bluuebunny/crossref_metadata_2025_split huggingface dataset:
P8 Care across settings: Evaluating an integrated specialist nurse-led palliative care clinic within a general practice setting
Authors: Harrop Emily , Baillie Jessica , Byrne Anthony , Stephens Karen , Nelson Annmarie 
Published: October 2013

BackgroundA community nurse-led palliative care clinic was introduced at a UK General Practitioner’s (GP) practice in April 2012. The clinic aimed to provide earlier identification of patients with cancer and non-malignant disease, initial patient assessment, education for GPs and other community professionals, and strengthen relationships with the local multi-disciplinary team. This provides a new model for engaging patients and ensuring that specialist palliative care is delivered across different clinical settings. Usually, clinical nurse specialists (CNS) support patients in the home. This new initiative brings a fortnightly clinic as a complementary resource to consolidate the joint primary/ palliative care approach.MethodsThis study evaluates implementation processes and the impact of the clinic on patient experiences and professional practices. It assesses uptake of palliative services and the management and delivery of palliative care by GPs and CNS.Baseline interviews with GPs (n = 5) and CNS (n = 4) were carried out in February 2012. Semi-structured interviews with patients (n = 6), GPs (n = 6) and CNS (n = 4) are being undertaken to assess perceptions of the clinic.Patient interviews will be analysed using an Interpretive Phenomenological Analysis (IPA) approach. Interviews with GPs and CNS will be analysed using Framework Analysis.ResultsPerceived aspirations for the clinic included: earlier referral; improved communication and continuity of care; psychological and practical benefits for patients/ carers; more targeted use of specialist nursing resources. Baseline interview data highlights the need for improved referral and communication practices, especially for non-cancer patients. Data from patient and follow-up interviews will be reported against these aspirations, with additional themes identified.Conclusions and applicationConclusions will be drawn on the effectiveness of the clinic and implications identified for palliative care provision in primary care settings, including the potential to roll out a similar model more widely.
P9 Is there anybody there - telephone advice lines who needs them?
Authors: Livingstone Tracy 
Published: October 2013

Background and ContextNightingale House Hospice have offered a 24-hour telephone advice line to patients and their carers in North East Wales since the year 2000. Predominantly the area covered is urban with good access to a variety of health and social care services.In 2010 the hospice were asked to provide a similar service providing advice on palliaitive care/specialist palliative care to health care professionals across all geographical areas of North Wales acting as a triage centre for palliative medicine consultant advice, this service was not made avaialble to patients and families due to concerns regarding potential volume of calls. This introduced a population located in large rural areas with more sporadic access to services.Aim & ApproachThe purpose of the audit was to encourage discussions about the ethics of delivering a two tier service based purely on geography but also considers the context of the calls in terms of the services available to patients within each locality in terms of model of service provided and also the hours of operation/deliveryOutcomesThis presentation details the findings of an audit of the advice call forms completed reviews and compares the data collected from both geographical areas covered by the advice line, considering the volume of calls from both areas, the time and duration of calls and also the reasons why people called.Application to practiceThe audit recognises some limitations in the method by which data is currently collected and reviewed providing guidance for the future in terms of what do we need to know in order to measure the impact and outcome of the provision of this service to patient s and their families.The work also draws conclusions for practice in terms of identifying current need within our locality.
P10 Hospice rapid response service – a prospective analysis
Authors: Clayton Beverley , Spencer Lesley 
Published: October 2013

Background/contextFollowing a retrospective analysis of urgent unplanned visits, evidence emerged that supported a new rapid response role for a clinical nurse specialist.Main AimsTo enable palliative care patients in the community, who have complex needs or whose condition is deteriorating, to access prompt specialist palliative care services.To assess whether more patientsare enabled to exercise their preference about place of deathApproach usedThe service was available to new and existing patients for end of life care and support of urgent symptom control issues (N = 78). Referrals requiring urgent attention were passed onto the Rapid Response Nurse. The CNS worked flexible hours in order to support the needs of the patient. Data was collected prospectively over a six month period using survey monkey.OutcomesSeventy Eight patients supported over 6 month period. 38% had a non - malignant diagnosis. 67% of patients were referred for terminal care with the remaining requiring symptom control. As a result of the rapid response visit 86% of patients remained in their own home. None were transferred into the acute sector. 75% of patients who died within the 6 month period achieved their preferred place of death with only 6% who wished for a home death unable to achieve this.Application to hospice practiceThe service was timely, responsive and supported increasing numbers of patents to be cared for and to die in their preferred place of death. All visits responded to crisis therefore all patients had potential to be admitted to hospital. Patients in the Nursing homes were particularly vulnerable.The service therefore prevented unnecessary admissions into the acute sector and supported Hospital Palliative Care Teams with rapid discharge home.A Rapid Response Clinical Nurse specialist is effective – right skill, right intervention, right time.
P11 The stars that come out at night - Presenting the hospice ’8 to 8’ night nursing Service
Authors: Neil-Jones Dawn , Spencer Lesley 
Published: October 2013

Background/contextMaximum impact in terms of achieving patients preferred place of care may be gained by focussing future service development on extending and improving care at home. This also ensures on-going collaboration between NHS and other providers of end of life care.Since September 2011 the Hospice has been developing the ‘8 to 8’ service which provides a night nursing service for existing Hospice patients and more recently, through partnership working with other healthcare providers for dying patients not known to the Hospice.Main AimsTo optimise the opportunity for patients requiring end of life care who wish to stay at home to remain in their preferred place of careTo prevent unnecessary admissions to hospitalsApproach usedThe service is delivered by both bank and permanent members of staff and includes both registered nurses and senior health care assistants. All staff are inducted by the Hospice and given the requisite palliative care skills. The service is led by a clinical nurse specialist who supports and co-ordinates the allocation of staff according to clinical need. The nurses remain with the patient throughout the night.OutcomesEvaluation demonstrates that the service has exceeded expectations. Most patients referred to the 8 to 8 service are for terminal care with 95% of patients achieving their preferred place of death. The service now delivers 50 nights per month across the catchment area.Application to hospice practiceThe 8 to 8 service has been commissioned by two clinical commissioning groups since its inception and continues to expand and build on its success. It is delivered by specially trained nurses who are compassionate, efficient, caring and greatly improve the patient experience. Increasing numbers of complex patients are now able to be cared for in their preferred place of care.
P12 Hospice at Home Service Listening, responding, developing
Authors: Gibson Vanessa , McEvilly Liza , Standfield Robert 
Published: October 2013

In 2008 the Department of Health (DH) identified increasing evidence that lack of co-ordinated community support was resulting in avoidable admissions and prolonged hospital stays. They went on to describe how hospice at home services could have a significant impact in enabling patients to die in their own home. The existing night hospice at home service provided practical support to patients and carers between 10 pm and 8 am. Building on the 7 C’s of the Gold Standards Framework (2005) the team promoted contingency planning and service co-ordination ensuring that they were already an integral and valued part of the community based services.However, with an expected increase in the number of deaths from cancer and non-cancer deaths (Kings Fund 2011) and a local emphasis on preventing unnecessary admissions (Health and Well-being Board, 2012) a wide ranging review of the hospice at home service was undertaken in 2012. Service users and health care colleagues emphasised the importance of:A 24/7 serviceRapid responseNot being reliant on external fundingSupporting carers via ‘on the job training and support’Being accessibleHighly skilled, consistent and compassionate staffThe review also identified several unmet needs which could be addressed by an expanded hospice a home team, these included:Crisis intervention, for example whilst acute symptoms were addressed, carer stress or ill healthRapid response and extended packages of care for changing needsPre-admission to the hospice in-patient unitSupported discharge from the hospice in-patient unitRapid discharge from the acute sectorOur service outcomes include:Provision of a hospice at home service tailored to meet local needsIncreased integration of hospice services.Cost effective use of hospice resourcesIncreasingly achieving preferred place of care/death
P13 Evening call
Authors: Levell Eirian 
Published: October 2013

IntroductionThe End of Life Care (EoLC) Strategy (2008) and Preferred Priorities of Care (2011) documents support enabling people to remain in their own homes.Prompted by the volume of calls into the in-patient unit, and workload of the district nurses in the early evening, the hospice piloted an extension to the Hospice@Home (H@H) working hours.AimTo reduce unnecessary admission to hospital at the end of life by providing extended access to support and guidance for patients, carers and health care professionals.MethodFollowing a three month analysis of telephone advice calls received by the Inpatient Unit (IPU), outside of H@H working hours, the pilot took place over a 9 month period. This extended the accessibility of trained nurse contact from 4.30pm to 9pm on a daily basis.ResultsThroughout the pilot phase, calls were recorded and outcomes summarised, paying particular attention to the purpose of calls, caller identity, and the time the call was received. These statistics provided evidence that the service was not routinely accessed after 7pm.During the pilot, five admissions to hospital were prevented, primarily due to the swift response and symptom management by H@H. Patients and carers benefitted from the flexibility and accessibility of a trained nurse to action changes, provide continuity and reassessment from 8.30am until 9pm.There were a high proportion of calls requesting complex symptom advice, reporting family distress and requesting an increase in care.ConclusionStaffing the extension to the service proved challenging however the pilot was positively evaluated by the district nursing team.Guidance, reassurance and prompt response to need, undoubtedly contributed to the prevention of crisis admissions to the acute trust.
P14 The impact of audit on CNS team development
Authors: Gibson Vanessa , Patel June 
Published: October 2013

In 2011 the Hospice Clinical Nurse Specialist (CNS) team were facing a significant increase in patient referrals numbers (approximately 70 per month). The demand for community based care, rather than acute hospital admission, was also resulting in increasingly complex and urgent referrals from all areas of the local healthcare economy. In addition, palliative and end-of-life care services traditionally available only to cancer patients were increasingly being accessed by patients with non- malignant diagnoses.In response the CNS team undertook a month long audit of referrals to the community nurse specialist service. The audit revealed:Low levels of referral information, resulting in delayed contactDifficulties assessing levels of urgencyLack of clarity regarding other services involved with the patientUnnecessary home visitsAs a result the CNS team has now introduced the following:A new streamlined referral processA full time specialist triage nurse who makes first contact with all referrals:She:Responds to all referral agenciesAssesses level of urgencyHolds her own low-level caseload that she contacts by phoneHelpline established and available to patients and health care professionals: this service provides immediate access to a highly skilled CNSAccessing and completing the electronic notes systems to ensure comprehensive and up to date clinical information is readily available to the wider healthcare team.Enhanced patient documentationContinuous development is key and plans are being developed for:A visiting ‘rapid response’ CNSA nurse led triage clinicIncreased triage nurse hoursThe CNS team have used audit to truly ‘hear’ what is happening in practice and as a result have used this knowledge to lead service redesign- a key aspect of the CNS role identified by National Cancer Action Team (2010)
P15 The right way to write? Development of new documentation for community palliative care
Authors: McPolin Hilary , McMullan Mary , McGinnity Grainne , Flynn Fiona 
Published: October 2013

Background/ContextEfficient, comprehensive documentation not only provides a record of care, but also reflects the quality of that care whilst reinforcing care standards. However, documentation in palliative care has often fallen short of these ideals (McEvoy, 2000). Following the development of a centralised triage system for new referrals to a community palliative care service, it was recognised that there was duplication of information being recorded by both the triage staff and the community nurses. There was also a general consensus that the triage documentation should be incorporated into the nursing assessment tool to reflect the patients’ journey and promote continuity of care.AimTo develop user friendly, time efficient documentation that provides a comprehensive holistic assessment of specialist palliative care patients and their families.Approach UsedA project team was formed with representatives from the triage team and the community nursing teams. Following a review of in-house documentation, Liverpool Care Pathway (LCP) and assessment tools from both hospital and community palliative care teams, a new tool was developed and piloted. Minor changes were made, based on the initial evaluations and subsequently, a second pilot was undertaken before the tool was finalised.OutcomesThe new tool was rolled out to all the community teams in January 2013. Feedback to date suggests a reduction in both the amount of duplication as well as the amount of time spent on recording the required information.Application to Hospice PracticeThe new documentation tool reflects a holistic, comprehensive, specialist palliative care nursing assessment, in a user friendly, time efficient format. It has improved communication and accessibility of information and recognises the need to increase the capacity for recording the needs of carers. Better documentation can lead to better patient care.
P16 Planning your week: a new model for rural working
Authors: Hart Derek , Martin Cathy , Draper Maggie 
Published: October 2013

An examination of caseload management is currently being undertaken by 2 community palliative care nurses who cover a large area, encompassing the environs of city to remote moor land. The remote areas have no mobile telephone access and poor infrastructure.The caseload was analysed and divided into 7 geographical areas (zones). Visits were to be arranged to these zones on specific days to optimise efficiency, taking into account mdt commitments.The aims were:To increase efficacy of visits, reduction of interruptionsReduce travelling time and mileageImprove response time from referral to first visit,Improve reliability and therefore develop stronger integrated working.Improve wellbeing and support of the CNS.Move from reactive “fire fighting” to proactive care where crises were predicted where possible.The approach used was:A time table of areas and days was created.Two nurses covered the caseload of approx 60 patients.The timetable took into account mentorship needs of the new CNS. It promoted men- tee and mentor working in neighbouring zones. Meeting places in the field (literally!) were highlighted should support be required.1 nurse per day was allocated to triage calls and trouble shoot.The administrative team were involved in planning and were aware of who to call.Outcomes – to be measured / reviewed September 2013Supportive mentorship of new CNS in rural environmentReduced MileageReduced interruption from mobile phone calls.Reduced sicknessImproved record keeping. The two nurses were reliant on each others records to provide continuity of care.A more efficient use of laptops reducing the need to return to base.Development of professional relationship between nurses encouraging peer review.Improved relationships with GPs and community nursing teams
P17 The community and hospice home nursing service
Authors: Spencer Lesley , Masetti Karen , Starnes Gina 
Published: October 2013

Background/ ContextEnd of Life care support throughout Surrey had been fragmented and lacked an integrated approach. As a result three organisations came together to form the ‘Community and Hospice Home Nursing Service’.The service supports a multi-disciplinary partnership approach to delivering nursing care at home. Central Surrey Health (CSH), and two Independent Hospices; Princess Alice Hospice (PAH) and St Catherine’s Hospice ( StCH) are now delivering a seamless seven day, 24 hour service.Main AimTo provide care that avoids inappropriate hospital admissions and enables more people to be cared for and die in their place of choice.Approach UsedThe service was designed following patient and carer feedback and necessitated hospices working together across traditional boundaries.Key elementsCo-ordination via a single point of accessAdditional clinical provision of night and day care by Staff Nurses and Senior Health Care Assistants.Partnership approach to care delivery.Importantly the Hospices involved are extending their reach to support those who have not or may not need referral to specialist palliative care.OutcomesNinety eight percent of patients achieved their preferred place of care with 95% achieving their preferred place of death; 85% of those who were referred to avoid an admission to hospital achieved this; 28% of patients had a non- malignant diagnosis. The key performance indicator, aimed at increasing the number of referrals on CSH end of life care register by 5% was achieved with a 70.4% increase.Application to hospice practiceCommissioners were delighted with the multi-professional and integrated partnership approach to care delivery and the solution focussed proactivity. They champion the partnership as a model for the future. The community and Hospice home nursing service suggests that an integrated approach to care delivery can improve outcomes whilst being cost effective.
04 St Joseph’s 1st Contact Team. A New Innovative Multiprofessional Model
Authors: Boyle Margaret , Bradley Ruth , Morris Angie 
Published: October 2013

BackgroundThe development of a new innovative service the St Joseph’s First Contact Team was identified in April 2012 as the critical project to commence the 3 year transformational change programme to develop community services. This pilot aspired to improve access to the ‘front door’ of St Joseph’s, improving response times for patients, their families and carer’s, ensuring all those referred were appropriately signposted to the whole range of services provided appropriate for them. The team consists of multi-professionals who are either in the team physically or as virtual members.Aims of the Service wereTo provide high quality, patient and carer focused, value driven services and experiences To meet the changing needs of local communitiesBe more responsive to our local communitiesMeet the strategic priorities of local Clinical Commissioning Groups and GPsContinue to meet the mission and core values of the HospiceEncourage innovation and develop staffShare specialist knowledge and skills of end of life care with community partnersApproach UsedUtilising transformational change methodology, working groups were established to develop the project and to guide and influence service development. Patient and service users were consulted and their views informed the service model.OutcomesOutcomes-were measured using quantitative data demonstrating activity, referrals response times and user feedback. Qualitative review of assessments undertaken by the FCT and other related professionals during the pilot period was undertaken. Various methodologies were used to collect data including user and staff surveys and the PAL care system.Applications to PracticeThe first contact team has transformed how we respond to our referrals and has promoted multi professional working and greater understanding of the range of services offered to patients, carers and families. A working group led by the Lead Nurse will continue to develop and monitor the quality and service to meet the changing needs of our diverse communities.
P18 “This is so big”
Authors: Shrimpton Sue 
Published: October 2013

BackgroundThe death of a parent in childhood is one of the most profound losses a child will ever experience. Supporting children whose parents are terminally ill is therefore an emotive topic. Much research states that if the needs of the child are not met, there can be immediate and long terms problems such as delinquency.A major driver for this study came from children talking at a child bereavement group telling me they had overheard conversations about their parent’ condition, but because they had not been told directly they felt they could not voice their worries.AimTo explore community palliative care clinical nurse specialists (CPCCNS) experience of supporting families with children.MethodsUsing a phenomenological approach, a purposeful sample of eight CPCCNS’ were interviewed. Interviews were recorded and transcribed verbatim. Using Colazzi’s analysis, themes were identified.ResultsThe themes were:Doubted abilityNot their roleGreater time in role increased confidence in abilityAcknowledgement of importance of supportAge, culture and religious differencesReferrals to other healthcare professionals and charitiesParallels in CPCCNS own life seemed to aid empathyConclusionCare of the ‘whole’ family is central to the WHO (2011) definition of palliative care. CPCCNS’ are in a prime position to support children at their most vulnerable, otherwise a delay may mean the child remains unsupported and there is a greater risk of issues during parents illness and following bereavement. This study highlights the role of the CPCCNS’ using data and narrative from interviews.Implications for hospice practiceAdequate support and training is essential in providing CPCCNS’ with the tools to support children of dying parents so they can feel able and more confident in this area of support.