bluuebunny/crossref_metadata_2025_split huggingface dataset:
AN AUDIT OF THE INITIATION, PRESCRIPTION AND ADMINISTRATION OF OPIOID ANALGESIA TO ADULT PALLIATIVE CANCER PATIENTS IN AN ACUTE HOSPITAL
Authors: Messam Kerry , Cooper Jan 
Published: February 2014

BackgroundDespite a plethora of literature and multiple guidelines, uncontrolled cancer pain remains hugely burdensome to patients. To address inconsistencies and misunderstanding surrounding the use of opioid analgesia in clinical practice, the UK National Institute for Clinical Excellence (NICE 2012) recently introduced national guidance in the form of the opioid care pathway to assist Health Care Professionals with the initiation and titration of opioid analgesia for patients with palliative disease.AimThis audit measured current practice in the initiation, prescription and administration of opioids in adult cancer patients with palliative disease in an acute hospital setting. Data was collected retrospectively from patient records and prescription/administration charts, to ascertain whether standards on opioid treatment set by NICE (2012), the UK National Patient Safety Agency (2010), UK Nursing and Midwifery Council (2010), and local hospital standards were being achieved.Results86 sets of clinical records were retrieved between December 2011 and November 2012. Results demonstrated significant concerns regarding the administration of opioids and a high incidence in PRN prescribing alone, with only 45 patients commenced on regular opioid prescriptions. Of the fifteen audited standards, only a third demonstrated compliance +/-10%.ConclusionsDespite intensive education, opioid initiation, prescription and administration in this group of palliative care patients was not consistent with published guidance and standards. Variations in clinical practice means that audit tools such as NICE (2012) should strongly encourage the recording of explicit exceptions to ensure accurate measurement of practice. Dissemination and collation of feedback is required to inform proposed recommendations, draft prescribing and administration guidance and a re-audit plan.
PROVISION OF END OF LIFE (EOL) CARE TO PATIENTS WITH HEART FAILURE (HF) IN AN ACUTE HOSPITAL TRUST
Authors: Bronnert Rosie , Clayton Louise , Verma Amit 
Published: February 2014

BackgroundPatients with Heart Failure (HF) often have palliative care needs but access to appropriate palliative and end of life care is not always achieved. Following the appointment of a hospital HF specialist nurse and Palliative Medicine Consultant, re-evaluation of clinical need and links between palliative and HF services occurred.AimsTo establish baseline documentation and provision of EoL care across the hospital trust for patients coded with a primary diagnosis of heart failure.ResultsIn 2012, 217 patients died within the trust with a primary diagnosis of heart failure. 70/217 notes were reviewed.39/70 had a diagnosis of LVSD. 12 had HF with Normal Ejection Fraction. 19 had a clinical diagnosis of HF. Death was expected in 65/70 patients.Key findings were:1. Preferences regarding place of death were discussed in 6/65 cases.2. Specialist Palliative Care saw 1/70 patients3. Anticipatory medications were prescribed for some or all of the common symptoms at EoL in 45/65 patients who were expected to die. 41/45 patients received some of these medications.4. Decisions about Cardiopulmonary Resuscitation (CPR): In the expected death group, 62/65 patients had Do Not Attempt CPR (DNACPR) decisions considered and made. These decisions were discussed with the patient and family in 14/62 cases, the patient in 8/62 and family in 32/62 cases. In the 14/52 with no discussion, no statements existed to support whether/why discussions were deemed unnecessary/inappropriate.ConclusionsDeaths from HF were usually anticipated and some provisions for EoL care were made. There is scope to improve discussions about preferences for care and involvement of Specialist Palliative Care.Following this survey, measures to increase Palliative Care involvement with patients with HF include Palliative Medicine Consultant attendance at weekly HF multi-disciplinary meetings, education and clinic slots. Re-evaluation to assess the impact of these changes is planned.
COMMUNICATION WITH PRIMARY CARE REGARDING END OF LIFE CARE (EOLC) IN RESPIRATORY MEDICINE
Authors: Topley Katherine , Boland Alison , Edwards Annette , Clifton Ian 
Published: February 2014

BackgroundLeeds Teaching Hospitals is a flagship trust for the EoLC strategy. We aim to improve the identification of these patients, and critically the communication with the patient, family and primary care.MethodWe conducted a retrospective review of clinic and discharge letters from patients who died as an in-patient or within 28 days of discharge. All were under the care of a respiratory physician during two 6 month periods in 2011 and 2012. Data is currently being collected for 6 months in 2013 and will be presented.ResultsNotes from a total of 186 and 181 patients, with a median age of 74.4 and 75.0 years, were reviewed in 2011 and 2012 respectively. Between 2011 and 2012 there was an increase in the proportion of deaths post-discharge from 22% to 29%. Documentation of a palliative intent to therapy was noted and communicated to primary care in 21% of in-patient deaths during both years. Documentation of palliative intent on the discharge summary for patients dying within 28 days of discharge fell from 78% to 40%.ConclusionsThe commonest causes of death for in-patients were pneumonia, lung malignancy and COPD. Those who died within 28 days of discharge had lung malignancy, other malignancy, ILD and COPD. The majority of patients with a documented communication about palliative intent had a diagnosis of thoracic malignancy. This reflects a more predictable disease trajectory and MDT decisions of “best supportive care”. Lack of confidence around predicting terminal disease in other respiratory diagnoses may account for the differences in rates of communication. In EoLC communication between professionals is a critical step in improving patient care and is particularly challenging in those with non-malignant disease.
AUDIT OF PRESCRIBING OF OPIATES AND SEDATIVES AT END OF LIFE IN A LARGE DISTRICT GENERAL HOSPITAL
Authors: Phillips Jacqueline , LeBon Beata , Jenkins Nicola 
Published: February 2014

BackgroundThe review of the LCP included concerns that opiates and sedatives had been used inappropriately at end of life. Although studies of prescribing for hospice inpatients concluded safe practice and lack of evidence that their use shortens survival, there is a lack of studies examining similar aspects of prescribing in hospital inpatients.AimsThe aims of the audit were to:Examine PRN and regular doses of opiates and sedatives in a sample of dying hospital inpatientsExamine the appropriateness of incremental increases of both drugs and their final dosesCompare the findings with the studies examining the above practice in hospice inpatients.MethodsThirty deaths and their LCP documentation were audited retrospectively. The following data were collated: length of time on the LCP, specialist palliative care involvement and PRN and regular opiate and sedative doses in the last 7 days of life and their incremental increases.ResultsThe average use of the LCP was 2.9 days. Opioid analgesia was administered to 73.3% patients (46.7% receiving it via a CSCI.) The mean daily morphine equivalent doses (MDMED) for days 1, 2, 3, 4, 5, 6, 7 before death were 22.3, 21.8, 22.7, 23.7, 23.6, 22.5 and 20.8 mg respectively (range 2.5–80 mg over 24 hrs; one dose of 80 mg skewing the results).Sedation (with midazolam, haloperidol or both) was provided in 70% cases (43% via a CSCI). In patients who received midazolam in a CSCI the mean daily doses on day 1, 2, 3, 4, 5, 6, 7 before death were 9.1, 8.3, 7.3, 11.3, 8.8, 5.0 and 3.8 mg respectively.ConclusionThe audit concluded safe use of opiates and sedatives with incremental increases justified by the PRN doses and documented symptoms with no evidence of doses being unduly accelerated during the LCP use. The final doses of both drugs were lower than those reported by some hospice based audits.
CAN A PATIENT-HELD ASSESSMENT TOOL IMPROVE PAIN MANAGEMENT IN PALLIATIVE OUTPATIENTS AT A RURAL KENYAN HOSPITAL?
Authors: Besley Charlie 
Published: February 2014

BackgroundPain is a frequent and distressing symptom in palliative care patients worldwide. Careful assessment is the first vital step in attempts to relieve this suffering. Assessment tools form a useful adjunct to pain management, but whether they make a difference to the patient themselves is not known.AIC Kijabe Hospital is a busy, rural, 'mission' hospital with an established Palliative Care Team.AimThe main objective of this study was to investigate whether the use of a pain assessment tool can make a difference to the patient's pain management.DesignA quantitative experimental study methodology was employed, with pre- & post-intervention comparison. In the pre-intervention phase, pain was assessed at study entry and at two weeks, following ‘standard’ care at home; 49 patients were recruited for this phase. In the intervention phase pain assessments were made at entry, with follow-up assessment after introduction of a patient-held pain assessment tool taken home by each patient; 50 patients were recruited for this phase.Analysis involved a comparison of baseline and two week pain scores between the pre- and post-intervention groups.ResultsThe results demonstrated that the use of a patient-held pain assessment tool lead to an increase in the number of patients reaching satisfactory pain relief. In the pre-intervention group 30% patients reached satisfactory analgesia, whilst in the intervention group, success rate was 69%. Whilst this was only a pilot study and numbers were small, if we compare follow-up pain scores in the two groups, using a simple chi-squared test analysis, we find a p-value of 0.013, indicating a significant difference.ConclusionThis study has demonstrated that a simple pain assessment tool, when linked to some action, in the hands of palliative care outpatients, may help achieve improved levels of analgesia. This is encouraging, and raises the opportunity for further clinical research in different settings.
KNOWLEDGE AND PRACTICE OF PALLIATIVE CARE PROFESSIONALS IN PREVENTION OF PATHOLOGICAL FRACTURE
Authors: Debattista Maria , Khodabukus Andrew F , Reynolds Joanne , Horton Paula , Howarth Susan , Humphries Barbara , Smith Jennifer C 
Published: February 2014

BackgroundMetastatic bone disease (MBD) has a damaging effect on quality of life and pathological fracture can impact on survival in advanced cancer. Patients with breast and prostatic cancer in particular who have bone metastases have a median life expectancy in excess of two years. It is essential that there is identification of patients who may benefit from surgical management that can prevent pathological fracture and its associated morbidity. There is recognition that there is under-referral to orthopaedic surgeons for consideration of palliative surgery and in 2005 guidelines were produced to support clinicians.AimsTo identify the preferences and actions of doctors and clinical nurse specialists in assessing bone pain in adult patients with advanced cancer compared with the 2005 regional standards and guidelines.MethodsTwo simultaneous surveys were done evaluating self-assessed clinical practice and a retrospective case-note review of assessments made by specialist palliative care teams. These were disseminated across integrated palliative care clinical networks in the North West of England.Results38 evaluations of self-assessed clinical practice were completed. 29% were unaware of guidance to support evaluation of MBD and pathological fracture. 66% of participants were unaware of their local lead orthopaedic surgeon for MBD. 69 case note reviews were completed. In the 44 patients not know to have metastatic bone disease at the site of pain 57% did not have an assessment of risk of metastatic disease in keeping with standards. 35 had assessments where risk of pathological fracture could be graded and in 80% of these no risk was documented.ConclusionsDespite the high frequency of bone pain there is insufficient documentation of risk of MBD and risk of pathological fracture. The results present an opportunity for clinicians to discuss local management options within palliative care services and with orthopaedic surgeons and oncologists.
AN AUDIT OF PALLIATIVE CARE PRACTICES IN THE BRISTOL ROYAL INFIRMARY EMERGENCY DEPARTMENT
Authors: Yeomans Daniel , Veysey Sian 
Published: February 2014

AimsThe aim of this audit was to compare current practice in the Emergency Department of the Bristol Royal Infirmary (BRI) to the guidelines set out by the College of Emergency Medicine (CEM, 2012)1MethodologyUsing retrospective analysis of patient notes, this audit asked appropriate questions adapted from the nine CEM criteria. Notes were examined from two groups of patients; those who died within the ED and those who died within 24 hours of ED admission (i.e. they had moved onto a different ward). For the purposes of this report, these will be referred to as Group A and Group B respectively. A sample of 2×25 patients overall was deemed to deliver sufficient transferable results.ResultsGroup A (died within the ED)19/25 families were involved with the care of their relatives23/25 patients had ceilings of treatment imposed14/25 patients had completed DNAR forms23/25 patients had organ transplantation considered20/25 families had bereavement services offered0/25 patients had end of life pathways startedGroup B (died within 24 hours)13/25 families were involved with decision making about treatment10/25 patients had ceilings of treatment imposed within the ED0/25 patients had end of life pathways started6/25 patients had completed DNAR formsConclusionsThis audit shows that the BRI ED is meeting four of the measured indicators, excluding those where it were not applicable, by over 80%. It also raises further questions about the validity of an end of life pathway within the ED environment, and the use of DNAR forms.
DEVELOPING AN EDUCATIONAL INTERVENTION TO ADDRESS THE DISCREPANCIES IN PRN ‘AS REQUIRED’ PRESCRIPTIONS WITHIN A HOSPICE SETTING
Authors: Cawley Declan 
Published: February 2014

BackgroundWithin the current healthcare arena, the identification of risks within organisations and minimising their negative impact on patient care is fundamental. Reports from the national and international literature have identified strong opioids and sedatives as a cause for concern within clinical practice. Recent baseline data identified significant variations in the practice of prescribing and administration of these drugs even within one organisation.AimsTo develop an educational intervention that is informed by clinical governance practices and utilising current work based assessments to evidence and embed good clinical practice.ResultsA baseline review of PRN ‘as required’ medications identified significant variations in drug dose and escalation, frequency of administration that doesn't match its' pharmacokinetics but importantly inconsistent documentation supporting ‘indication or use’ to guide nursing administration. A document was produced to highlight the issues from the baseline review, detailing the particular areas of concern and what current guidance suggests. In step 1, clinical vignettes were presented with the view of self-completion prior of Step 2. Within Step 2, trainees gave feedback on their rationale for their prescribing and what they actually documented. The case based discussion approach (CbD) was rated as very useful by trainees new to the specialty. A pre-completed sheet with appropriate prescribing and rationale was given to the trainee with useful resources after the discussion.ConclusionsWithin clinical practice, implementation of good practice guidance is fundamental to the success of any audit or baseline review of discrepancies in care. However there is a lack of work based assessments combining guidance, an opportunity for self-completion and then informed feedback so that an individual's learning needs can be appropriately highlighted and subsequently addressed. We believe the principle of this approach has the wider opportunity to tailor the learning needs of the trainee within certain challenging areas of practice.
PALLIATIVE EDUCATION FOR UNDERGRADUATE MEDICAL STUDENTS BASED ON THE NATIONAL SURVEY IN JAPAN
Authors: Tamba Kaichiro 
Published: February 2014

BackgroundPalliative care education for undergraduate medical students has not been well established in Japan. A foundation supported our university to have a department of palliative care medicine for undergraduate palliative education for three years. Fortunately, a nationwide consensus syllabus of palliative medicine for undergraduate medical education had been developed.ObjectivesTo reflect the development of curriculum of palliative care for undergraduate.Materials & MethodsMaterials; (1) source of the syllabus, (2) source of teaching materials, (3) teaching staffs and supporters. Methods; evaluation by (1) development of the curriculum, (2) analysis of the budget, (3) analysis of the access of our website with Google analysis®.Results(1) Development of the curriculum; Number of the annual classes of palliative care increased from 13, 18, 22, respectively. (2) Analysis of the budget; 66.4% of annual expenditure was personnel expenses, 10.0% for administrative expenses, 6.0% for supplies expenses, 4.1% for travel expenses, 3.9 % for appliances, 9.6% for others. (3) Effect of disclosure of educational resources; the daily access to our website was significantly concentrated just before the national medical practitioners qualifying examination in Japan compared with that after the exam (p<0.0001).ConclusionsExperienced palliative staffs, total support by the university, moderate financial resource and developed syllabus enabled systematized palliative education for undergraduate medical students. It might propagate related to the national medical practitioners qualifying examination.
IMPACT OF AN EDUCATION PROGRAMME FOR HEALTH PROFESSIONALS ON SUPPORTING PREFERRED PRIORITIES FOR CARE DISCUSSIONS WITH PATIENTS
Authors: Powell Paula , Cummins Janet , Gallagher Lisa , Joyce Anne-Marie 
Published: February 2014

BackgroundThis poster describes an audit conducted by the Community Integrated Advance Care Planning Team for St Helens and Knowsley of documentation by patients of their Preferred Priorities for Care and the impact of this on their place of death.AimFor St Helens and Knowsley Community Services advance care planning has been a priority since 2009 when a facilitator came into post to support this. A number of education initiatives across both areas have focused on giving health professionals the skills and confidence to support patients in making decisions about their care and documenting them. A robust audit trail has allowed the team to track the Preferred Priorities for Care (PPC) document that is used locally and collate the data on patient's place of death in comparison to their preference.Results1007 PPC documents have been completed to date with 659 deaths so far. 1 (0.1%) patient chose hospital as their preferred place of dying. 30 (3%)chose hospice as their first choice 96.9% home or care home (usual place of residence)The audit has shown that 88% of patients who completed a PPC achieved their preference for place of dying which is significantly above the 40% home/care home deaths in the locality.The audit has also provided data on which health professionals and settings are completing PPCs and where training can be targeted for the future.ConclusionSupporting (through education) health professionals to make advance care plans with patients can have a significant impact on a patient's place of care at the end of their life.
PREPAREDNESS TO CARE IN ADVANCED COPD: HOW PREPARED ARE INFORMAL CARERS OF PATIENTS WITH ADVANCED COPD AND WHAT ARE THEIR SUPPORT NEEDS? BASELINE DATA FROM AN ONGOING LONGITUDINAL STUDY
Authors: Farquhar Morag , Ewing Gail , Moore Caroline , Gardener Carole , Butcher Hanne Holt , White Patrick , Grande Gunn ,   On behalf of Living with Breathlessness study team
Published: February 2014

BackgroundChronic obstructive pulmonary disease (COPD) is a chronic progressive condition which, when advanced, can lead to high carer-burden. We lack good research evidence on the needs of informal carers of patients with advanced non-malignant disease and how best to support them; in particular the lack of longitudinal carer research has been noted.AimsTo describe the preparedness to care among informal carers of patients with advanced COPD and their support needs at the baseline of an ongoing longitudinal study.MethodsMixed method baseline interviews with a cohort of approximately 100 informal carers of patients recruited from a primary care population base in the East of England. The cohort forms part of the Living with Breathlessness study and, as such, is being followed over time in a mixed-method 18-month Longitudinal Interview Study involving 3-monthly semi-structured interviews with flexible methodology to capture changing patient function and service access, and carer need and support. Quantitative carer measures include Preparedness for Caregiving Tool and Carers Support Needs Assessment Tool analysed using descriptive statistics. Purposively sampled qualitative data will be analysed using a framework approach and multiple-perspective case study methodology.ResultsAt the time of abstract submission baseline data collection is ongoing but due for completion by the end of October 2013. The results will describe the preparedness of informal carers to care and the relationship between preparedness and carer support needs when caring for patients with advanced COPD.ConclusionsThe Living with Breathlessness study aims to provide new evidence on the trajectories of health and social care needs and service access of patients with advanced COPD and their informal carers to inform a new framework for care and support in advanced non-malignant disease.