bluuebunny/crossref_metadata_2025_split huggingface dataset:
IMPROVING NURSING DOCUMENTATION
Authors: McMullen Laura , Gale Sue 
Published: February 2014

BackgroundAudits in 2008 and 2009 show documentation was incomplete in 50% and 57% of cases: below an ideal standard of 91–100%. Omissions were due to poor utility by nurses and unsuitable pro-forma design, (duplication, lack of clarity, haphazard) and time consuming when transcribing to additional sheets at discharge. Nurses re-designed their pages which redressed problems highlighted and facilitated its use at discharge to community Health Care Professionals (HCPs). The resultant pro-forma was audited.AimTo ascertain completion of the new documentation compared with previous audits, confirm its use to community HCPs, and identify areas for improvement.MethodThe documentation was audited retrospectively using a copy of the pro-forma as the audit tool. Analysis was RAG rated: RED less than 70% completed, least acceptable, actions required. AMBER 70% – 90% completed, acceptable but scope for improvement. GREEN 91% – 100% completed, ideal standard.Results15 sets of notes were audited (65% of one month's admissions). Data were collected on pages completed by nurses, which totalled 117 fields. Overall, 74% of the fields achieved either GREEN or AMBER status with the remaining 26% in the RED. Information commonly omitted related to community services, such as was the patient registered as ‘palliative’ with their out-of-hours GP provider, community HCP's contact details, and care planning post discharge. Data missing on admission included; co-morbidities, metastasises, contact numbers and expected discharge date. Results for tests/investigations were not documented in most cases. Each patient's community HCPs were sent a copy on discharge.ConclusionSignificant improvements made using the new documentation; 26% in the RED compared with 100% in both pervious audits. Patient information is more succinct, de-duplicated, streamlined, and comprehensive enough to use at discharge to community HCPs; a survey of the latter underway. Nurses encouraged, and are, more diligent in recording information. Community information pending further review.
'TAKING THE CLINIC TO THE PATIENT'
Authors: Waldock Joy 
Published: February 2014

BackgroundPalliative care patients often struggle to attend outpatient clinics as they reach the end of life, preferring to be seen at home by Macmillan nurses. Sometimes a medical review is needed but as consultants often work across different settings with fixed commitments, ‘ad hoc’ home visits can be difficult.Hospitals gain income from outpatient attendances and there is a pressure to ensure clinics are full and non attendance rates are kept low.Within MYH (population ∼500,000) there were 4 palliative medicine outpatient clinics each week in three different hospitals. An average of 14% of clinic slots were filled. In October 2012 the decision was made to ‘take the clinic to the patient’ and one consultant changed the clinic and to offer ‘slots’ for home visits.AimsThe aim of this evaluation was to see how many patients were seen at home in a 6 month period, whether they would have been well enough to attend a clinic and to assess the symptoms seen.Results1–3 patients/session94% had cancer41% had pain, 43% other symptoms, 16% psychological issues (some overlap)38% were well enough to attend an outpatient clinic, 41% were notIn 21% might have been ‘possible but difficult'Several patients were seen in the last 2 weeks of life, a situation where a clinic attendance is not likely to be appropriate.Conclusions/recommendationsNumbers are small, there is capacity for more visits.Patients were seen who would not have managed to get to a clinic.There was still capacity in the remaining 3 clinics.Arrangements are informal but seem to suit the community team.Having one fixed day to do visits is helpful from the consultant's organisational point of view but may not be as responsive as ideal for the community team.
ISSUES ENCOUNTERED BY FAMILY MEMBER FOR CARING OF ELDERLY POPULATION: A PERSPECTIVE OF ELDERLY PATIENTS VISITING PRIMARY CARE CLINICS IN PAKISTAN
Authors: Ashfaq Tabinda , Mohammad Fauzia Haji 
Published: February 2014

BackgroundElderly population particularly aged 65years and more contributes to 380 million people globally and by the year 2020, this population is projected to increase to more than 690 million .This older population is vulnerable to various disabilities as a consequence of stroke, dementia, heart diseases and trauma and demands the need of care giving services provided by care givers to older population can improve their quality of life and survival.ObjectiveTo find out issues encountered by family members for caring of elderly population as perceived by elderly patients visiting primary care clinics in Pakistan.MethodologyA cross sectional questionnaire-based study was conducted at the Community Health Centre (CHC), Aga Khan University Hospital (AKUH) Karachi, Pakistan. All consenting individuals, visiting the CHC and aged 65 years or above were interviewed after taking written informed consent and strict confidentiality was assured.ResultsA total of 400 elderly completed the interview. Majority were females, 65-69 years age, Over half of the individuals ie: 227 (85%) had received Care Giver experience for assistance and among these 195 (72%) had care provided by an immediate family member. Majority of the patients (86%) preferred family member as care givers and were satisfied by service provided by their family members (94%) however only 4% were not satisfied. Problems in providing care giving was faced by (43 %) of the care providers .most common issues encountered by family member while providing care giving included financial difficulty (3 0%) lack of time (30%) followed by job responsibility (22%),home responsibilities (10%) and, health reasons (6%) respectively.ConclusionElderly care is provided by majority of the family members resulting in increased satisfaction level, however small number still not satisfied due to unfulfilled need of these older people. This demands that efforts should be made to strengthen the family support by increasing awareness regarding elderly care and arranging support system by the government.
IMPLEMENTATION OF A SMALL, PORTABLE, OPIATE CONVERSION GUIDE FOR STAFF IN AN INDEPENDENT HOSPICE
Authors: Bernstein Laura , Nightingale Laura 
Published: February 2014

BackgroundEffective and safe titration of medication has a major impact on patient comfort. Confusion surrounding the differing ranges and potencies of opiates and benzodiazepines can result in under- or overdosing of medication leading to inadequate control of symptoms or resultant toxicities respectively. Through staff feedback, teaching sessions and review of drug errors, we identified that staff used differing opioid conversion guides and lacked confidence when converting between benzodiazepines. Staff identified the need for a consistent local approach when converting between different opioids or benzodiazepines using a guide that could be easily accessed across clinical settings.AimsTo provide staff with a conversion table for opioids and benzodiazepines which is evidence-based, cost-effective, replicable and accessible across clinical settings.To standardise prescribing.To reduce drug errors related to opioid and benzodiazepine prescribing, conversion & administration.ResultsA small, portable, laminated conversion chart for opioids and benzodiazepines was created to enable consistent conversion between different drugs and between the oral, subcutaneous and transdermal routes. The chart is an identical size to the staff ID badge so that they can be easily attached together to a lanyard for ease of access and use.ConclusionsUnanimously positive feedback was received from staff following the introduction of the conversion chart. In particular, staff value the accessibility and usability of the chart in clinical practice since it has been attached to their lanyard.It enables less experienced doctors to prescribe accurately and empowers nursing staff to confirm doses prior to administering the medication, using standardised guidance. Following a positive reception, the lanyard-attached conversion chart has now been adopted by the local NHS trust. It is too early following implementation to assess impact on drug errors, but there are plans to review this through the local Medicines Management Group.
INTRODUCTION OF A REVISED, COMBINED ADMISSION AND DISCHARGE PACK, WITHIN AN INPATIENT PALLIATIVE CARE SETTING
Authors: Watts Anita , Gale Sue 
Published: February 2014

Introduction of a revised, combined Admission and Discharge pack, within an inpatient Palliative care setting.BackgroundDischarge documentation in a Specialist Palliative Care unit was found to be repetitive, time consuming, not user friendly, and poorly utilised by nurses.AimTo create a comprehensive, streamlined and user friendly admission to discharge pack. The intention was to enhance communication between multi-disciplinary and community teams.MethodA group was formed to review and redress the identified problems. An admission-to-discharge pack was designed, reducing existing documentation. The scheme was piloted. A survey was sent to the target community health care professionals within one week of discharge.ResultsSurvey response rate was 40%. All respondents indicated that the information was ‘Very useful’ and relevant post-discharge. No irrelevant material was identified; the format was reported as organised and comprehensive. Suggestions for additional information were ‘Do Not Attempt Resuscitation status (DNAR)’, medication summary, and inclusion of other inpatient specialists.DiscussionThe new documentation was successful in that it mapped relevant information from admission to discharge. It was also comprehensive enough to use at discharge to community HCP, thus negating the need for transferring information to additional referral forms; which is time consuming and repetitive. Inpatients' DNAR status is not transferable and should be re-assessed post-discharge, and a medication summary is faxed therefore no changes were made pertaining to these two request; ‘Other hospital specialist/s’ was added.ConclusionThis survey showed positive feedback from community HCPs. The new documentation was well received and found to be useful. Providing timely and comprehensive information to community HCPs is imperative for care and its planning, especially at end-of-life when changes can rapidly occur due to the complexities within this client group. The overall aim was achieved and the documentation greatly improved. A subsequent audit confirms improved compliance with document completion.
WHAT FACTORS INFLUENCE THE TERMINALLY ILL PATIENT REFERRED TO THE HOSPITAL SPECIALIST PALLIATIVE CARE TEAM IN A NHS HOSPITAL, NOT ACHIEVING THEIR PREFERRED PLACE OF DEATH? A CRITICAL EVALUATION
Authors: Damanhuri Geraldine 
Published: February 2014

BackgroundThe purpose of "The End of Life Care Strategy" document (2008), was to introduce a strategy to promote high quality end of life care (EOLC) for patients approaching the end of their lives. One quality marker was to ensure that individual patient preferences and choices for EOLC were documented, communicated and achieved if possible. There is evidence of an overwhelming preference for patients to die at home, hospice or nursing home.AimTo discover if patients known to a NHS hospital palliative care team achieve their preferred place of death (PPD). To explore, illuminate and describe reasons why this may or may not happen. Results will be used to inform, educate and improve clinical practice.Research DesignA critical evaluation retrospective explorative case study using both quantitative and qualitative methods.SettingA NHS hospital in an inner city setting in Southern EnglandSampleA non-probability purposive sample of 110 participants referred to the hospital specialist palliative care team from 1st April 2011 to 30th September 2011 who died before 31st December 2011.Data Collection MethodAudit, a retrospective collection of data from case notes using a proforma/questionnaire developed from discussion with specialist palliative care professionals.Data AnalysisThe data collection system Meridian was utilised for data analysis and display with analysis of quantitative data and recording of qualitative data. Qualitative data analysis used a thematic approach.Results40% of participants achieved their PPD, 52% did not, and 8% not recorded. — Reasons for participants not achieving their PPD included, uncontrolled pain and complex symptoms, inability to guarantee 24 hour care in the community, discharge planning. delay in discharge, rapid deterioration and relatives concerns.ConclusionTo facilitate patients achieving their PPD requires the use of a prognostic tool, courageous skilful communication, good documentation, out of hours care, improved education, early referrals.
CHANGING THE TIMES OF ADMINISTRATION OF CONTROLLED DRUGS REDUCES ERRORS
Authors: Grogan Eleanor , Hale Leanne , White Dawn , Duke Marie 
Published: February 2014

BackgroundAn innovative new palliative care unit opened in December 2011 within an NHS hospital with a completely new team, many of whom had not worked in a predominantly palliative setting before. A high volume of controlled drugs was given to patients and the number of errors, as reported by the electronic internal error reporting system, was higher than desired. Controlled drugs were given out to patients at the end of the nursing night shift (for morning drugs) and end of the late shift (for evening drugs). Changing the times of administration of drugs so that this was done at the start rather than the end of a shift was thought to offer a possible solution to this problem.AimTo reduce the number of errors made with controlled drug administration in a cost effective way.ResultBefore changing the timing of the controlled drug rounds there were 23 errors relating to controlled drugs reported in 13 months (7 relating to administration and 5 of these to administration of regular, rather than “as required”, medication). The controlled drug timings were altered slightly so that, instead of being done by the nurses at the end of a shift, they were administered by nurses at the start of their shift when they were less tired. Since changing to the slightly different times there have been 4 reported errors relating to controlled drugs in 6 months, none of which relate to administration of controlled drugs.ConclusionMaintaining a 12 hour gap between controlled drug administration but giving the medicine out at the start of nursing shifts has been a free and effective way to reduce the number of controlled drug errors occurring on the ward and reduce administration errors to zero.
ST.CHRISTOPHERS GROUP PARTNERSHIP WITH THE ROYAL ACADEMY OF ARTS
Authors: Sands Mick , Tasker Marion , Dives Tamsin , Lawson Gini , Ridley Andy , Prince Gerry , Tsiris Giorgos 
Published: February 2014

BackgroundThis paper explores and assesses a dynamic annual arts partnership organised by the hospice and the Royal Academy over the past three years.The Royal Academy is an independent institution led by eminent artists and architects that promotes the creation and appreciation of the visual arts through exhibitions of international importance, education and debate.The St. Christopher's Group promotes and provides skilled, compassionate, high quality palliative care and has a vision of the place and therapeutic purpose of the arts both in end of life care and as part of health promotion.Patients visit a major art exhibition and work with artists to create their own art as part of a joint project.AimsTo give patients special access to major Academy exhibitions and to provide workshops to create their own art, individually and collaboratively; exhibiting work at the Royal Academy and the hospice; promoting healthier attitudes and organising public discussion of issues raised by project and exhibition; to explore the place of the arts and a major national arts institution within the end of life journey of hospice patients and their families.ResultsPatients were motivated to complete the artwork and visit the Academy. Working in the atmosphere of a major exhibition and seeing their art exhibited was very affirming. They developed new respect for their work, felt enriched, created positive memories. A major end of project event at the Academy provides a forum for wider debate with eminent artists, dying patients and the general public. For patients: increased confidence, motivation, self-discovery, achievement, affirmation, celebration.ConclusionsIt's difficult to develop a project over time with patients who are managing complex medical issues and fluctuating levels of illness. Travel and mobility concerns challenge careful planning. Such projects depend on multi-professional collaboration. Many art institutions hold similar visions of inclusivity, education, debate. Such projects are eminently transferable.
DISCHARGE AND ITS PLANNING IN PALLIATIVE CARE; A TIME AND MOTION STUDY
Authors: Smith Louise , Gale Sue 
Published: February 2014

BackgroundThe discharge of Palliative Care patients is deemed complex solely by their nature of being Palliative. Observational studies of discharged patients within a palliative care unit revealed them to be fragmented and tardy. A time and motion study was undertaken with the aim of highlighting the complexities of discharge and its planning, the length of time taken, and evaluation of the time wasted.MethodData were collected from 12 patients over a six week period using a purposefully designed pro-forma comprising 13 elements of discharge. Staff self-assessed discharge activities prospectively using a tick box system. Each pro-forma was nurse anonymous and space allocated for start and completion time of activities and for staff to write notes concerning the element they were involved in. Missing data was calculated using the average duration of activities previously recorded for the same data field.FindingsAn average of 4 nursing staff were involved in each discharge, taking 1 hour and 39 minutes per patient. 116 activities were recorded in total, averaging 10 per patient. Calls to community staff were the most time consuming activity, averaging 5 calls per patient at 20 minute duration. Waiting for return calls impeded discharge. Data reporting and findings are under reported due to time constraints on staffing.ConclusionA discharge coordinator role should be considered to create a more integrated patient pathway and redress some of the problems currently highlighted. Enabling the development of a discharge policy encompassing a rapid discharge pathway for patients who's preferred place of care is home, a more coherent and in-depth holistic assessment, and the commencement of national and local incentives such as Coordinate my Care. A discharge coordinator would provide patients with a timely and succinct discharge pathway, and enhance communication with community teams. Nursing time saved would be better utilized giving hands-on care.
'IS IT MY LAST CHRISTMAS DINNER?' SURVIVAL OF CANCER PATIENTS HAVING PALLIATIVE CHEMOTHERAPY DURING CHRISTMAS PERIOD
Authors: Silverman Rafael , Smith Louis , Sundar Santhanam 
Published: February 2014

BackgroundAdvanced incurable cancer patients quite often live by milestones such as son or daughter's graduation, birth of a new grandchild or festive periods such as Christmas. Cancer patients need practical and real life survival information to plan their limited life. But most of survival data available in literature is from fitter patients in clinical trials who have a better survival. There is a dearth of real-life, pragmatic, survival information from routine clinical practice. To address this need, we assessed the chances of patients having palliative chemotherapy during 2011 Christmas period to survive until the 2012 Christmas period.MethodsAll adult cancer patients, who had palliative chemotherapy in Dec 2011, were identified from the electronic chemotherapy prescription system (ChemoCare®) and survival data was extracted from the Hospital electronic records. 30-day mortality assessed as per NCEPOD SACT report recommendation.ResultsMedian age was 65 years (range 31 to 87 years) and 52% were female. Site of primary cancer was Breast (18%), Lung (17%), Ovary (12%), Colon (11%), Prostate (10%), Kidney 8% & other sites in 24%. Median survival was 10.5 months (range 0 to 21 months). 1.9% of patients died within 30 days of chemotherapy. Only 45% of patients who had palliative chemotherapy during December 2011 were alive on 2012 Christmas day. But reassuringly, 30% of patients were still alive in August 2013 and these relatively long term survivors were distributed across the disease spectrum.ConclusionA significant number of patients (55%) died before the next Christmas period. Hence clinical judgement is critical in prescribing palliative chemotherapy to patients during the Christmas period. Patients, who are clinically judged to be poorly and unlikely to survive a year, should be given the opportunity to skip chemotherapy and spend time with family during Christmas period if they wish to do so.
TOO BUSY TO CARE?
Authors: Jones Debbie , McConaghy Margaret , Haywood Chris , Coackley Alison 
Published: February 2014

BackgroundAn increase in the complexity of patient's admitted to the Hospice and a greater use of acute interventions had resulted in staff feeling“too busy to care”with less time to provide high quality care.We recognised the need to change working practices to improve patient experience and staff satisfaction. After reviewing possible models and undertaking a scoping exercise, we agreed to implement the NHSReleasing Time to Care: The Productive Ward as a recognised quality initiative. This was previously restricted to hospital and community use, designed to help teams review working practices and minimise inefficient systems. This was supported at Network level in collaboration with 5 other Hospices.AimsIncrease Time for Caring therefore improving patient experienceImprove departmental/inter-departmental communicationImprove patient /staff environmentImprove staff satisfactionApproach usedNetwork supportEnhanced team workingStaff and senior management commitmentCollaborative module implementation trainingPhased roll outEvaluation at steering group levelOutcomesConfirmed network funding in conjunction with other hospicesNetwork training and support to empower staffFocus on collaborative approach, shared learning experience, making a wider impact than working in isolationTransparent care provision using quality measuresEfficient staff working practicesCost effectiveness, efficient use of limited resourcesImprovement in communication across all services and local hospicesAwareness of the importance of environment; little wins to improve patient care have a positive effect on staff moraleImproved patient safety and standard of care evidenced by quality measuresBenefit at local, organisational and network levelApplication to Hospice PracticeImproved collaboration and networkingUseful toolkit that has impacted on time for caring making a difference to patient experience and staff satisfactionTransferabilitySupports integrated working