bluuebunny/crossref_metadata_2025_split huggingface dataset:
FORWARD TO THE FUTURE: INTRODUCTION OF ADVANCE CARE PLANNING IN A TERTIARY CANCER CENTRE
Authors: Noble Agnes , Coackley Alison , Griffiths Ann , Howarth Susan 
Published: February 2014

BackgroundAdvance Care Planning is a process of discussion with individuals about their wishes and preferences regarding the type of care they would wish to receive or refuse in the future, should they lack capacity at that time. These discussions need to be handled with sensitivity and skill, the outcomes documented and reviewed regularly, and communicated to other relevant people with the individual's consent. The recognition of the importance of Advance Care Planning has been highlighted by the National End of Life Care Programme. As a UK tertiary cancer centre serving a population of 2.3 million, the implementation of Advance Care Planning produced significant and unique challenges.AimTo introduce Advance Care Planning into a tertiary cancer centre.MethodEducation was delivered to all health care professionals in both formal and informal sessions, including 'drop in' sessions provided over a whole day. Resource folders were introduced into all wards, containing written information for staff, and localised information and documentations for patients.ResultsThere was good attendance from staff across the organisation and the formal sessions stimulated much discussion especially regarding the role of a tertiary centre. These discussions included the inherent difficulties involved in liaising with a range of health care professionals across the region. There are multiple Health Care Teams in the Network, all of whom are at different stages of implementing Advance Care Planning for their patients. It was agreed that sensitive communication with the patient was of the utmost importance, with some staff admitting their lack of confidence in this area.ConclusionsThe introduction of Advanced Care Planning into a tertiary cancer centre is a challenge due to the wide geographical area. Further education sessions are planned including an intermediate experiential two-day communication skills training course to help staff required to initiate sensitive discussions with patients.
ENGAGEMENT WITH PROGNOSTICATION. INCORPORATING THE GOLD STANDARDS FRAMEWORK INTO DISCHARGE PLANNING
Authors: Griffiths Ann , Coackley Alison , Noble Agnes , Howarth Susan , Lee Heather , Hampton-Matthews Julian , Foulkes Margaret 
Published: February 2014

BackgroundThe GSF was developed in 2000 to improve palliative care in primary care by improving :- 1. Quality of care 2. Co-ordination and communication 3. Patient outcomes and cost effectiveness.Acute hospitals have been described as the missing link, providing seamless, co-ordinated high quality End of Life care. Enabling staff to identify patients in the last 12 months of life in a systematic sustainable way and linking this into discharge planning proves difficult.There has been no experiences in implementing GSF in Tertiary Cancer Centres, this causes many challenges; around communication with multi-disciplinary teams across a large geographical area.AimTo improve engagement of staff in identifying patients in the last 12 months of life.MethodRAG is a tool used for highlighting patients needs, referrals and outcomes to aid in a safe/timely discharge. RAG (Red/Amber/Green) boards have been implemented as part of the discharge planning. It's regarded as a good way of engaging colleagues in the identification of patients within the last twelve months of life.ResultsA weekly meeting is held on all wards. Staff discuss and agree the expected prognosis for individual patients. Each category is linked to specific needs which are addressed.Blue=Stable diseaseGreen=Less than twelve monthsAmber=Weeks prognosisRed=Days prognosisThe visual aide memoir assists all health care professionals to review the needs of individual patients ensuring appropriate support is in place for both patients and carers at the time of dischargeConclusionThe GSF can be linked with the discharge planning process in an acute hospital setting. This facilitates discussion and ensures the needs of patients are addressed and met in a timely manner. Appropriate communication with primary healthcare teams is achieved with collaboration and seamless care across healthcare settings becomes a reality.
TO ESCALATE OR TO PALLIATE? AN AUDIT OF PATIENTS AT RISK OF DETERIORATION ON MEDICAL WARDS
Authors: Grewal Bhajneek , Johnson Fiona 
Published: February 2014

BackgroundJunior doctors are often the first to assess deteriorating patients out of hours. From our experience, many deteriorating patients do not have escalation plans in place from the patient's regular medical team. Making decisions to escalate or palliate unwell patients is therefore made more challenging.ObjectivesThe primary objectives of this audit were to identify:1) If deteriorating patients are recognised by nursing staff on the wards2) If these patients are assessed promptly and by the appropriate professional3) If escalation plans exist to guide on call doctors when making management plans for these patients.MethodsData was retrospectively collected using a modified audit tool based on NICE 50 (Acutely ill patients in hospital). Patients at risk of deterioration were identified by an Early Warning Score >5. Thirty case notes were examined on several medical wards in Airedale General Hospital.ResultsA doctor or member of the Outreach Team was contacted in 70% of cases when a patient had a high EWS >5 (standard 100%). A third of patients were not reviewed after a high EWS (standard 100%). Only 5 out of 30 patients had a clear escalation plan highlighting whether higher level care was appropriate. Evidence of preventable harm was not found but examples of poor practice were identified e.g. patients with palliative conditions in whom DNACPR had not been considered.DiscussionThe results were presented orally to clinical staff and in the hospital newsletter to raise awareness of the need to make improvements. A distinctive Escalation Plan form and sticker was designed and is being piloted on the medical wards to encourage 'Day' teams to state a ceiling of care. Feedback will be obtained from staff when re-audit takes place.ConclusionAssessment and management of deteriorating patients must be improved. With the above interventions we hope to show that this can be achieved in the DGH setting.
DOCUMENTATION OF RESUSCITATION DECISIONS IN AN SPECIALIST PALLIATIVE CARE IN-PATIENT UNIT
Authors: Strubbe Patricia , Millar Jane , Haddock Claire , Redmond Lottie 
Published: February 2014

BackgroundWe are based in what was the South Central Health Authority which introduced a Unified DNACPR (Do Not Attempt Cardio Pulmonary Resuscitation) policy and document (lilac form). This enabled the transfer of DNACPR decisions across different settings. This document is still recognised since the introduction of the clinical commissioning groups. When patients are admitted to an in-patient Palliative Care unit we make a decision about the patient's resuscitation and transfer (to an acute hospital in case of sudden acute deterioration) status. We document whether the patient/ carer has been informed and review the decision weekly. We also document whether a patient brought in a lilac form on admission. On discharge we offer the patients who were DNACPR during, but not prior to admission, the opportunity to ‘own’ the DNACPR decision by offering them to take the lilac form home. All the above is communicated to the clinicians in the discharge letter.Aims of the auditWe did 2 retrospective audits of 40 consecutive set of notes to assess the completion of the resuscitation documentation and whether this information is documented on the discharge letter sent to GP and other clinicians involved in the patient's care.ResultsWe will present the results of the first audit which showed a fairly good compliance both in filling in the resuscitation and transfer documentation in the notes and the documentation in the discharge letters. Specific recommendations were made about the documentation, timing of review of the decisions and on when to offer patients, who did not have a lilac form prior to admission but were DNACPR during admission, the option of taking a lilac form home on discharge. The results of the re-audit will be presented and whether the recommendations improved decision making and communication with patients, carers and professionals.
DEMOGRAPHIC AND HEALTH PROFILES OF PATIENTS SEEN BY PALLIATIVE CARE ADVANCED PRACTICE NURSE IN SONGKHLA HOSPITAL, THAILAND
Authors: Sae-Chit Kallaya , Nilmanat Kittikorn 
Published: February 2014

BackgroundPalliative care services in Thailand had been gradually developed. However, little is known about services provided.ObjectivesThis retrospective study was aimed to describe demographic and medical and health profiles of patients seen by a palliative care advanced practice nurse in Songkhla hospital.Materials & MethodsAll patients who were referred to a palliative care advanced practice nurse at Songkhla hospital were identified and recruited. Palliative Care nursing records for these patients were reviewed and analysed for various demographic data, medical diagnosis and treatment information and patients' awareness of their health status and treatments plan.ResultsA total of 98 records were deem suitable for analysis. 57.1% (56) were male. The vast majority of subjects was Buddhist (84.7%). A mean age was 63.6. Over half of the subjects had PPS in range 40 – 60(53.1%) and cancer diagnosis (58.2). Top three medication received during hospitalization included antibiotic drug (67.35%), sedative drugs (32.65%), and analgesic drugs (27.55%). Majority of samples received feeding byNG tubeas current intervention. Dyspnea, fatigue, and pain were commonly reported as the most concerned symptom. 53.1% of patients were aware of their terminal diagnosis. An end of life decisions were discussed with 21.4% of patients and with 59.2% of family members. Discharge condition included clinically improved (41.8%), death (36.7%), refusal of further treatments (20.4%) and referral (1.1%).ConclusionsThe findings provide a picture of patient characteristics and medical profiles. The results will be useful for health professional to develop palliative care services.
RELEVANCE OF CANADIAN HEALTH CARE EVALUATION PROJECT (CANHELP) QUESTIONNAIRE FOR PATIENTS ON HOMECARE IN MUMBAI
Authors: Ghoshal Arunangshu , Dighe Manjiri , Deodhar Jayita , Dhiliwal Sunil , Damani Anuja , Muckaden Mary Ann 
Published: February 2014

BackgroundThe Palliative Care unit at Tata Memorial Hospital has a multidisciplinary home care team serving Mumbai based population for over a decade.ObjectiveStudy the relevance of Canadian Health Care Evaluation Project (CANHELP) questionnaire in Mumbai based patients and families registered with Palliative Medicine Department, Tata Memorial Centre who are being presently provided with homecare services and to identify unmet needs of care provided at end-of-life.MethodsCANHELP Questionnaire assesses importance of end of life care provision and satisfaction derived, on a scale of 1–5 (ascending scale).There are 38 patient centred questions and 40 family questions/per unit; divided into subscales by authors. In this cross-sectional IRB approved study, the CANHELP questionnaire was served on 20 such patients and their families from September to November 2012 after taking informed consent in their preferred language. Data were collected and analyzed using SPSS.ConclusionsThe mean value calculated for Importance reflects that both the patients and families found end of life care provision to be very important and the CANHELP questionnaire to be relevant. Satisfaction reflects that both groups were somewhat satisfied with end of life care services provided.The families were somewhat satisfied with their own involvement in care at the end of life for their patients. They feel that they can contribute more towards it. The patients were not very satisfied with their participation in deciding the care process at the end of life. A closer look reveals that this is particularly regarding discussions with doctor about the place of management and the use of life sustaining technologies at the end of life and there is a need for further discussions regarding this.
END OF LIFE CARE CHAMPIONS—A PARTNERSHIP APPROACH TO DEVELOPING TRANSFORMATIONAL LEADERS IN THE ACUTE SECTOR
Authors: Sweetland Caroline , Drabble Tess , Walford Carole 
Published: February 2014

AimsAhead of the Frances report (2012), the acute and third sector in West Dorset collaborated to drive through improvements in end of life care in Dorset County Hospital Foundation Trust (DCHFT). The project aimed to: Increase the focus on dignified care to the frail and elderly in DCHFT Develop End of Life Care Champions as transformational leaders (Krause 2007): influencing, motivating, and inspiring their colleagues through their End of Life Care practice.StructureThe project had 2 main elements: The support of End of Life Care Champions identified from each ward Delivery of 12 multi-professional study days on communication skills, endorsed by Bournemouth University and 6 Royal College of Physicians CPD points. Weldmar Hospicecare Trust delivered two programmes (registered/non-registered) of 3 study days. Content was drawn from the EoLC competencies, Routes to Success publication; focussing on: rapid discharge from hospital communication resuscitation orders Liverpool Care Pathway. Delivery included Support to disseminate knowledge e-learning. Presentations from GSF Beacon accredited care homes. ‘Learning in practice’ day in varied settings : hospice, funeral directors, local care homes.ResultsJoint longitudinal analysis is in early stages, initial anecdotal evidence is positive: improvement in effectiveness of rapid discharges; increased written compliments and reduction in complaints relating to end of life care. The EoLC Champions themselves expressed increased confidence in: talking with patients/families regarding death and dying advocating with senior clinicians. sharing knowledge through: EoLC notice boards, information folders, teaching and launch of ‘Back of the Door poster project’. The communication study days have been equally positive: participants valuing experiential teaching techniques.ConclusionThe project strengthened partnership between the hospital and hospice, from collaboration on the bid to full support from clinical leaders and management. Future plans are to embed knowledge and skills and then support the champions through action learning groups.
INITIATING DISCUSSION IN END OF LIFE CARE: CLINICIAN'S PERSPECTIVES
Authors: Jones Kerry , Baines Rebecca , Lang Iain 
Published: February 2014

Background and AimsEngaging patients nearing the end of life in discussion about their subsequent treatment is regarded as a vital aspect to the provision of effective and cost-effective palliative care (Department of Health, 2011; National Institute of Clinical Excellence, 2012). There is little research to date which suggests how such discussions can be easier to initiate or how clinicians can optimise their communication with patients and their families on end of life care.These issues are typically addressed using Advance Care Plans such as the Liverpool Care Pathway or a locally developed Treatment Escalation Plan (TEP) and a multi professional framework for the delivery of compassionate care in the last hours and days of life. The TEP was developed in response to variability in care planning and the lack of patient and carer involvement in it.In this paper, I discuss clinician's accounts of the barriers and facilitators to initiating conversations about advanced care planning at the end of life with patients and their families and their approaches to overcoming these challenges.Methods and ResultsData collected from 20 qualitative in-depth interviews with Palliative Care Consultants and other senior clinician's in a hospice and hospital environment show that several domains were identified as vital to the provision of a compassionate approach to end of life care. These include, developing a trusting and ongoing relationship with both the patient and family members, adopting a multi disciplinary approach, engaging in opportunistic and ongoing discussions concerning malignant and non-malignant disease.Clinicians who engaged patients and their families in multiple conversations about their needs and treatments, and who sought to include psychological, social as well as biomedical aspects of care, report providing this aspect of end of life care as integral to providing compassionate care at the end of life.
IMPROVING END OF LIFE CARE (EOLC) THROUGH INNOVATIVE WORKING
Authors: Bailey Fiona , Dargan Susan , Hill Rachel , Quinn Barry 
Published: February 2014

BackgroundAs part of improving EoLC at Ashford and St Peter's NHS Foundation Trust (ASPH), the Trust collaborated with Woking and Sam Beare Hospices (WSBH) to increase access to hospice beds for patients who might not traditionally have been considered for referral, by contracting 2 EoLC beds at the hospice.Aimsimprove the end of life care experiencesupport patient choice around preferred place of care/deathpromote earlier identificationseamless service delivering EOLCMethodologyHospital and Hospice staff developed an agreed pathway. Patients are identified by medical and surgical teams, and then reviewed by the hospital palliative care team, to ensure that the transfer is appropriate and that it's the patient's wish to be admitted to the hospice. The hospital speedily transfers a patient when a bed is available and without a formal referral.ResultsIn the pilot period (3.5 months) there were 34 admissions, with 19 of these patients having a non cancer diagnosis. However, 10 patients died in less than 24 hours. Although all relatives reported they were glad that the patient had been transferred, the project team felt that such a short length of stay was unacceptably high and the process was reviewed. During the following 4 months, there were 22 admissions with 2 deaths in less than 24 hours. 9 of these patients had a non cancer diagnosis.ConclusionThis model has helped to increase the awareness of EoLC in ASPH and to promote closer collaboration with the hospice. It has illustrated the challenges of identifying patients at the EoL. The high number of patients dying in less that 24 hours may reflect the need for earlier identification and that in some non malignant conditions, treatment may continue until close to death.
A QUALITATIVE STAFF EVALUATION RE-AUDIT OF THE HOSPITAL SPECIALIST PALLIATIVE CARE TEAM AND EVALUATION OF OUR 7 DAY SERVICE
Authors: Kirton Lea 
Published: February 2014

During October 2011 an internal staff questionnaire was designed to gain feedback on the hospital specialist palliative care team from selected nursing groups, junior doctors and consultants. The aim was to gain feedback on the impact and effectiveness of the specialist palliative care service.A majority of the responses were positive in the impact the service has had on patient care.Key learning points were the need to continue to raise the profile of the palliative care team, to ensure all areas have access to our availability and how to contact us, and the need for continued/rolling education for all disciplines of staff.There are currently 17 acute hospital trusts in the East of England with specialist palliative care teams, 5 of which (including Colchester Hospital University Foundation Trust) offer a 7 day service.CHUFT specialist palliative care teams 7 day service commenced in October 2010. The team covers 24 adult wards across 2 sites.The aim of this piece of work is to re-audit staffs evaluation of the service, and to look at referrals received by the service from October 2012-June 2013, with particular reference to the weekend service provision and effectiveness of this.
PROLONGED DWINDLING CHARACTERISES THE ILLNESS TRAJECTORY OF NURSING HOME RESIDENTS AT THE END OF LIFE
Authors: Finucane Anne , Stevenson Barbara , Murray Scott 
Published: February 2014

BackgroundThree trajectories of physical decline have been identified towards the end of life: (i) a short period of evident decline typically experienced by patients with cancer; (ii) long term limitations with intermittent serious episodes typically experienced by patients with organ failure; and (iii) prolonged dwindling typically experienced by patients with frailty or dementia. An understanding of these trajectories will facilitate anticipatory care planning and decision-making as end-of-life approaches.AimTo determine the dominant illness trajectories of nursing care home residents, and to explore multimorbidities in this patient group.MethodWe collected data as part of a larger project to improve palliative care in South Edinburgh care homes. Eight participating care homes completed an after death audit form for the last ten residents who died prior to the project starting. This included their cause of death and main and other diagnoses.ResultsData on 77 residents was reviewed. The illness trajectory of 90% of residents was characterised by prolonged dwindling, although 30% of residents experienced mixed illness trajectories. About half of those with a mixed trajectory experienced dementia and cancer while half experienced dementia and organ failure. 67% of residents experienced two or more chronic morbidities. Overall, 78% had dementia.ConclusionNine out of ten nursing home residents experienced prolonged dwindling prior to death. Most had multiple morbidities and high symptom burden. Traditionally palliative care services have been modelled on the needs of patients with malignant disease. Interventions to improve palliative care in nursing homes need to be modelled on patients who experience prolonged dwindling characterised by dementia.
ADVANCE CARE PLANNING IN PRACTICE
Authors: Harrison Kerry , McGee Helen 
Published: February 2014

BackgroundAdvance Care Planning (ACP) is a voluntary process of discussion about future care between an individual and their care providers and is recommended as best practice in end of life care.Hospice in the Weald (HitW) routinely documents patients' ACP in the patient record. This audit was carried out to ascertain what impact this information had on the patients' end of life care.AimsTo identify how many deceased patients had ACP conversations clearly documented in their recordTo explore the content of the information in the notes in a 10% random sampleTo look at place of death for these patients and compare with those who didn't have ACP notesMethodA retrospective audit was performed looking at patients who died between 1/8/2012–29/2/2013. A 10% random sample was identified, of whom half had ACP clearly documented. The notes were read and salient information recorded.Results439 patients died during the 7 month period of whom 51% had an identifiable ACP conversation recorded in their notes. 44 notes were looked at and there was a marked difference between the place of death for those with documented ACP and those without (Home 37% vs 22% and Hospital 4% vs 19%). There were many instances where although ACP conversations were taking place they were not recorded in one location and not updated and therefore were not easily accessible to all staff.ConclusionsThis audit confirms that well documented ACP conversations do impact on place of death but that even within a specialised setting, it can be difficult to identify significant ACP discussions and for all staff to be easily aware of them. This has implications for recording and sharing this information between organisations which is recommended best practice. Changes to our recording processes are now in place in an attempt to improve this for the future.