bluuebunny/crossref_metadata_2025_split huggingface dataset:
USE OF A TASK AND FINISH GROUP TO IMPROVE CHILDREN'S SUPPORT BEFORE THE DEATH OF A PARENT
Authors: Clipsham Laura , Pickard Jane 
Published: February 2014

BackgroundIn January 2013, the support of children aged 18 years and younger with a parent admitted to the hospice was audited. This showed variations in the assessment of children's needs and subsequent discussions within the multidisciplinary team, leading to the formation of a multidisciplinary Task and Finish group to review how this aspect of holistic care can be improved.MethodsA multidisciplinary group met regularly over a 6 month period. Terms of reference were agreed with the aim of reviewing identification of children's support needs, and seeking ways to improve this. Audit standards for adoption by the hospice were agreed to facilitate ongoing service evaluation.ResultsThe group identified a need for the following:Improved documentation: Weekly MDT meetings are a suitable forum for identifying and discussing concerns. A trial of specific prompts for record of discussions increased the documentation of children's knowledge of their parent's illness and the impact of the illness on children and their family to 100% (previously 28.6% and 71.4% respectively).Accessible resources for patients and staff: Approval was gained from the Patient Information Group for age-appropriate leaflets to be freely accessible in the hospice, with additional child bereavement resources available if requested. Cushions showing emotions were purchased for the children's play area to improve communication with younger children.Ongoing review of practice: A steering group was established to continue work focusing on meeting children's bereavement needs.ConclusionsIntroduction of specific prompts to aid documentation of MDT discussions appear to be effective at highlighting the need for additional support for children, whilst still enabling an holistic, individualised approach to patient care. It is recommended that a specific MDT template be developed which incorporates these. The introduction of additional resources and ongoing review by a steering group will facilitate ongoing service development.
SMALL CHANGES, BIG DIFFERENCE: IMPROVEMENTS IN HOSPITAL BEREAVEMENT SERVICES
Authors: Swift Ben 
Published: February 2014

BackgroundIn 2010 new staff were employed and formed into a formal joint Mortuary & Bereavement Service for the Trust.AimsTo develop the service whilst reviewing quality and turnaround time.MethodsReview of existing facilities and practices revealed many areas ripe for development and this presentation describes how the changes were achieved for an area which remains largely hidden to the rest of the hospital.ResultsA professional looking uniform and investment in staff training and development; rebuilding and modernization of the entire mortuary and bereavement suite (include colour changing lights for skin effects) on two sites; development of a bed cover allowed dignified, respectful transfer of in patients' beds, rather than a concealment trolley, with resulting reduction in manual handling.Mortuary sessions for hospital staff improved understanding, reduced fear of the unknown, improved communication with families and compliance with care after death procedures. Procedural changes resulted in improved quality of death certification and the resulting documentation presented more professionally and respectfully in specially designed folders with useful information.Many small touches – quality ‘property bags’ for patients' effects; 'last thoughts, words and wishes' cards; ‘forget me not’ seeded cards; keepsake pebbles; ribbon ties and muslin bags for hair locks; free parking for those collecting certificates have served to improve a difficult experience.Redesigned, more user-friendly bereavement booklets; staff cards with prompts for discussing tissue donation and departmental cultural awareness posters produced to ensure cultural sensitivity to individual need; support for parents facing the loss of a child and those who have miscarried, ensure burial and cremation facilities are appropriate.ConclusionsFeedback from patients is collated and used in real time to continue change. This presentation describes the difference this sensitivity and creativity have made to bereaved families' experiences.
ANALYSIS OF DIAMORPHINE DOSES PRESCRIBED FOR PATIENTS RECEIVING ‘JUST IN CASE FOUR CORE DRUGS’ FOR END OF LIFE CARE
Authors: Dickman Andrew , Khoo Grace , Morris Tracey 
Published: February 2014

BackgroundIn September 2012, an anticipatory prescribing policy was introduced across the healthcare. The ‘Just in Case Four Core Drugs’ (JiC4CD) policy can support proactive symptom control by promoting anticipatory prescribing, ensuring that common symptoms (for example nausea and vomiting, pain, respiratory secretions and agitation) are responded to in a timely fashion.The four core drugs have been chosen for the locality because they are consistent with the prescribing algorithms of the local Liverpool Care Pathway. These drugs are diamorphine, glycopyrronium, levomepromazine and midazolam, although alternatives are acceptable should they be necessary (e.g. oxycodone instead of diamorphine). A recent national survey concluded that morphine, not diamorphine, is the most commonly prescribed opioid for administration by continuous subcutaneous infusion. There is a potential cost saving by substituting morphine for diamorphine.AimsTo analyse the doses of diamorphine prescribed for patients receiving JiC4CD and to determine the feasibility of switching to morphine.MethodElectronic discharge prescriptions over a 12-month period for JiC4CD were identified. Those prescriptions for diamorphine were analysed to determine the mean, median and mode doses prescribed.ResultsA total of 211 discharge prescriptions for JiC4CD were dispensed by the hospital pharmacy over the 12 month period. There were 193 (91.4%) discharge prescriptions that included diamorphine as the opioid of choice. The mean (4.77 mg), median (5 mg) and mode (5 mg ) doses were determined.ConclusionThe analysis illustrated that morphine could be considered as an alternative to diamorphine for patients receiving JiC4CD for end-of-life care.
IMPLEMENTATION OF THE AMBER CARE BUNDLE: A WAY TO MANAGE UNCERTAINTY
Authors: Meredith Joanne , Evans Howard 
Published: February 2014

BackgroundWarrington and Halton NHS Foundation Trust is a part of Transforming End of Life Care in Acute Hospitals. The Transform programme advocates the use of tools and enablers to standardise good evidence based care for patients that are nearing end of life. The AMBER care bundle is one of the 5 key enablers, used to support communication with patients and family and promote good planning when recovery is uncertain.AimTo Embed the tool through facilitation on selected wards throughout the trust and measure and record the impact on patient care, to continue to improve end of life care, in the acute setting.To audit the use of the AMBER care bundle in relation to improvement in the length of stay, hospital readmission, coordination of care, medical planning and communication when recovery is uncertain.MethodA sample audit of notes for inpatients that had died where their care had been supported using the AMBER care bundle. A sample of patients summary care records when patients had been discharged from hospital following a stay where care was supported using the AMBER care bundle.The audit proforma included quality of the completion of the bundle itself, documentation of Preferred Place of Care, length of stay, communication, decision making and readmission into hospital.A retrospective audit of case notes for in patients that had died that had not been supported using the AMBER care bundle used as a comparison.ResultsThe audit did show that there was a significant difference in quality of documentation, planning and the recording of preferred priorities for care for those patients that had been supported using the AMBER care Bundle, than not.Health professionals were able to identify the correct patients as suitable for support using the bundle.ConclusionThe AMBER bundle improved the documentation in patient's case notes of escalation decisions, and the documentation of conversations with patient and or their family at a time of uncertainty.
HOSPICE AT HOME SERVICES—THE IMPORTANCE OF INTEGRATION AND MEDICAL SUPPORT
Authors: Hugel Heino , Gavin Catherine , Mitchell Carol , Edwards Debbie 
Published: February 2014

BackgroundHospice at home services are an increasingly important part of specialist palliative care support to patients in the community. Most hospice at home services consist of different nursing interventions, but don't include medical support.AimsWe describe outcome data including a service evaluation of a hospice at home service model that includes full medical support. This service model comprises a nurse lead sitting component, a nurse lead accompanied transfer home, but also consultant lead specialist palliative care medical support for complex clinical situations in patients referred to the service. The service is firmly integrated into a specialist palliative care provider that provides the full spectrum of specialist palliative care including inpatient and outpatient services for the locality.Results170 patients were supported by the service in an 18 months period from 1/2012–6/2013. 80 (47%) received a specialist palliative care medical visit as part of their intervention. 135 patients died within the 18 months period. Of these 114 (84%) died in their usual place of residence (100 at home, 14 in a nursing home). Sixteen (12%) died in hospice inpatient unit and only five (4%) died in hospital. A service evaluation was carried out for a ten month period from 1/2012–10/2012. Health care professionals who had referred to the service and families of patients who had used the service were sent questionnaires. Both patients and health care professionals rated the service in general very highly. Particularly health care professionals commented that the medical intervention component had helped to avoid crisis situations and allowed patients to stay at home.ConclusionsThese results suggest that firm integration of hospice at home services into existing specialist palliative care services and medical support including consultant leadership should be key components of this type of service.
X-RAY AUDIT AT PRINCESS ALICE HOSPICE: IS THERE A ROLE FOR ON-SITE X-RAY IMAGING AT HOSPICES?
Authors: Potter Valerie , Gannon Craig 
Published: February 2014

BackgroundA small number of hospices have access to X-ray imaging on-site. A larger number do not and when X-ray imaging is indicated, this necessitates transfer. There is little literature surrounding the use of radiology within the hospice setting. One study in Leeds which looked at requested imaging for inpatient and outpatients over 1 year within a hospice that accessed its local hospital trust for imaging, concluded that most referrals were appropriate. Their study revealed 62 requested scans, 8 being for plain X-rays. This audit was to assess the potential need for in-house X-ray imaging at our hospice.AimsPrincess Alice Hospice has a 28 bedded inpatient unit. This prospective audit was performed on inpatients over a 6 month period in 2013 to identify cases where an X-ray was considered. It involved recording of all incidences when plain imaging was considered, X-ray type, indication, perceived level of need, appropriateness for transfer and outcome. We audited against the standard that if X-ray imaging is needed, it is performed where necessary and appropriate.ResultsOur audit revealed 18 incidences in total when X-rays were considered over 6 months(11 CXRs, 3 pelvic, 1 shoulder and 3 AXRs). In 4 of the 18 (22%), it was deemed crucial to obtain and all of these patients were transferred. The remaining 14 patients were managed on the basis of clinical findings. 7 of the 18 were appropriate to transfer.ConclusionsOur results did not provide convincing evidence for access to on-site X-ray imaging. Where it is considered crucial and is appropriate, all patients are being transferred. In our inpatient population, it is often more appropriate to treat clinically. There are both advantages and disadvantages to on-site radiology access and this audit generated limited data. Further work is needed into the availability and appropriateness of imaging in the hospice setting.
WORKING IN PARTNERSHIP: HOSPICE AND HOSPITAL DISCHARGE SUPPORT TEAM INITIATIVE
Authors: Haywood Chris , McConaghy Margaret , Lawton Janet 
Published: February 2014

BackgroundWith an ageing population, economic deprivation and poor health, the increasing demand for Specialist Palliative Care (SPC) services is putting pressure on hospice and hospital beds. Audit has shown that where patients with Palliative Care needs express a preference regarding place of dying, over 90% choose their usual place of residence. There is no dedicated workforce available at either hospital or hospice to support transfers and accompany patients and carers to their preferred place of care at the end of life, if necessary staying with them until District Nursing Services and/or carer is in place at the home setting. An innovative approach of a dedicated Hospice Discharge Support Team was established.AimsTo support routine and rapid discharges (particularly out of hours) from hospital and hospice services to preferred place of care at end of life.To accompany patient/family on their journey to ensure a smooth transition between services reducing anxietyTo improve Satisfaction of Care by reviewing ‘end of life’ complaintsTo reduce hospital deaths where appropriateReadmission avoidanceMethodsAn agreement between Hospice and Acute Services for a 12 month pilot Development of a Hospice Discharge Support Team with appropriate training Initial 85% funding secured through a Grants application to Help the Hospices Quarterly monitoring.ResultsAchievement of patients preferred priorities for care via audit Data used to help to inform Commissioners to secure sustainable funding for continuation of the service Findings included in Quality Accounts.ConclusionThis service ensures a comprehensive holistic hand-over to the Primary or Care Home Healthcare Team, providing timely support so that necessary equipment and care packages can be put in place to ensure a smooth transition from care settings. This service strengthens stronger working relationships with Acute, Community Services, Care Homes and Specialist Palliative Care Services.
QUALITY END OF LIFE CARE FOR ALL (QELCA) IMPLEMENTATION AND EVALUATION
Authors: Boulton Sophie , Smith Carina , Abel Julian 
Published: February 2014

Innovation within the NHS is vital to achieve two aims: firstly and most importantly: improving patient care; secondly saving money, to sustain our healthcare system.A “good death” was defined in 1997 by the Institute of Medicine as:“free from avoidable distress and suffering for patients, families, and caregivers; in general accord with patients' families' wishes; and reasonably consistent with clinical, cultural, and ethical standards”.In England, some 1,300 people die every day. 60% of these people die in hospital but around 70% would prefer to die at home. Estimates suggest we spend about £55m each day on this failure to give people a good death.Nationally excellent work is happening to address these issues, and at Weston General we are pioneering in Palliative Care. As F1 doctors we have been working with the Palliative Care team to contribute to the improvements. Weston received a budget to employ specialist palliative care nurses trained by the local hospice to work in each ward of the hospital.We then put together a computer program allowing data from all deaths to be easily collated. This has allowed us to produce monthly palliative care reports to prove the impact of our new nurses and educate junior doctors on the importance of advanced care planning. We now have a tool that allows us to measure outcomes and monitor adherence to local and national policy regarding end of life care.With this knowledge comes the power to begin the change, to realise a “good death” for all patients. On our final report we found 51.5% of deaths in our area occurred in people's usual place of residence, the highest in the country. Compiled with other both quantitative and qualitative data we can prove Weston's innovations are striving towards giving people a “good death.”
AN EVALUATION OF A COMMUNITY MULTIDISCIPLINARY TEAM MEETING FOR PATIENTS WITH END STAGE RESPIRATORY DISEASE
Authors: Dando Nicholas , Chiverton Jane 
Published: February 2014

BackgroundNICE quality markers for COPD state that all patients with end stage COPD should have access to specialist palliative care support. To improve identification and management of patients with end stage COPD in North East Hampshire, an integrated multidisciplinary team (MDT) was established between the local hospice, hospital and community teams. This evaluation reviewed the activity of the MDT after 1 year.MethodThe list of patients discussed at each meeting (June 2012 – June 2013) was reviewed and cross referenced with the patient's electronic patient record to determine whether they were referred to the hospice. For patients who were known to the hospice, outcomes including ongoing specialist palliative care input, discharge and place of death were recorded.Results34 patients were discussed over 4 meetings. 24 (71%) were already known or referred to the hospice during the year. The majority (74%) had a diagnosis of COPD. 12 (35%) patients died over the year with 58% dying at home or in the hospice. 15 (44%) patients had ongoing specialist palliative care needs requiring input from the hospice MDT as well as the community matron. 2 patients were discharged to the care of the community matron.ConclusionsA community respiratory MDT meeting provides an important forum for discussion of patients with end stage disease. The meeting facilitates information sharing and coordination of care between the key health professionals involved in the patients management. Although the majority of patients were reviewed by the specialist palliative care team, community matrons remained integral to patient care. As the MDT develops, it will be important to ensure that patients who wish to die at home or in the hospice are identified and supported to meet their wishes. This may result in a reduction in the number of patients dying in the acute hospital environment.
A SPACE TO BREATHE; A HOSPICE BASED, MULTIDISCIPLINARY, PALLIATIVE CARE PROGRAMME FOR PEOPLE WITH SEVERE COPD
Authors: Cambell Fiona , Leek Jo , Hudson Sharon , Colclough Rachael , Pereira Bruce , Sullivan Anita , Davies Charles 
Published: February 2014

BackgroundPeople with severe COPD have a burden of symptoms, often greater than those with lung cancer and have unmet need (Gore and Brophy 2000). A local palliative care needs analysis was conducted across primary and secondary care. Gaps were identified in the management of anxiety, breathlessness, social isolation, advance planning and carer support. Patients had high comparative admission rate and length of stay.A team, including a psychologist, OT, palliative and respiratory medicine and physiotherapy and a palliative care CNS, developed and delivered the programme.The focus of the programme was behavioural change through psycho-education, exercise and relaxation, underpinned by CBT.MethodReferral was from acute respiratory service for those with at least 2 acute admissions in the previous 6 months, FEV1 of <50% predicted and symptoms of anxiety, fatigue and breathlessness. They attended the hospice programme for 5 weeks with transport provided.Two programmes were completed with a total of 12 patients and 3 carersHADS and CATS were taken at week 1 and week 6.6 month pre and post course admission data was collected.ResultsPatients described; improvement in confidence and quality of life and improved management of their exacerbations. HADS and CATS remained unchanged. Initial data from programme 1 demonstrated reduction in total admissions from 7 to 4 and reduction in total bed days from 47 to 20, over a 6 month period.ConclusionsPatient evaluated improvement in function and quality of life and reduction in hospital bed days would suggested continuation of the programme with a change in quality of life measurement.
A MIXED METHOD STUDY EXPLORING A PALLIATIVE CARE APPROACH FOR PEOPLE WITH ADVANCED HEART FAILURE
Authors: Gadoud Amy , Macleod Una , Kane Eleanor , Ansell Pat , Johnson Miriam 
Published: February 2014

BackgroundPatients with advanced heart failure have significant unmet palliative care needs. UK policy recommends identification of those requiring palliative care based on prognosis (last year of life).AimTo explore aspects of a palliative care approach for people with advanced heart failure: recognition of need, transitions in care and impact on patients, family carers and clinicians.MethodsSystematic literature review of prognostic variables associated with the last year of life in heart failure. Secondary analysis of contemporaneously collected primary care records from a national database, to compare recognition of the need for palliative care between cancer and heart failure patients. Qualitative semi-structured interviews with patients receiving a palliative approach to care, their carers and clinicians. A mixed method approach with a concurrent triangulation strategy was used; each study was conducted separately and findings were integrated.FindingsGeneral practice research database (GPRD) data demonstrated gross inequity between documented recognition of the need for a palliative care approach; heart failure patients were poorly represented on the palliative care register and those that were, were registered close to death. Prognostic markers, identified in both the systematic review and GPRD, had limited clinical usefulness for identifying the last year of life. From interview data, clinicians appeared reluctant to discuss a palliative care approach without clear irreversible deterioration of the patient. However, patients welcomed, and some initiated, conversations regarding the change in focus of care. Following such discussion all involved found this approach beneficial, even with subsequent periods of stability or improvement. Other barriers included lack of recognition of symptoms by clinicians and difficulties in delivering proactive care.ConclusionsA palliative care approach before the very end of life is beneficial in this group. A patient centred, problem-based flexible approach to recognising the need for palliative care, rather than prognosis is recommended.