bluuebunny/crossref_metadata_2025_split huggingface dataset:
01 Our deeds determine us, as much as we determine our deeds
Authors: Turnbull Ian 
Published: October 2013

IntroductionIn March 2012 Willowbrook started to support the rehabilitation of currently serving offenders by offering volunteer placements in our Warehouse. This was a very bold move by the Hospice which had previously relied on traditional volunteering methods.AimsThe Hospice’s Strategic Business plan is to broaden the diversity of its volunteering by giving volunteer opportunities to young people who may not have come across the Hospice movement in their lives. Willowbrook could provide work experience to prisoner’s approaching the end of their sentence supporting the Prisons Outreach Placement programme and raise extra funds to provide for patient care.MethodsThe views of all the participants needed to be taken into account - a visit to the prison arranged meeting with the Prison Placement Officer, a business case was proposed to the Hospice Trustees, Senior Managers and Warehouse Staff. In May 2012 the first prisoners arrived at the warehouse.ResultsFor the Hospice - over the 18 months the 10 prisoners have made a fantastic contribution with over 5000 hours of support the warehouse has been able to increase its contribution to patient care by 12%, all the prisoners have settled in quickly with both Hospice staff and existing volunteers.For the Prison Service - Willowbrook is a highly reputable organisation, they know the prisoners will be supervised and provided with training.For the Prisoner - they feel more fulfilled and have more skills to take them back into ‘normal’ life.ConclusionsThe Hospice Prison Volunteer Placement programme continues to be a highly successful partnership between the Prison Service, prisoners and the Hospice. The hospice gains more volunteering time and funds, the prisoners have gained confidence, team working and independence skills that they can utilise outside the prison and the Prison Service has a professional, reliable organisation to work with.
010 Inspiring compassionate care in an acute hospital setting – the power of QELCA
Authors: Standfield Robert , Wellings Val , Harrison Alison , Garside Jennifer 
Published: October 2013

Transforming the traditional delivery of specialist end-of-life care education and training for nursing staff in acute hospital settings through the Quality End of Life Care for All (QELCA) education and training programme has resulted in immediate positive benefits for both the hospice and the local acute hospital Trust.The prevalence of a top-down target driven culture has meant that persuading hospital managers in hospital settings that compassionate care is directly relevant to improving acute care has been a challenge. The opportunity to transform this thinking was taken by the local acute hospital when they embarked on the Transforming End of Life Care in Acute Hospitals Programme that includes the adoption of the AMBER care bundle and incorporates QELCA training.Through the delivery of the prescribed QELCA curriculum, that combines and integrates theory with experiential learning through working alongside experienced hospice nurses, there has been a transformational change in the nursing care. This is underpinned by changed thinking and delivery of care that focuses directly on the needs of the patient rather than the needs of the organisation.The impact in the Acute trust has included:82% of relatives said they were aware that their relative’s recovery was uncertain.91% of patients received care supported by the AMBER care bundle had a patient and family meeting.1.5% of patients who received care supported by the AMBER care bundle, who were discharged were admitted back to the hospital in an emergency.100% patients had a DNACPR Form completed.Successful partnership working has also resulted in a renewed interest in furthering specialist palliative and end-of-life care education within secondary care and the CCG extending the AMBER care bundle/QELCA as part of their CQUIN investment. Further funding for the QELCA training has been provided through a successful bid to the Strategic Health Authority.
P78 Clinical leaders forum - “This is place where I always feel heard, I love the energy of our meetings”
Authors: Clarke Karen , Wass Tricia 
Published: October 2013

BackgroundThe forum reflects an aspiration to bring the patients’ voice into strategic developments through greater engagement of front-line clinical staff with senior decision makers in an innovative and interactive way.AimsCreate an open, participative culture that seeks to improve strategic decision making by integrating professional clinical practice into strategy.Demystify and model senior level/ strategic decision makingCapitalise on the benefits of integrating disciplines, working across departments and breaking down hierarchy.ApproachFacilitated monthly gatherings; involvingCEO, Directors, Doctors, Nurses and AHP’s, were set up in 2009. Facilitation used to ensure: ample time for differing views to be heard; an open environment to discuss both challenging and/or controversial issues; and time to thoroughly explore topics. A stable membership has created a trusting environment where other colleagues including volunteers have been invited if the topic requires wider participation.A forum, not a meeting, promotes information exchange and enables some distillation of thinking whilst encouraging strategic leaders to consider and remain grounded in clinical practice and encouraging clinical managers to think strategically.The forum was reviewed in 2011 and again in 2013 resulting in new and increased membership and some changes to the running of the forums.OutcomesCatalyst for changeAn integrated and transparent business planning and strategic decision making processCloser collaboration between Trustees and Clinical leaders.ApplicationThis forum enables the hospice to achieve the top four key operating principles contained within the Commission’s “Preparing for the future: Key operating principles”: We have developed our strategic leadership, and improved the capabilities of the workforce, while using our discussions at the forum to inform rigorous strategic analysis. Finally, our innovative and inclusive approach has enabled us to think beyond what we currently do and positively influence our culture.
P79 Using SBAR to enhance the Multi-Disciplinary Team Meeting (MDTM)
Authors: Bass Maddy 
Published: October 2013

SBAR is a quality and service improvement tool developed by the NHS Institution for Service Innovation & Improvement. It has been designed to streamline conversations between health and social are professionals, ensuring relevant, succinct information is shared.At St Mary’s Hospice there was not a recognisable MDT meeting. Although in-patients were discussed weekly, it was called a “communication meeting”, with little structure or outcome. On joining the organisation in 2012, I carried out a “snapshot” survey of the current MDT meeting and found that it lacked structure, outcomes, was very physically focussed, and did not include full MDT discussion. In October I wrote up my findings, stressing the positives as well as the challenges. This was shared with staff at one of these communication meetings. The response of all staff was very supportive.I therefore devised an MDTM based on SBAR. This had been used in my previous place of work for MDT meetings but I further developed this into specific documentation, and planning paperwork (this will be shared at the conference). “Situation” covers patient information such as diagnosis, family tree, reason for referral and input; background includes relevant medical history, events leading up to referral, any other holistic issues; assessment includes what has been found / assessed since involvement, including advance care planning; recommendations include the plan of care.The new format began trial in February and will continue until July 2013. It will then be audited: this will include staff surveys, audit of how the documentation has been utilised, and a full review. Details will be included at the conference, if this is accepted.Early feedback shows increased attendance by the MDT, patients from all departments now being discussed, clearer documentation informing succinct relevant discussion, and clear being plans made each week for patients discussed.
P80 Applying the clinical governance toolkit in the hospice setting; a potential strategy to improve care through staff engagement in clinical governance
Authors: Twomey Colin 
Published: October 2013

IntroductionClinical governance is essential to the delivery of high quality safe and effective patient care. It provides a framework to continuously improve the quality of hospice services.AimsTo critically appraise the current clinical governance systems within our hospice and to re-design these to be efficient, transparent and encourage staff engagement.MethodsWorkshops were held to examine existing governance structures and highlight areas of need and develop a solution which was both readily implementable and effective. The workshops reviewed current literature and examples of good practice surrounding clinical governance in hospices.ResultsA consensus decision was reached to construct clinical governance under the ‘three pillars’ of patient safety, clinical effectiveness and patient experience as described by the Clinical Governance Toolbox (1). In order to enhance engagement with clinical governance three new groups were created for each ‘pillar’. Each group consists of a multi-professional membership of clinical and non-clinical staff and is Chaired by a member of the senior management team. The group members will be responsible for disseminating information and educating staff and volunteers in their day-to-day work as well as in a monthly newsletter. The Clinical Governance board, drawing together the work of the three pillars, will provide organisational oversight. The Clinical Governance Board is comprised of staff members, Trustees and an external scrutinizer.ConclusionsIn adopting this clinical governance structure we believe we have developed a streamlined system that will promote best practice in all members of staff through clarity, communication, accessibility and inclusiveness. Importantly this process has also improved awareness of clinical governance throughout our team through the dynamic workshops responsible for re-designing our systems.
P82 The introduction of electronic patient records on a hospice In-Patient Unit (IPU)
Authors: Butterfield Nicola 
Published: October 2013

Background/ContextHealthcare information systems have evolved to play a major role in healthcare in modern society and the introduction of the electronic patient record aims to improve patient safety and documentation quality. SystmOne is a centralised clinical system developed by TPP (The Phoenix Partnership) and its introduction at the Hospice was due to a need to introduce an updated medical activity system that incorporated patient records.AimTo successfully up-skill the hospice staff and to safely and effectively introduce SystmOne onto the IPU.Approach usedThe introduction of SystmOne was seen as a major change for the IPU and hence a change management model was used to support this. The main areas addressed were process mapping, to identify areas where we could work more effectively and staff training. Staff training was of paramount importance as 26% of the IPU staff had no basic IT skills. This was given to those staff before embarking upon the SystmOne training.The ward staff were all involved in the development of new IPU documentation and the review of nursing care plans.The change has been anchored by the alteration in ward routine, staff job descriptions and the change in hospice policies.OutcomesImproved communication between departments and external organisations who use SystmOneReduced amount of time spent completing documentationImproved documentation standardsReduction in patients being asked the same questions on several occasionsMore than one person/department being able to access the patient notes at any one timeElimination of time spent searching for patient notesEnhanced management of out of hours phone calls thereby improving clinical safetyImproved audit and monitoringApplication to hospice practiceWe were one of the first IPU’s to ‘go-live’ with Systmone and the improvements have been wide-reaching for both patients and staff.Nicola ButterfieldLead Nurse, IPUBirmingham St Mary’s Hospice
P83 Applying NHS productive series model to hospice care – releasing time to care
Authors: Goodchild Cathryn , Draper Maggie 
Published: October 2013

IntroductionProductive Ward and Productive Community are a series of modules designed to deliver sustainable service improvement, and are well established in the NHS. We decided to adopt the model, fund the education and development and apply it to:Hospice Inpatient UnitHospice Day Care provisionHospice Community Palliative Care teamHospice Lymphodema ServiceAimsTo use the series across the organisation to improve efficiency and consider processes in a systematic way using a tested methodology. This will lead to reduction in time wasted, duplication, frustrations etc and the aim is that the time saved can be re-invested in direct patient care. This involves a culture shift within the organisation to adopt new ways of working and is unique within the Hospice movement. The aim is to embed new improved ways of working across the organisation and to empower staff from the “ground up“.MethodsExternal training deliveredSteering group establishedLaunch in different teams and establishment of championsWork streams to deliver 2 modules in first year :Knowing How We Are Doing– public display of information e.g.: response times, no of referrals, falls, staffing levels/ sickness rates/ caseload averages/RAG rating etc.Well Organised Working Environment/Ward–review of referral process and pathway, evaluating stock levels and standardisation of store cupboards/ clinician’s bags etc.EvaluationThe Productive Series model encourages:Continuous evaluation and feedback to teams.Ownership of changes, sustaining improvement and embedding practiceEmpowering of staff across bands and settings to deliver the organisation’s vision and release time to care.Further information to follow regarding roll out, changes adopted and impact evaluated by October 2013
P84 Quality monitoring in a hospice
Authors: Flanagan Pauline , Roberts Michelle 
Published: October 2013

Background/contextHospices are expected to quantify the quality of care and demonstrate outcome improvements1,2. There has been a change in emphasis from system and process to outcome1-4. However, little hospice-specific guidance is available1-6.The DMH produces quarterly quality monitoring (QM) reports and is seeing useful intelligence.AimTo produce hospice-specific intelligenceTo evidence that the hospice remains low risk.Approach usedQM is part of the hospice’s well-established clinical governance function. Reports use monthly (& rolling annual) data with published statistics (Office of National Statistics; National End of Life Care Intelligence Network).Electronic patient-notes enable data collation in a way that was impossible with paper notes.Hospice-specific outcome indicators have been developed to evidence compliance with outcome measures given in the NICE 2011 quality statements2and the essential standards of quality and safety4.OutcomesThe hospice has robust evidence of the following:Number (%) and diagnosis of patients receiving carePrimary care aimEquity of accessImpact of the 24/7 advice linePercentage of hospicedeaths of patients offered an ACPpatients achieving their preferred place of care.Percentage of in-patientson the LCP at the time of their death.assessed for risks associated with moving and handling.experiencing minor/serious injury.assessed for tissue viability within 6 hours of admission.Waterlow score - an indication of patient frailty.The DMH can demonstrate that twice as many EOL patients receiving care die at home as those not referred to the hospice.
P86 Audit mapping against CQC Outcomes
Authors: Stanford Jo , Phillips Ruth 
Published: October 2013

Audit mapping against CQC OutcomesIntroductionThe Care Quality Commission (CQC) requires agencies to provide evidence that they are meeting the CQC outcomes. Clinical Governance is a framework through which organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care.AimsThe Clinical Governance Reporting Guidelines have been reviewed and restructured inline with the Care Quality Commission (CQC) outcomes. The purpose of this exercise was to streamline the audit reporting process inline with the CQC, make the audits more meaningful, and avoid duplication of work.MethodsUsing the hospices existing Clinical Governance Audit Programme, where possible, each CQC outcome was allocated to an audit. Some audits were allocated more than one ‘outcome’ResultsBelow is an example of how some of the audits are mapped against the CQC Outcomes.CategoryAudit titleReference numberFrequency of auditCQC OutcomeInvolvement and InfoPeer – Activities1.16 monthly1a, 1b, 1c,1f,Safeguarding and SafetySafeguarding3.7Quarterly4b, 4i, 7a, 7b,Personalised Care, treatment and supportSymptom Management2.46 monthly1a, 1b, 1c, 4d, 4e, 4k, 4w, 9a,Quality of managementA&I5.1Quarterly4b, 11a, 11c, 16c, 20a, 20bComplaints5.2Quarterly16a, 17a, 17e, 20f, 20h, 20iDiscussionThe children’s hospice audit programme meets and provides evidence for many of the CQC Outcomes. Evidence for those the outcomes that are not met, can be provided in various other ways.ConclusionThis mapping exercise has been helpful in identifying how the hospice was already providing evidence for the CQC, but also helped to identify any shortfalls. Some audits have been reviewed to ensure that they serve a purpose and also can provide evidence for the CQC.
P87 May I?: Audit of documentation of consent for care
Authors: Birch Helen , Baldry Catherine , Groves Karen , Balmer Shirley 
Published: October 2013

AimsConsent to valid treatment and care is central in all forms of healthcare: patients have a fundamental, legal and ethical right to determine what happens to them. Hospice at Home works with community services to fill gaps in end of life care for patients whose preferred place of care is home. Care is provided predominantly by health care assistants, and a few registered nurses (RN’s). RN’s receive consent training in their nursing studies. The aim was that all hospice at home evaluations should clearly state ‘consent status documented for all care interventions given’.Many patients are unconscious and unresponsive when care interventions occur. Hospice policy states ‘Consent status must be documented for all personal and invasive procedures’. It was difficult to see at a glance if consent status was recorded in the care plan.MethodA retrospective (random) audit of 204 care plans was performed to determine if consent status for personal care was documented. Confidentiality was maintained at all times. 77% records completed by HCAs and 23% by RNsResultCycle 1-74% of care plans had consent status recorded. 26% records had no evidence of consent status documented. Further analysis identified only 37% of RNs had recorded consent status. Training needs were identified and implemented in various ways to include Consent, Mental Capacity Act (2005), and Record keeping.Cycle 2Re- audited 6 months later using same criteria and data collection tools. - 93% of care plans had consent status recorded for personal care, improvement in the number of RN’s recording consent status- 77%ResultsCare plans now checked daily to identify staff not adhering to policy. The need to replicate audit in other areas of the Palliative Care Services was highlighted. Induction and in- service training now includes education on consent and good record keeping for all grades of staff. Re-audit in 12 months to ensure improvement continues
011 A Hospice Experience of Patient-Led Assessments of the Care and Environment
Authors: Flanagan Pauline , Williamson Nicci , Grocott Ruth , Scaife Geoff 
Published: October 2013

Background/contextIn April 2013, the Department of Health (DH) introduced patient-led assessment of the care environment (PLACE) to give patients a strong voice in the assessment of privacy, dignity, food and cleanliness in hospitals offering NHS-funded care. Carers are eligible to undertake this assessment on behalf of the patient.The DH and NHS Commissioning Board recommend that hospices participate in this initiative, which provides a non-technical view of the buildings and non-clinical services and is based on a visual assessment against defined criteria and guidance.AimsTo undertake the first PLACE assessment of the DMH.To use members of the Carers’ Forum to undertake an assessment of the organisation.Approach usedThe Carers’ Forum members were invited to complete the PLACE assessment. Those involved needed to be objective, unbiased and have the confidence to be open and honest.Two carers agreed to undertake the assessment, accompanied by the Clinical Governance Manager (CGM) and the deputy Infection Control Nurse; this gave the required PLACE Team ratio of patient to staff assessors.The carers were classified as volunteers, underwent a standard CRB check and were issued with a name badge.All assessors undertook training provided by the Health and Social Care Information Centre (HSCIC).PLACE scoring was made against standard criteria and reflected what was seen on the day.OutcomesDMH results were published on the HSCIC website.The hospice is working with the PLACE team to make the assessment more applicable to hospices.The carers felt that they were contributing to the quality process in a positive and constructive way.Application to hospice practiceParticipation in a national initiative to measure quality from a patient/carer perspective.Access to national benchmarked data, which is accessible to the CQC, NICE, NHS Commissioning Board, DoH, Local commissioning groups and local Healthwatch.
P88 Using an outcome measure in specialist palliative care settings
Authors: Walker Gail , Cochrane Evelyn 
Published: October 2013

BackgroundMore and more people are living with chronic disease near the end of their life, therefore palliative care needs are increasing. Outcome measurement has a major role to play in improving the quality, efficiency and availability of palliative care.AimTo capture what patients think about the impact of care on quality of life and their major concerns and on key symptoms.MethodPatients were invited to participate in a 6-month pilot using the St Christopher’s Index of Patient Priorities (SKIPP) questionnaire within the Hospice, Day Care and Community Macmillan Nurse Team.Data was collected and analysed using the recognised tool from St Christopher’s Hospice.ResultsFindings from this pilot would suggest that patients did benefit from input from the Hospice, Day Care or Community Macmillan Nurse Team and identified a positive shift in how things were going for patients over a period of time. Though the number of patients was small and there were some patients who were unable to complete the questionnaire in full, there was still significant evidence to suggest a positive impact on patients’ quality of life, key symptoms and major concerns.DiscussionIt is recognised that obtaining valid and reliable measurement of the outcomes achieved by palliative care for patients is extremely challenging often because patients are too ill or because of fluctuating and changing needs. However the questionnaire takes account of response shift, a well known phenomenon in which a persons’ perception of subjective sensations can change over time.ConclusionHaving a tool such as SKIPP has been deemed a very useful way of evaluating the impact three areas within Specialist Palliative Care have on a patients quality of life, key symptoms and major concerns. It is planned to repeat this exercise again for a 6 month period.