bluuebunny/crossref_metadata_2025_split huggingface dataset:
AUDIT OF PALLIATIVE CARE PATIENT IDENTIFICATION IN GENERAL PRACTICE
Authors: Courtney Richard , Calow Alan 
Published: February 2014

BackgroundThe Gold Standards Framework highlights the need for early identification of palliative care patients within the community. Thus allowing optimization of patient care and avoidance of unnecessary treatments near the end of life. The Dying Matters website states GP palliative registers should only have approximately 25% of cancer diagnoses on them.AimTo assess if the practice wad correctly registering palliative care patients and what proportion of the palliative register had cancer diagnoses.MethodUsing the GP computer system (Emis) a search was made of the most recent deaths over 7 months. This was cross referenced with the palliative care register at that time to find which patients had not been correctly registered onto the palliative care register prior to their deaths. The notes of these non-palliative care registered deaths were assessed retrospectively to see if the could have been previously added onto the palliative register. Markers within the medical records were previous patient/relative discussion around palliative care, DNAR forms and the use of Prognostic Indicators Guidance.ResultsA total of 33 patient deaths were identified over 7 months. 12 were correctly palliative care registered. 11 deaths could not have been predicted from the records and 10 deaths were expected and therefore eligible for the palliative care register.Notably 66% of the palliative list had a cancer diagnosis, whereas 9 out of 10 of the unregistered but expected deaths had non-cancer diagnoses. This highlighted clearly that the other common palliative groups were being missed.ConclusionPerforming such an audit can allow any practice to evaluate their concordance with the current Gold Standards Framework. It re-iterated how the Prognostic Indicator Guidance could be used to identify non-cancer palliative care patients for inclusion onto the palliative register.
SEAMLESS TRANSFER OF CARE FOR END OF LIFE PATIENTS
Authors: Wilde Jane , McDermott Sarah 
Published: February 2014

The End Of Life Discharge Facilitators role began in October 2011, designed to facilitate and support timely discharge at End Of Life, for patients who express their wish to be cared for at home through provision of an interface between the acute trust, hospices and District Nursing in Leeds.The main objectives of the role were to improve collaborative working across organisations and the co-ordination of care provision in the transfer of care to increase the number of deaths in usual place of residence and reduce the number of hospital deaths in line with the vision outlined within the Palliative Care Strategy 2008. Locally it was felt that there were a number of reasons some patients were not always achieving their preferred place of care including:District Nurse availability to attend a care planning meeting in a timely manner to facilitate the discharge for patients wishing to have end of life care at home.The role supports the District Nursing teams across the city, not only facilitating seamless transfer of care also contributing to the education and training of ward and community staff around discharge planning.There are already demonstrable outcomes in terms of facilitating patient choice at end of life. To date the facilitators have supported 350 discharges to preferred place of care.The iniciative has significantly increased the capacity of the District Nursing teams, as the facilitator completes a quality, robust set of notes, ordering of equipment, ensuring anticipatory medications, DNACPR documentation accompany the patient home where appropriate. This has meant the receiving District Nursing team use their time more effectively with the patient at point of discharge.The post has further streamlined existing systems and processes re discharge as the facilitators have been able to highlight areas for improvement, enabling them to greatly reduce the numbers of poor/failed discharges.
“IT'S A MARATHON NOT A SPRINT” – SETTING THE PACE IN DEVELOPMENT OF A REGIONAL PALLIATIVE CARE RESEARCH SPECIALTY GROUP
Authors: Lindsay Fiona , Malik Farida 
Published: February 2014

BackgroundResearch in palliative care is imperative to improve the evidence base and maintain the best quality care for patients and families. In 2011, the Sussex Cancer Network (SCN) Palliative Care Group identified the need to formally develop a dedicated regional research group.AimsTo promote palliative care research, with multi-professional representation from specialist palliative care services, throughout Sussex. To increase recruitment to palliative care trials, including development of new research within the region.MethodsThe Sussex Palliative Care Research Specialty Group (SPCRSG) was formed with multi-disciplinary representation from Sussex-wide adult specialist palliative care services and allied research/academic professionals. It is jointly led by the authors and supported by the Surrey & Sussex Comprehensive Local Research Network and formerly by the SCN.Key activities of the group include: regular education and business meetings, with external expert speakers and Royal College of Physicians CPD approval; regular review of ongoing and potential research studies, particularly those on the NIHR portfolio; promoting research (Good Clinical Practice) training; and linking with established academic centres.ResultsSix hospices, three hospital trusts and two community services have been represented in the five meetings held to date with a median number of attendees of 12 (range 6–17). The usefulness of education sessions have been evaluated as either ‘good’ or ‘excellent’ by 75–88% of attendees. Attendees reported networking opportunities and discussion about independent hospice sector research governance as valuable.Research activity has increased with involvement in three NIHR Portfolio studies within the Sussex region since the inception of the SPCRSG.ConclusionsDevelopment of the SPCRSG has been beneficial and would be transferable to other regional palliative care services. To keep up the future pace in providing relevant and effective support and on-going education, it is important to understand what factors promote participation and what barriers to undertaking palliative care research there are.
CLINICAL OUTCOME MEASURES WITHIN A SPECIALIST PALLIATIVE CARE SERVICE (SPCS): DO THEY PROVIDE ADDED VALUE?
Authors: Mayland Catriona , Bayly Joanne 
Published: February 2014

BackgroundUsing clinical outcome measures helps support the delivery of high quality care which is amenable to critical evaluation. The project aims were to: identify potential outcome measures; pilot them within clinical settings; and provide recommendations regarding routine clinical use within a SPCS.MethodsPotential outcome measures were identified and critically evaluated. Three instruments - Palliative care Outcome Scale version 2 (POS-2); Palliative Performance Status (PPS); and Edmonton Functional Assessment Tool (EFAT) – were further assessed in a 2 month pilot within in-patient; out-patient; day therapy and outreach services. Each instrument was assessed on two consecutive occasions (unless the patient died or was discharged).ResultsFrom 97 patients, 52 (54%) were female and mean age was 68 years (range 27–89 years). POS-2 scores ranged from 1–27 (total score 40=very symptomatic and distressed) with highest scores present for in-patients. Seven patients had POS-2 score >20. All expressed high levels of psychological distress for themselves and their family.Seventeen (73.9%) of the 25 in-patients had a low PPS score (<50%=considerable assistance needed for self-care). For 9 in-patients with a length of stay >14 days, all bar one had a low PPS score on admission.EFAT scores showed highest levels of dysfunction were for outreach and in-patients. EFAT's ability to sufficiently discriminate clinically meaningful variations in function within each care setting limited its recommendation for regular use.Day therapy patients tended to have the lowest POS-2 and EFAT scores.ConclusionsFollowing this project, POS-2 and PPS have been incorporated into routine clinical practice within the day therapy unit and more recently in-patient unit. Initial reflections suggest they aid multi-disciplinary team working and highlight particular patient concerns requiring interventions. PPS scores could potentially be linked with length of stay to help anticipate patients with particular complexity and dependency.
WHEN UNPLANNED ACUTE HOSPITAL ATTENDANCE IS APPROPRIATE: DEVELOPING A PATHWAY TO FACILITATE URGENT HOSPITAL REVIEW OF PATIENTS ATTENDING A SPECIALIST PALLIATIVE CARE DAY UNIT
Authors: Turley Maddy , Constable Gemma , Nambisan Vinnie 
Published: February 2014

BackgroundSpecialist palliative care services are increasingly accessed by people in the early stages of a life-limiting illness, when functional status may be good and treatment aimed at prolonging life. Whilst avoidance of inappropriate hospital attendance for these patients is desirable, the value ofappropriatehospital attendance should be recognised. We report an audit that appraised and developed the referral process from a specialist palliative care day unit to a local acute hospital for patients with suspected acute medical emergencies.MethodA retrospective case-note audit was carried out of all emergency referrals made from a specialist palliative care day unit to a local acute NHS trust over a three-month period. Qualitative and quantitative analyses were used to explore: the frequency of, and reasons for, emergency referral; association with primary disease type; the action taken by the acute hospital receiving team; documentation of the event; and clinical outcomes.ResultsWe identified nine referrals, equating to 1.3% of day hospice attendances, with all patients having a primary diagnosis of cancer. Reasons for referral (and frequency) included clinical suspicion of: pulmonary embolism; acute cardiac ischaemia; and sepsis. Seven episodes led to hospital admission (length of stay 2–14 days), with all patients subsequently being discharged home.Communication between palliative and acute services was comprehensive at the time of referral, but lacking at the time of discharge.DiscussionThis audit highlights the importance of recognising and taking steps to appropriately manage emergency medical problems in a specialist palliative care patient population. Such problems might occur with increasing frequency as access to specialist palliative care services for those with early-stage disease expands. The results have been used to develop a robust process that uses effective partnership working and communication between palliative and acute services to facilitate appropriate hospital assessment, investigation and treatment.
ARE SUBCUTANEOUS FLUIDS UNDERUSED IN THE HOSPICE SETTING?
Authors: Lowe Emma , Gillon Suzie 
Published: February 2014

BackgroundSubcutaneous (SC) fluids have been shown in several randomised controlled trials to be as effective as intravenous (IV) fluids for the treatment of mild-moderate dehydration, and are probably superior in confused patients. They are associated with reduced equipment costs, nursing time, fewer complications and less patient discomfort. However, they are often underused due to reliance on, and familiarity with the IV route.AimsTo assess how many patients were receiving fluids within a 32 bed UK hospice and review what proportion could have been appropriate for SC rather than IV fluids.Methods140 consecutive hospice inpatient admissions, for which notes were available, were reviewed retrospectively.Data was collected on demographics, indications for fluids as well as type and delivery of fluids. An algorithm to enable selection of SC fluids versus IV fluids within the hospice was drawn up and then used to assess retrospective use.Results21 patients (15%) received 26 episodes of fluids during their admission (all via the IV route). All had a malignant disease and had a mean hospice stay of 19 days. 16/21 patients died and 5 were discharged. Fluids were given for an average of 53 hours with 24 episodes delivering 2 litres of fluid or less per 24 hours. Indications were: infection (7), renal impairment/dehydration (6), hypercalcaemia (5), other (8). 24 episodes were assessed as having been suitable for SC fluid delivery although 16 had IV access for another reason. 7 episodes had a documented complication of fluid use, 5 of which related to cannulation.ConclusionsAll the patients in this study were given fluids exclusively via the IV route, but most would have been suitable for SC fluid administration. There is scope for a change in policy to administration more routinely via the SC route.
“PLANNING FOR THE FUTURE”: A TOOL FOR PROMPTING AND RECORDING FOR ADVANCE CARE PLANNING
Authors: Watmough Jonathan , Gunson Eilidh , Sheils Rachel , Ackroyd Rajeena 
Published: February 2014

BackgroundThe importance of Advance Care Planning (ACP) is widely recognised. The process can increase patients' chances of achieving their preferred outcomes, prompt them to discuss concerns with their families, and help them to make realistic plans. While some patients want to write advance statements, others do not wish to discuss the future with professionals at all. Another group of patients wants to plan but does not want a patient-held document. Given patients' differing preferences regarding ACP, it would be useful for professionals to keep a record of these specific preferences, as well as broader preferences for future care.AimsTo develop a document that would (i) prompt professionals to consider ACP consistently, (ii) document the justification when ACP discussions are not offered, and (iii) provide a centralised record of outcomes of ACP discussions. To audit how many of the forms are being completed appropriately once implemented, and the outcomes of using the form.MethodWe designed a proforma (“Planning for the Future”) which is filed at the front of every inpatient's notes, next to any DNA CPR form. In January 2013, we audited proformas for the 55 most recent admissions.ResultsFifty-one of the 55 patient records contained the "Planning for the Future" form. Fifty one percent (26/51) recorded patients' preferred places of death, 21/51 recorded other wishes and preferences, and 24/51 forms documented formal decision making about whether or not to offer ACP. In 11 of these 24, ACP was deemed inappropriate due to impaired mental capacity or a preference not to discuss the future.ConclusionsWe now have a systematic way of prompting consideration of ACP discussions, indicating whether ACP has been offered, justifying cases where it has not, and centrally documenting a patient's cumulative wishes and preferences. The proforma will be redesigned to increase its use and give our patients the best possible help in planning for the future.
INCREASING ACCESS TO SPECIALIST PALLIATIVE CARE FOR PATIENTS WITH NON-MALIGNANT DISEASE: A ‘BIG BANG’ APPROACH
Authors: Hayle Catherine , Ahmad Fawad , Emms Helen , Lewis-Jones Catherine 
Published: February 2014

BackgroundAccess to specialist palliative care for patients with advanced non-cancer diagnoses is much lower than for those with cancer, despite a similar symptom burden and poor health-related quality of life. Wirral Hospice St John's sought to address this inequality through the appointment of a consultant in palliative medicine with a specific remit to increase access for patients with non-malignant disease.AimTo monitor the proportion of hospice referrals for patients with non-malignant disease over a three-month period at the start of the initiative.MethodsCross-sector work was undertaken to publicise the project. A letter was sent to all GPs, and a variety of educational events for GPs, community matrons and specialist nurses were held. Secondary care was approached via individual specialty meetings, consultant physicians' meetings and a postgraduate education event. Close liaison with the Clinical Commissioning Group was ongoing throughout. Education and listening events for hospice staff (clinical and non-clinical) were conducted, and updates regarding specific conditions organised. Data regarding referral patterns were collected contemporaneously.ResultsReferrals to all services for patients with a primary non-cancer diagnosis increased steadily from 5.7% (May'13) to 18.2% (Aug'13). The increase was most pronounced in day therapy (6.9% to 30.8%), followed by inpatient care (2.5% to 13.5%), and outpatient services (8.3% to 16.7%). The majority of referrals were for patients with respiratory disease (69%), followed by neurological disease (22%).ConclusionsIt is possible to increase access to specialist palliative care for patients with non-cancer disease within a short timescale. Dedicated time to liaise with colleagues in primary and secondary care is vital to achieve this. Robust monitoring of referral patterns and service capacity, together with education for hospice staff is also important in order to maintain a safe, high quality service. Work is ongoing to ensure equity of access between disease groups.
A COMMUNITY PALLIATIVE CARE NURSE SPECIALIST LED INTERVENTION TO IMPROVE PALLIATIVE CARE IN CARE HOMES: PRELIMINARY RESULTS
Authors: Finucane Anne M , Gardner Hilary , Stevenson Barbara , Muir Lynn , Gibson Hilary , Barker Liz , Murray Scott A. 
Published: February 2014

BackgroundApproximately 20% of people die in long term care settings. National and international policies call for care homes to provide reliably good end-of-life care. Specialist palliative care providers are well placed to support care homes to deliver palliative care to residents who would benefit.AimTo improve the delivery of palliative care in care home using a community palliative care clinical nurse specialist (CNS) model of support.ResultsTwenty-two South Edinburgh nursing care homes agreed to take part in this project. Eight took part in Phase 1. After death audit data was collected in each care home following the death of a resident at baseline (i.e. prior to the intervention), and once the intervention had started.Components of the intervention were: support from a dedicated Community Palliative Care Clinical Nurse Specialist; identification of two palliative care leads in each care home; palliative care training; multidisciplinary palliative care review meetings, and support to use tools to help identify residents approaching end of life.Baseline data relating to 77 residents was collected: 92% of residents died in the care home; 64% had a record of anticipatory care planning; 19% died on an integrated care pathway and 55% had anticipatory medicines prescribed. The intervention is continuing. Data on outcomes during the intervention period will be compared against the baseline data.ConclusionOur study explores the extent to which a community palliative care nurse specialist led model of care home support enables care home staff to improve the delivery of palliative care to their residents. The findings will inform the delivery of the intervention to 14 care homes in Phase 2. More generally, this project will guide the design of new palliative care interventions that will allow palliative care specialists to extend their influence to reach patients with frailty and dementia.
IDENTIFICATION OF THE MOST COMMONLY PRESCRIBED OPIOID FOR ADMINISTRATION BY CONTINUOUS SUBCUTANEOUS INFUSION
Authors: Dickman Andrew 
Published: February 2014

BackgroundContinuous subcutaneous infusions (CSCI) are commonly used to maintain symptom control once the oral route is no longer available. In 2004, there was a worldwide shortage of diamorphine and most centres adopted morphine as the opioid of choice. Diamorphine has since become available again, but it is more expensive than morphine. A national survey of UK practice performed in summer 2004 identified diamorphine as the most commonly prescribed opioid for administration by CSCI. No survey of national practice has been performed since.AimsTo identify the most commonly prescribed opioid for administration by CSCI in the UK and to compare with local practice.MethodUK pharmacists and pharmacy technicians were invited to complete an internet-based national survey of current practice. For each CSCI, participants recorded information about constituent drugs, doses, diluent, total volume, duration of administration and visual appearance. A sub-analysis of the data was performed in order to identify the frequency of opioid prescribing. The results were compared to those obtained from local practice.ResultsA total of 2000 CSCIs were recorded in the national survey by 35 centres distributed across the UK. Morphine was the most commonly prescribed opioid, occurring in 28% of CSCIs. Oxycodone was the second most frequently prescribed opioid, followed by alfentanil and diamorphine. Analysis of local practice identified morphine as the most commonly prescribed opioid, with alfentanil being the second, followed by oxycodone and diamorphine.ConclusionMorphine has been shown to be the most commonly prescribed opioid for administration by CSCI.
AN AUDIT OF DOCUMENTED REFERRAL INFORMATION FOR CHILDREN REFERRED TO A UK PAEDIATRIC AND YOUNG PERSON'S HOSPICE
Authors: McKeating Catriona , Koodiyedath Bindu , Nicholson Johanna , Miller Mike 
Published: February 2014

BackgroundRecent research shows a rising national prevalence of Life Limiting Conditions in children identifying an escalating need for paediatric palliative care services in the UK.1Hospice services must ensure quality, sustainable care and essential to providing this is the careful documentation and consideration of all referred patients.The services offered by paediatric hospice settings vary widely throughout the UK. Such individual care settings require individualised referral processes and individualised referral documentation.Martin House Children's Hospice in Yorkshire looks after 340 children and young people with life limiting illnesses from birth to age 35 years. The hospice receives approximately 87 new referrals on average (mean) per calendar year for children aged 0–19 years.AimsTo undertake an audit assessing the quality of information recorded on hospice referral forms against the Scottish Intercollegiate Guidelines Network 31 template.2SIGN 31 is a valid “gold standard” for audit of current practice and recommended as a suitable tool to ensure quality in referral communication. Half of all referrals received during a 6 month period at Martin House were retrospectively examined for the recommended minimum essential information within SIGN 31.ResultsThe audit Identified incomplete and inconsistent documentation in recording of referrer contact information, reason for referral and child/young person's location at the time of referral.The audit highlighted other inconsistently documented information out-with the recommendations of SIGN 31 guidance considered important for paediatric palliative care referrals. This included the order of referral (i.e. first/second), parental and child's consent to and awareness of the referral, languages and religious beliefs of the child and family, parent's names and legal guardianship status.ConclusionsThe audited referral documentation and referral system is not presently in-line with the ‘gold standard’ SIGN 31 guidance and requires improved consistency in documentation of the required minimum data set to ensure quality care for children referred to the hospice service.