Care and Death.