bluuebunny/crossref_metadata_2025_split huggingface dataset:
P110 Evaluation of medicines adherence in day hospice patients
Authors: Greenwood Julia 
Published: October 2013

BackgroundCentral to the care of patients in Day Hospice is an understanding of their compliance with medication. The Hospice has a Medicines Management Policy in place, but had no structured approach to measuring patients’ levels of concordance, from their perspective.Aim of the EvaluationThe aim of the evaluation was to develop a method by which patient compliance could be assessed, explored and improvedMethodThe National Institute for Clinical Excellence (NICE) produced guidance and a patient questionnaire on Medicines Adherence in 2009. The questions explore the role of the healthcare professional in supporting patient’s decision making, and understanding of their medicines. An amended version of the NICE questionnaire was developed and used, for which sixteen patients were randomly selected. Verbal consent was obtained and anonymity assured.ResultsIt provided useful information about our effectiveness in supporting patients with their medicines adherence. We scored well in engaging patients in joint decision-making, however some other aspects such as exploration of the burdens and benefits of medication, and common side effects needed improvement.LimitationsSome questions could be misinterpreted, and there was no facility to expand on answers given. The length and style of the questionnaire was quite difficult to implement with people who were fatigued and unwell.ConclusionsThis evaluation has been important to our understanding of our effectiveness in supporting medicines adherence. We intend to inform NICE of the amendments made prior to using the questionnaire within specialist palliative day services. We aim to further develop the questionnaire to evaluate patients’ experiences and concerns regarding their medication regimes, and to address the need for carer involvement (End of Life Care Strategy 2008), as they underpin concordance for many of our patients.
P111 Terminal opioid and sedative titration in two hospices
Authors: Shuler Andrew , Caddell Gail , Foster-Alexander Kirsten , Jager-Romero Joey de , Poolman Marlise 
Published: October 2013

IntroductionThere was anecdotal observation by professionals working across both sites that there was a difference to practice with opioid and sedative titration at the end of life. As an extension to early work at one of the hospices, it was decided to consider practice across the region, so a second hospice was invited to participate.AimsTo quantitively assess practice of sedative use in relation to the EAPC recommended framework for the use of sedation in palliative care.To quantitively assess practice of opioid use in the terminal phase.To assess whether practice differs between hospices in North Wales, and to consider any potential reasons for the difference and implications for practice.MethodsA retrospective case-note review of patients who died in the two units. Data collected included drugs, doses and increments, and proxy assessment of symptoms in the last week of life (MSAS-GDI).ResultsGroups were comparable in terms of background and demographics.Practice differed with one unit using Midazolam and Levomepromazine more frequently and at higher starting doses.There was no difference to symptom burden between sites.DiscussionAll doses used were within the limits described in the EAPC framework.At subsequent focus group discussion potential reasons were discussed including differences in anti-secretory medication use and its impact on sedative use.These findings have precipitated further work on both sites.
P112 Morphine and other opioid painkillers for moderate to severe pain: a NICE guidance compliant patient information leaflet
Authors: Bunn Ray , Gregory Amanda 
Published: October 2013

The Medicines Management Group (a multidisciplinary team comprising of medical, nursing and pharmacy representation) at an independent hospice has developed a patient information leaflet (PIL) on strong opioids. This decision was made in response to the recent National Institute for Health and Clinical Excellence (NICE) guidance on ‘Opioids in palliative care: safe and effective prescribing of strong opioids for pain in palliative care of adults’(1)which recommends that verbal communication between healthcare professionals and patients about their medicines should be supported by evidence based, written information. The aim was to produce a PIL which was NICE guidance compliant and which also contained other salient information relating to the use of strong opioids. The PIL is titled "Morphine and other opioid painkillers for moderate to severe pain" and contains the following section headings:Using Opioids - why prescribed, preparation and how to take, managing breakthrough painSide effects - common side effects, what to do if experiencing side effectsDriving and TravellingOther Information - collecting from pharmacy, opioids and alcohol, storage, disposalThere is also the facility on the front cover of the PIL for the dispensing pharmacy to stick duplicate labels of strong opioid medicines dispensed so that patients and carers know to which drugs the PIL refers. The PIL produced has, if locally adapted, wide potential for use in any palliative care organisation and pharmacy dispensing strong opioids for moderate to severe pain in the UK.
P113 Re-designing how patient medicines information is presented on discharge
Authors: Bunn Ray , Gregory Amanda 
Published: October 2013

A plethora of written patient information accompanies medicines dispensed (TTOs) for patients discharged from an independent Hospice inpatient unit. This includes:Manufacturer’s patient information leaflets (PILs) for each medicine used within license - legally required.Locally developed PILs for medicines that are unlicensed or for use off-label.Green (regular) and blue (when necessary) ‘Drug Information Cards’ listing all medicines and dosage information electronically transposed from the TTO prescription.Locally developed PILs informing about medicine groups warranting special care in use e.g. ‘morphine and other opioid painkillers for moderate to severe pain’.It was observed that this ‘jumble’ of leaflets and medicines looked disorderly and unprofessional, with a real risk of information being lost, overlooked or simply discarded as unimportant. The aim was to develop how written patient information was presented to patients and carers in a way that was:Professional and distinctly noticeable.Neat, orderly and clear.This problem was presented to the hospice Medicines Management Group (MMG) for resolution. The MMG is a multidisciplinary team comprising of medical, nursing and pharmacy representation with roles including the continuously improvement of the quality of pharmaceutical related practice and processes, often in an innovative way. They developed the following solution:‘Hospice branded’ A4 front and rear cover, cardboard folder with rear cover hole punched near spine.Flat bar file fastener fitted to the rear page to hold:Explanatory page.A4 unlicensed PILs.A4 Drug Information Cards.An A4 plastic pouch holding the manufacturers PILs (variable sizes)The completed file is then placed in the bag containing TTOs.This solution has potential for application in other settings.
P114 Improving the use of patients own medication in the hospice setting
Authors: Crowther Jeanette , Wanklyn Steven , Johnson Mel , Lund Samantha 
Published: October 2013

IntroductionThe use a of patients’ own medications is improved at Trinity Hospice by patient’s being encouraged to bring them in when being admitted. Advantages of using a patient’s own medications are widely recognised and include aiding prompt completion of medicines reconciliation, thus achieving more accurate prescribing on admission, medication being available faster on the wards and of a quality that is suitable for self-administration, reducing the number of late and missed doses, patients continuing to use medication brands with which they are familiar or are required to due to inter-brand differences in bioavailability and considerable savings for the hospice’s drug expenditure.AimsTo establish a procedure framework that improves the re-use of a patient’s own medications whilst minimising patient risk.To inform governance priorities for the re-use of a patient’s own medications particularly those involving high risk drugs.MethodA multidisciplinary team was established with representation from pharmacy, doctors and nurses in order to develop a clinical protocol for the management of a patient’s own medications.The protocol manages how a patient’s own medications are assessed for suitability to be administered using a decision-support algorithm, obtaining further supplies and the essential documentation. Staff were deemed competent to undertake this procedure provided they attended a training workshop and successfully complete the training competency.Results & DiscussionIn order to quality-assure the protocol adherence to the process will be audited on a regular basis. The results of this alongside incident surveillance will provide on-going risk management and identify areas for improvement.ConclusionTrinity hospice has approved this protocol. Staff eligible to undertake a role have been accredited to do so. Under the terms of the Hospice’s approval an audit of adherence and critical risk assessment will inform the further development of this medicine system.
P115 Clinical Pharmacists - Hands on in the patients home at end of life
Authors: Bartlett Joanne , Seager Louise 
Published: October 2013

The introduction of frontline clinical pharmacy services for patients in their preferred place of care is redefining the traditional role of the specialist clinical pharmacist in palliative care.This innovative role allows patients, carers and other healthcare professions to access the expertise of the clinical pharmacist in the patients home and is aimed specifically at complex patient groups moving towards end of life.The aim of the role is to enable patients with more complex drug needs to remain in their preferred place of care, the role sits in a wider specialist community team comprising of physiotherapists, occupational therapists, dieticians, social worker and nurses.Referrals includeComplex symptom control i.e. unresponsive to or having experienced side effects and adverse drug reactions with conventional first and second line therapiesPatients with multiple co-morbidities on complex regimes who require rationalisation of their medicinesPatients requiring medication review/rationalisation including following discharge from secondary careDrug/dose choice for patients with impaired drug metabolism or clearance i.e. renal/liver impairmentAdvice on drug choice, route and formulation for patients with drug administration difficultiesIssues around access to specialist palliative care medicines in the community settingPatients with a non-cancer diagnosis including those with end stage heart failure, renal failure, COPD, liver failure, motor neurone disease etc.Patients on palliative chemotherapyIn addition to working with the specialist palliative care team there are many external links these include GPs, district nurses, specialist clinical nurses (community and hospital), consultants, community pharmacists and hospice at home to provide seamless care for palliative patients across the interface. This involves joint professional visits, attendance of GSF meetings or hospital MDT meetings etc.The Clinical Pharmacy team prescribe for their patients ensuring timely access to specialist medicines and prompt symptom control
P116 Anticipatory medication ‘as stock’ for residents who are in the dying phase: a project in 3 nursing care homes
Authors: Morris Kathy , Hockley Jo , Gibbs Margaret 
Published: October 2013

The Gold Standards Framework for Care Homes [GSFCH] and the Liverpool Care Pathway [LCP] guidance suggests the importance of obtaining anticipatory medication for the control of symptoms in the last days of life for nursing home (NH) residents. There is considerable wastage however as NH residents are dispensed anticipatory drugs on a named-patient basis. There is also evidence that when these drugs are not available residents are hospitalised inappropriately.AimThe aims of the project were to explore the frequency of symptoms experienced in the dying phase and to explore whether there was a need for residents to have their own supply of drugs by examining wastage. The idea was to establish a process in order for homes to obtain anticipatory medication as ‘stock’ and to capture the benefits of doing this.ProcessThe managers of three NHs, who had shown interest in obtaining medication for the last days of life, met with a local GSFCH facilitator, specialist palliative care pharmacist and a pharmacist from the regulatory body. A proposal that included a list of necessary medication and how to acquire them was written. The NH staff developed the required Standard Operating Procedures. A prospective audit on medication used was commenced.ResultsSignificant improvements in the availability of anticipatory medication were found. 53% of residents were symptomatic highlighting the need to have anticipatory medication available. No medication other than “stock” was required by NHs. If all residents had their own supply of medication £4,506 worth of drugs would have been wasted. All staff involved perceived that this work had been beneficial.ConclusionAnticipatory medication ‘as stock’ for people dying in NHs is an important step forward. There is less wastage of medication, less delay in controlling symptoms, reduced call out of GPs and less anxiety.
P117 The implementation of a locally developed advance care planning document across four diverse health and social care settings
Authors: Dempsey Debbie , Owens Sarah 
Published: October 2013

Advance care planning (ACP) has seen its profile raised in recent years, with various UK government publications serving to drive forward the importance of identifying people’s preferences, wishes and expectations for their future care.Clear documentation is essential for effective sharing of information amongst the multi-disciplinary team, in a bid to ensure an individuals plan is communicated, respected and goals of care are achieved.In the author’s geographical area, it has been identified that there is no robust ACP document currently in use, particularly within the care home setting, therefore the author facilitated the production of a locally produced ACP document via the local palliative and end of life care strategy group.This qualitative study used mixed methods including semi-structured interviews, questionnaires and a focus group to explore the introduction of this ACP document, highlighting both staff and patient’s/residents perceptions of the process and the identified challenges and benefits. Four sites were chosen to pilot the document, (local nursing home, day hospice unit, memory service, supported living complex) representing a diverse range of health and social care services.Key themes emerged from the analysis of the interviews and questionnaires: Staff confidence, timing of discussions, patient empowerment, patient diagnosis and apprehension regarding legally binding decisions. The perceived importance of having ACP discussions was the underlying similarity between the services; however the challenges varied depending upon the nature of the setting.The results identified that 23 ACP documents were completed in the pilot phase, with 80% of patients/residents stating that they would recommend this process to others. Reduction of anxiety, peace of mind and control were frequently expressed by participants.A need for further research in those diagnosed with early dementia is indicated. Collaboration across services may be needed to develop ACP trigger guidelines that fit the complex needs of diverse patient/client groups. Also the challenge of maintaining training within rapidly changing workforces is acknowledged.Key Words: Preferences, Documentation, Advance Statement, Advance Decision, Timing, Confidence, Communication
014 Challenging the perception of death and dying through documentary film making in a hospice
Authors: Erna Haraldsdottir , Hardie Amy , Kendall Marilyn 
Published: October 2013

BackgroundHealth promoting palliative care is a relatively new concept in palliative care that aims to increase public awareness and open discussion in relation to death and dying. A year long collaboration between a documentary film artist and patients and staff in a Scottish hospice addressed these aims. They produced 20 short films and a character led documentary feature film showing different strategies that led to increased vitality at the end of life.MethodThe film-maker worked with over 40 patients, family members and staff in the hospice to identify and expand on participants’ experiences and develop them as narrative for the wider community.Following the patients’ lead, further research into music and performance arts required collaboration with a music director and choreographer in the day-care ward. An extended period of filming and editing followed, where the material was scrutinised and distilled into portraits and songs.ResultsThe resulting documentary film follows patients in the hospice and in their homes, reflecting their strength and individuality, their hopes and dreams as well as their struggle with disease as they use music and creativity to mirror their personal identity and the day- to -day life in the hospice. Responses to the film qualify it as an art based research as watching it enables learning, enhances and challenge audiences’ understanding and perception of death and dying.Key themes that patients raised were their need to be seen as individuals rather than patients and their desire to challenge preconceptions that dying patients are weak, vulnerable and passive.Conclusion:Making a film within a hospice has enabled patients to have a voice as individuals and challenge current perceptions of the dying patient.Wide distribution of the film through television and cinema will encourage public debate across all medias, challenging assumptions about death, dying and the day-to-day life in a hospice.
P118 Advance care planning in care homes: an exploration with staff, residents and families
Authors: Stone Louisa , Kinley Julie , Hockley Jo 
Published: October 2013

AimsTo explore staff, residents and families’ experience of participating in advance care planning discussions.Background/literature review:Within the UK, implementation of the Gold Standards Framework in Care Homes (GSFCH) programme is being promoted to develop the quality of end of life care for frail older people living/dying in care homes (DoH 2008). An integral part of this involves advance care planning (ACP) discussions. This study explored the experience of initiating and undertaking these discussions.MethodsA qualitative descriptive study was undertaken in three nursing homes implementing the GSFCH programme. Following an ACP discussion, semi-structured interviews were undertaken with the resident, their family member/s and the staff member undertaking ACP. Thematic analysis was used to identify the main categories and themes.ResultsTwenty eight interviews were carried out. Five main categories arose: understanding ACP; undertaking ACP discussions; the impact of ACP discussions; use of documentation; and, relationship and rapport.Staffs understanding of ACP varied and this affected the depth of their discussions with families and residents. The use of documentation either acted as a useful prompt or limited the discussion, blocked opportunistic cues and encouraged a ‘tick-box’ exercise. Staff had to face their fears around discussing death and dying. The assistance of a trained facilitator helped staff to develop knowledge, skills and confidence with end of life conversations. Residents were open to having ACP discussions, though the way it was introduced could impact on the result. Families found comfort that their loved ones future care had been considered.ConclusionsCare home staff need to develop the knowledge, skills and confidence to engage in discussions around end of life care. The assistance of a trained facilitator who role models this process would enable this.
P119 Improving end of life care in Worcestershire: Advance care planning
Authors: Grint Tracey 
Published: October 2013

Advance care planning (ACP) is a process of reflection and communication in which a person with decision making capacity is able to express his/her wishes regarding preferences and wishes for their end of life care. The End of life strategy ( 2008) highlights the need for proactive guidance in exploring a person’s preferences and wishes at an early stage within life limiting illness, resulting in the potential of unnecessary and unwanted crisis interventions being minimised. The newly formed, three clinical commissioning groups (CCG’S) for Worcestershire have acknowledged ACP as a priority and commissioned a countywide project, under the auspices of the End of Life and Palliative Care network for Worcestershire the role out and implementation of the new countywide ACP documents, this is seen as critical components of the quality improvement process in health and social care (Help the Hospices,2012).A 12 month project overseen by an ACP Project Manager and hosted in collaboration with St Richard’s Hospice will see the Implementation of a training and awareness programme across all health and social care providers being undertaken. This is to enable collaborative countywide working and embed the ACP documents in to practice. Training and awareness will be developed for the workforce to enable underpinning knowledge and skills required in supporting patients through ACP discussions.Enabling:Patient choice regarding preference and wishes as end of life approachesProactive guidance for preferred place of careMinimise crisis admission as end of life approachesA skilled workforce across health and social care will enable a consistent approach to advance care planning countrywide ensuring a patient’s wishes and preferences are elicited, documented and shared.Integrated care at end of life within the changing health and social care policy landscape will be delivered in line with the recommendations from, Preparing for the future: key operating principles (Help the Hospice,2012).
P120 The impact of advance care planning of place of death, a hospice retrospective cohort study
Authors: Rich Alison , Julian Abel , Bailey John 
Published: October 2013

ObjectivesThere is limited evidence of the impact of advance care planning (ACP) on outcomes. We conducted a retrospective cohort study on deaths of all patients known to a hospice in a 2.5-year period to see if use of ACP affected actual place of death, hospital use and cost of hospital care in the last year.Results969 patients were included. 550 (57%) people completed ACP. 414 (75%) achieved their choice of place of death. For those who chose home, 34 (11.3%) died in hospital; a care home 2 (1.7%) died in hospital; a hospice 14 (11.2%) died in hospital and 6 (86%) who chose to die in hospital did so. 112 (26.5%) of people without ACP died in hospital. Mean number of days in hospital in the last year of life was 18.1 in the ACP group and 26.5 in the non-ACP group (p < 0.001). Mean cost of hospital treatment during the last year of life for those who died in hospital was £11,299, those dying outside of hospital £7,730 (p < 0.001). Mean number of emergency admissions for those who died in hospital was 2.2 and who died elsewhere was 1.7 (p < 0.001).ConclusionsACP can be used routinely in a hospice setting. Those who used ACP spent less time in hospital in their last year. ACP is associated with a reduction in the number of days in hospital in the last year of life with less hospital costs, supporting the assumptions made in the End of Life Care Strategy 2008.