bluuebunny/crossref_metadata_2025_split huggingface dataset:
IMPROVING PATIENT CARE - THE LEEDS DEDICATED PALLIATIVE CARE AMBULANCE SERVICE
Authors: Borrill Deborah , Colam-Ainsworth Will 
Published: February 2014

BackgroundLeeds have benefited from a bespoke palliative care ambulance service since 2007 when work done with Marie Curie and the “Delivering Choice” programme highlighted the need for the service.Early consultation with stakeholders identified that a lack of appropriate ambulance transport can be one of the factors that restricts or prevents the fulfilment of a patient's previously expressed wish to die in the place of their choice.AimThe aim of the dedicated palliative care ambulance service is to provide flexible, prompt, safe and comfortable transport to patients moving to a place of their choice towards the end of life and to those needing palliative treatments and investigations.MethodThe Hospital Specialist Palliative Care Team, Leeds Commissioners, Yorkshire Ambulance Service (YAS) Leeds Hospices and Leeds Community Health worked closely together at a local level to improve the present palliative care ambulance service.Leeds commissioners have now funded a second ambulance to run on weekdays, covering the busiest times and new dedicated crews have been recruited and trained by the local hospice.ResultsThis service will benefit patients, carers, healthcare professionals and healthcare providers by:Helping patients achieve their choice for place of care by reducing delays in discharge caused by restrictions to transportEnsuring appropriately trained ambulance personnel will provide quality care services to patients at the end of life during transportationProviding effective ways of working with professionalsProviding better coordination and connectivity between hospital, hospice, community and ambulance servicesConclusionIn providing patients with choice in place of care at the end of life, whilst improving service provision, it is expected that the number of patients dying at home will increase. Future plans are to monitor present demand with a view to expanding the service further to support the transfer of palliative patients in Leeds.
CAN ELECTRONIC EVALUATION OF EDUCATION DEMONSTRATE BENEFIT TO PRACTICE?
Authors: Myers Laura , Mahoney Mary 
Published: February 2014

BackgroundSt Catherine's hospice has designed a new organisational strategy, which includes reaching more people who are dying and their families, regardless of their illness. The success of such an endeavour is dependent on knowledgeable and confident clinical staff. A pilot electronic evaluation project has been established and is beginning to produce data showing the effect of education on practice.MethodElectronic links to questionnaires were sent to course participants immediately before and after attending study days and three months later. Core data comprised self-reported ratings of understanding and confidence based on learning outcomes. Additional pre-course data established the rationale for attendance and expected learning. Post-course data identified learning and how it would be used in practice, as well as feedback on the content, delivery, and pitch of individual sessions. The three month follow up questionnaire provided participants with the opportunity for reflection on their learning and asked for examples of its use in practice.ResultsCompletion of the forms was inconsistent; some participants finding the process easy, while others were hampered by their inability to use or access computers. A great deal of data was generated, including graphs showing enhanced self-reported post-course levels of confidence and understanding, qualitative comments, and use of learning in practice. Three types of reports were created: one for educators, containing all data and used for course review; the second for individual speakers, providing feedback on their sessions; and a third for commissioners to demonstrate perceived learning and application to clinical work. The project brought about a structure for gathering evaluation data and producing reports that are clear, concise and illustrate the difference education makes to practice. The design and implementation of this electronic process was initially resource intensive and now provides a structured method for data collection and analysis.ConclusionElectronic evaluation of hospice education provides clearer data that learning benefits practice.
DEVELOPING AN EDUCATIONAL INTERVENTION TO HELP STUDENTS PROCESS THEIR EXPERIENCES IN END OF LIFE CARE
Authors: Brock Martin , Brown Michelle 
Published: February 2014

BackgroundBarriers exist which often compromise the care a patient and their relative/carer receive at the end of life.1One barrier that has been identified is the preparation student nurses receive in order to adequately care for this group of patients.2Subsequently the DH suggested that “end of life care needs embedding in training curriculums at all levels and for all staff groups”.1(pg 14)The general population may not experience or deal with death until they reach middle age.3A number of student nurses therefore may have limited experience in dealing with the emotional death and grief.The nursing programme is competence based therefore student nurses may view their own distress negatively. The impact may be inhibit sharing and seeking support.EOL education may be challenging as it can provoke anxiety. Providing an environment that reassures and feels safe with a philosophy of shared compassion for all involved is an essential element within end of life educational interventions.AimsIntroduce an educational initiative that provides a culture for changeImprove end of life care experiences for all involvedDevelop a pathway of support which will allow students to process their experiences and achieve the necessary skills.FrameworkEmbed initiative within each stage of the BSc (Hons) nursing award.▸ Cooperative learning▸ Safe environment▸ Peer support promoting a sense of family4The effectiveness will be measured using an adapted version of the Evaluation ToolkitConclusionsHigh quality end of life care is essential and pre-registration training has been acknowledged as an area where shortcomings may be addressed.Student nurses require supportive educational interventions surrounding end of life care that facilitate changes in knowledge, behaviour and attitudes in preparation for their transition into the nursing profession.
AN EDUCATIONAL TOOLKIT: SPECIALIST PALLIATIVE CARE TELEPHONE ADVICE LINE
Authors: Haywood Chris , McConaghy Margaret , Thompson Anthony , Molyneux Clare 
Published: February 2014

BackgroundAudit has shown that Integrated Specialist Palliative Care Telephone Advice Lines provide expert support to healthcare professionals caring for patients with palliative and end of life care needs. Governance arrangements including education and support for staff in answering the telephone is variable. A toolkit was devised to support both nursing and medical staff who respond to calls within a Hospice Inpatient Unit.AimsProduce a toolkit with a clear framework to facilitate, enhance and improve knowledge, skills and confidence of staff in responding to calls made to a Specialist Palliative Care Telephone Advice LineAid individual clinical decision making recognising individual limitations; providing guidance on when to escalate to Senior ColleaguesAddress individual training needs of staff in a cost effective wayMethodsPowerPoint slides for awareness sessions and trainingPre and post evaluation documentationCombination individual and group training using actual callsWritten reflection with supervisory follow upFocus on timely, constructive, positive feedback and sharing good practiceRepeated at 6 monthsResultsImprovements of quality aspect of calls by use of the toolkitNotable improvements of staff knowledge, skills and confidencePositive impact on GovernanceClearer identification of education and training issues that arise when providing this type of serviceThe ToolkitGuidance documentsDVD with actual callsProforma: reflective practicePre & Post evaluationPowerpoint presentationUseful tipsConclusionToolkit is clearly effective as a quality improvement initiative.Awareness heightened; quality of calls matter for patient safety and professionalismStrengthened confidence and communication across servicesEasily able to be replicatedEasily repeated to ensure improvements are maintainedCould be used as a method of ensuring staff competence as part of Personal Development PlansCould be used to support mandatory education and training for those services providing 24/7 Telephone Advice
DEVELOPING A MOUSEMAT AS AN EDUCATIONAL TOOL IN PALLIATIVE CARE
Authors: Powell Paula 
Published: February 2014

This poster describes the development of a mousemat to aid GPs in safe and effective prescribing at end of life. The mousemat has advice on prescribing anticipatory medication and using syringe drivers. This innovative approach has been hugely welcomed by GPs who find it practical and accessible.300 have been given to GPs, OOH services and District Nurses in St Helens and Knowsley and other areas across Merseyside and Cheshire plan to adapt the format for local use.
EVALUATING A PROFESSIONAL DEVELOPMENT PROGRAMME
Authors: Hedges Christine , Wee Bee 
Published: February 2014

Background & AimsThis project used the Kirkpatrick™ model of learning to help evaluate a Senior Nurses' Professional Development Programme (PDP). It acknowledges that the educational impact on practice, both directly and indirectly, is difficult to measure and is in need of development. In light of this, we aimed to use the Kirkpatrick learning framework to consider a more comprehensive evaluation.Evaluation toolsKirkpatrick's model identifies 4 levels/stages of learning which assist an evaluation. We concentrated on levels 2 and 3.Level 2– Evaluation of traineelearning: Likert scales quantified increases in topic understanding and confidence levels.Level 3– Evaluation of traineeBehaviour: A focus group gained feedback on changes in practice.ResultsLevel 2 — Evaluating evidence of learning —We were able to present increases in topic related learning and confidence, identifying differences.Level 3 — Evaluating changes in practice —Changes in practice emerged in two separate ways. Firstly, changes resulted from the programme's topics of education, critical appraisal and research design, pain management and leadership/time management. Secondly, benefits emerged from having attended the programme itself. There were increases in; commitment to practice development, group cohesion, positive working practices between teams, a valuing of and commitment to the ethos and style of the PDP itself as a model for education and training.ConclusionsThe Kirkpatrick model provides a sound structure for training evaluation. Using quantitative and qualitative methods, were able to: quantify positive increases in understanding and confidence in the session topics, undertake a focus group which identified positive changes in practice and commitment to professional development recognise the need to extend the programme's evaluation to stakeholders (Kirkpatrick's level 4)
TO INTEGRATE OR NOT TO INTEGRATE
Authors: Cummins Janet , Joyce Annemarie , Gallagher Lisa 
Published: February 2014

The Development of an Integrated Community Advance Care Planning Service across neighbouring Boroughs and its impact on the uptake of End of Life Care Tools.BackgroundThe first Advance Care Facilitator was introduced in Knowsley in December 2008; the overall purpose of the post was to make quality improvements in the provision of End of Life Care by supporting the development end of life care tools;-The Gold Standards Framework (GSF), Preferred Priorities for Care (PPC) and the Liverpool Care Pathway (LCP). A second facilitator was taken on in February 2010; both facilitators were employed by 5 Boroughs Partnership. In August 2011 Willowbrook Hospice won a contract to host a Facilitator and Admin Co-ordinator to cover neighbouring St Helens. A proposal was put forward to join forces with Knowsley and Halton to develop an Integrated Community Advance Care Planning Service and in April 2011 agreement was reached for the three areas to work together. Unfortunately Halton pulled out of the agreement but the Partnership between Knowsley and St Helens went ahead.AimThe aim was that facilitators would work together – maximising opportunities in an efficient cost effective manner.ResultsIn the first 12 months of integration the team delivered education to a total of 1080 people;-EOLC tools6 steps Care Home ProgrammeGSF Care Home ProgrammeOpening the Spiritual GateVerification of deathSyringe Driver trainingDying Matters – Public Engagement.The team conducted the following auditsGSFPPCLCPEOLC ToolsConclusionIntegrating services enabled the team to deliver education to a wider group of people in a cost effective manner and audit outcomes in a shorter time than if they had worked separately by sharing and pooling knowledge, skills and resources.
USE OF KETAMINE FOR INTRACTABLE PAIN IN TERMINALLY ILL PATIENTS
Authors: Shah Tejal , Holtom Nicola 
Published: February 2014

BackgroundThere is insufficient evidence from controlled clinical studies to support the use of Ketamine in refractory cancer pain. This has lead to lack of confidence and inconsistent clinical use of the drug among many specialist palliative centres in the United Kingdom.Aims▸To analyse the current practice and barriers in prescribing Ketamine.▸To capture the confidence of specialist palliative care physicians in prescribing Ketamine.MethodsSpecialist palliative care doctors across the region were invited to reply to a questionnaire based survey via email.Results43 doctors participated in the study. 81.4% have used Ketamine for controlling intractable pain during ‘end of life’ situations in addition to strong opioids, 60.5% used it as an adjuvant with opioids in the early stages of pain relief and 51.2% used it to enable the reduction of opioid dose due to its side effects.Confidence amongst the specialist palliative care physicians ranged from 3 to 10 on a visual analogue scale (10 representing the most confidence), with an average rating of 6.8. Lack of expertise and familiarity (55.9%), lack of evidence (44.2%), and side effects (25.5%) were the barriers observed in the use of Ketamine.Only 32.6% (4) centres had a written protocol for use within the service and have developed shared guidance for the community services. 79.1% of the respondents felt they would benefit from further training and education.ConclusionRandomised controlled trials are difficult within the palliative care patient population. This has resulted in a lack of uniformity in practice of the use of Ketamine. Almost 80% of the survey participants felt there was a need for further research and education in the use of Ketamine.RecommendationsDeveloping written departmental policies with shared guidance to generalists would help in a more consistent and effective use of the drug amongst specialist palliative doctors. Education and training are required to improve confidence with its use.
AN INNOVATIVE DEVELOPMENT APPROACH FOR ACUTE HOSPITAL SENIOR CLINICIANS TO IMPLEMENT THE NATIONAL EOLC STRATEGY 2008
Authors: Edwards Annette , Hicks Fiona , Winterburn Kathryn , McTague Laura , Carey Anne-Marie 
Published: February 2014

BackgroundApproximately half the annual 600,000 deaths in England occur in acute hospitals although research indicates that most would choose to die elsewhere. The National End of Life Care Strategy encourages senior clinicians outside the speciality of palliative medicine to engage with end-of-life care and make it a routine part of their practice.AimTo pilot a programme enabling consultant colleagues from other specialties to identify their own learning needs, engage with the issues, undertake specific technical/clinical learning about palliative and end-of-life care, and identify improvements in their own practice. Having increased their own expertise, they would share and spread learning to clinical colleagues within their departments.MethodFunding for the pilot was obtained from Yorkshire and Humber Strategic Health Authority (SHA) for a group (approximately 6) of motivated hospital consultants, and a GP to provide a community perspective, in two trusts – one large Teaching Hospital and one small District General. The programme was led by consultants in palliative medicine who had been trained in facilitating action learning, supported by a small steering group. It included joint clinics and ward rounds, one-to-one meetings and bespoke training as identified by participants. Work was progressed through Action Learning Sets. Evaluation included Training Needs Analyses, questionnaires and audit of practice.ResultsIn addition to improved knowledge about palliative care in general, participants identified increased openness in discussing end-of-life issues and confidence in provision of community services. Service improvements include changes in content of outpatient and discharge letters, development of guidelines, implementation of the AMBER care bundle and Rapid Discharge, and addressing DNACPR practices in their departments. Participants have opted to continue meeting quarterly and act as champions for end-of-life care.DiscussionTrust “buy-in” to the programme is essential to its success. Innovations have been different in each Trust. A proposal has been submitted to extend the programme to two other trusts before national roll out.
ACTION LEARNING AS A NOVEL APPROACH TO CHANGE CLINICAL PRACTICE
Authors: Hicks Fiona , Winterburn Kathryn , Edwards Annette 
Published: February 2014

BackgroundEnd-of-life care is essential to medical practice. Encouraging behavioural change in senior doctors who are trained to cure, and may see death as failure, is crucial to improving care and may benefit from novel approaches. Action Learning is a recognised tenet of management development but is rarely used within the education and development of doctors.AimTo evaluate the role of Action Learning as part of an end-of-life care development programme, bringing consultant colleagues together to encourage reflective practice, surface and resolve problems, share and consolidate learning.MethodThis SHA funded pilot involved 2 trusts, each including 6 or 7 consultants and a GP. Both groups were facilitated by 2 consultants in palliative medicine, meeting monthly for 18 months. The programme was evaluated using training needs analyses at the beginning, middle and end, participant questionnaires asking for anonymous feedback and audits of practice and service developments. The 4 facilitators met together 6 weekly with a consultant in Organisational Development from the SHA in their own Action Learning Set and completed reflective diaries.ResultsThe use of action learning was highly valued by participants, many of whom had never previously met nor encountered this method of learning. The group provided an opportunity to discuss issues and “try out” difficult conversations in a challenging yet safe environment. Sets were very well attended, and regular meetings provided the impetus to complete agreed tasks.Some facilitators initially struggled with the concept, but confidence grew during the learning process and as genuine peer learning enabled participants to help each other.DiscussionThis pilot supported the idea that action learning can address learning needs and support behavioural change in senior doctors. This approach could be considered to address other areas within health care where organisational change is needed.
EVALUATION OF IMPROVEMENT IN PERCEIVED CONFIDENCE AND COMPETENCE IN KEY PALLIATIVE MEDICINE TOPICS FOLLOWING 1 MONTH ELECTIVES FOR INTERNAL MEDICINE RESIDENTS
Authors: Watkinson Deborah 
Published: February 2014

BackgroundPostgraduate medical training in Singapore is changing from UK-style to a US-based residency hybrid. Previously trainees joined our hospital palliative medicine rotation for 6 months and had a comprehensive series of tutorials and practice-based learning. Now the challenge is to deliver an appropriate programme to residents who choose a 1 month elective option and are at various stages in junior residency.QuestionPre-posting meanEnd-posting mean% improvement12.453.363722.273.646031.543.271141.935852.273.184062.4532272.813.452381.543.0914991.363.36147101.273.54179112.543.4536122.643.2724132.362.6412142.183.0942152.363271623.3668171.913.1866182350191.543.09100We wished to determine whether our learning programme (specific weekly case based tutorials in key areas conducted by a small group of tutors for residents only, supplemented by practice-based learning) was effective. A self-evaluation questionnaire of perceived confidence and competence in 19 symptom control and communication domains, appropriate to an internal medicine resident was adapted from previous published surveys and linked to the stated learning outcomes for the elective residents. Students were asked to complete a pre-posting and end-posting survey to determine improvement.Resultsfor the first 10 residents evaluated are presented.ConclusionThis evaluation demonstrated that it is possible to improve resident's perceived confidence in key areas with most improvement in confidence in using parenteral opioids, end of life symptoms and practical procedures.This exercise helped consultants to know where to focus teaching and practice during the posting and encouraged residents to realise that they had improved.Further work is planned to link this to their pre- and end-posting MCQ scores to evaluate whether perceived improvement links to improved knowledge scores and the relationship to year of residency.
DECIDING RIGHT: RIGHT CARE, RIGHT PLAN, RIGHT PATIENT; AN INDIVIDUALISED APPROACH TO PALLIATIVE CARE'
Authors: Than Tun , Adam Zahida , Wadhhwa Preeti , Ayubi Mohamed 
Published: February 2014

BackgroundRecognising the scope for improvement in palliative care services across Leicester city, the commissioning group, the local hospice (LOROS) and Macmillan Cancer Support collaborated in launching an innovative “Deciding Right“ project. The project aims to promote identification of patients in their last year of life to provide a timely and robust multidisciplinary care based on the patient's choices.DescriptionThe project emphasizes on training and education of local health care professionals at various levels. Four locality GP mentors, appointed to facilitate and deliver the objectives of the project, received training at masters level in conjunction with Demon Fort University. The unique collaboration of the commissioning group, local palliative care consultants and Macmillan Cancer Support paved the pathway for the appointed mentors to access training at national level through Macmillan GP support program in addition to locally provided mentoring support from the palliative care consultants. Furthermore, the project also promoted identification of a palliative care lead GP for each participating practice. All lead GPs are given training in identification of patients in their last year of life along with communication skills to conduct effective and timely discussion with the patients and families to develop and implement the mutually agreed palliative care plans in collaboration. The target group for training extended to include sessional GPs and carers from local residential homes to enable them to understand and apply core concepts of palliative care.Results and reflectionsThe project achieved improvements in the palliative care register across the city and paved the path to develop further through implementation of after death audits (ADA). It also highlighted the need for more comprehensive guidelines for anticipatory prescribing. Initial survey of ADA data has shown that most (>90%) of the patients who have care plans achieved their choices including their preferred place of death.