bluuebunny/crossref_metadata_2025_split huggingface dataset:
P152 Making user involvement happen
Authors: Dee Frankie , Widlake Jutta 
Published: October 2013

BackgroundStakeholders need a voice that is focussed on the quality of a service rather than numbers. They want to provide feed-back and make recommendations developing a true partnership. User involvement can provide this process. A group was set up 3 years ago to develop this and has now moved from “meeting” to “making happen”AimHelp in identifying areas requiring improvementDemonstrate the patient’s right to have a say in their care. (NICE, 2004).Demonstrate compliance with the End of Life Care Strategy (DoH, 2008).Legal imperative for all organisations providing NHS funded services. (National Health Services Act 2006, Local Government and Public Involvement in Health Act 2007, Equity and Excellence: Liberating the NHS, 2008)Materials and methodsA steering group was set up incorporating senior members of staff including a Trustee and the Chief Executive. This group identified various methods for involving our stakeholders which includedInterviewing patients, carers, volunteers and paid staffListening exercise with carersQuestionnairesProductive Ward Seriesa template for writing reports on these activitiesa leaflet to hand-out giving an explanation of “Involvement”ResultsAs a result of this we are now:-Piloting Nurse Led ClinicsOpening Day Care to bereaved carersUsing a new discharge planning template on the inpatient unitImplementing a “Carer’s Break” scheme via Day CareDeveloping a complementary therapy strategy based on user feedback about the value of this service to themConclusionsThe moving from “meeting” to “happening” has helped to promote the principles of equality, fairness and inclusiveness by actively seeking to engage with our stakeholders including our staff.The identification of services valued by patients and their carers has ensured that our finances are spent in addressing the needs of our patients rather than what we consider their needs to be.
P153 Service User Group (SUG) - From inception to beyond
Authors: Thompson Doreen 
Published: October 2013

BackgroundTo establish a SUG giving patients, carers, staff and members of the public opportunity to engage in improving hospice services.Involvement covers a range of activities, from consulting service users about their views in partnership, to aid the development of projects or services.Ensures the views of patients, carers and the public are listened to, ensuring that we continue to maintain excellence within our service now and into the future.Aims and objectivesSUG established to enable the hospice to provide evidence of consultation on matters directly related to patient care.SUG involved in consultation on available information for service users.Review and approve production of literature to ensure service users receive relevant information.SUG involved in fund raising and promotion of hospice services.SUG ensures service users input into service provision, promoting standards of excellence in patient careApproach usedIPU Sister identified as project lead.Advertised to promote development of Service User Group. Invited participants to join via appropriate communication channels.Guest speaker utilised to drive engagement.OutcomesThe SUG is involved in decision making on hospice improvements and have participated in workshops with a local Cancer Network Group. A service user and the Network group leader were key speakers at the group conference. The SUG have worked on patient feedback and audit tools and information leaflets for patients and families.The SUG were runners-up in the Patient Experience Network (P. E. N.) awards 2012.SUG has forged links with the local Hospital patient partnership forum. Representatives attend the meetings of both groups.With a diverse, growing local population the SUG helps to reflect our local community needs. Their unique input helps the organisation see new perspectives on service development.
P154 Food and nutrition in a hospice: From audit to action
Authors: Tsiompanou Eleni , Day Teresa , Knight Andrew 
Published: October 2013

In 2011, Princess Alice Hospice (PAH) participated in the test phase of the Nutrition and Hydration Audit tool which was created jointly by the Help the Hospices Food and Nutrition Group (FNG) and the National Audit Tools Group (NATG)1. Since this pilot audit was completed a number of steps were taken to reach standards that were highlighted by the audit:A ‘Nutrition Requirements Tool’ was introduced on the ward. Further work has been undertaken to develop this tool.Understanding the patient experience is at the heart of hospice care. We asked patients on the ward and in Day Hospice to tell us what they thought of our food service. Patients told us that the food and drink service that we provide is excellent. Areas of potential improvement are: protected mealtimes; attending to cultural & religious requirements, allergies and intolerances, special diets; giving written information re: food service; menus and food portions.We provided regular teaching/training sessions for internal and external staff and volunteers. Our training enables healthcare professionals to become more involved in establishing nutrition as part of the patient’s care plan and actively listen to patients and carers, offering support for their needs in relation to foods and lifestyle.An eight-week support and education programme for patients and carers was designed in Day Hospice, offering up-to-date information from our multi-disciplinary team on nutrition and diet, lifestyle and symptom control.Our Nutrition Steering Group meets to promote the role of the multidisciplinary approach to nutritional management and care of our patients.Princess Alice Hospice is committed to delivering safe and high quality nutritional care to people with life-limiting illnesses, their families and carers. We are keen to share our results and experience with others and to improve further our service.
P155 Making sense of shades of grey!: Impact of hospice ultrasound use on patient care
Authors: Jones Tim , Groves Karen 
Published: October 2013

BackgroundPatients with advanced disease require transportation to hospital for ultrasound identification of abnormal fluid and location marking. This is not only exhausting, but introduces service delays, increases work for an already overburdened hospital radiology service and reproducing the exact position of original scan is difficult.AimDoes the introduction of portable ultrasound improve patient, carer & health professional experience and co-ordination of care?MethodTwo hospice doctors underwent the necessary ultrasound scanning training for non radiologists. Following a selection process, an appropriate portable ultrasound machine was purchased, and support agreed with one of the local radiologists.ResultsA retrospective review of thirty months ultrasound use was undertaken. One hundred and four patients have had one hundred and sixty eight separate scanning episodes resulting in eighty five procedures. Uses have included confirmation of presence & location of abdominal ascites prior to paracentesis, confirmation of location of pleural fluid prior to aspiration, confirmation of full bladder prior to catheterisation (urethral or suprapubic), monitoring the growth of large intra-abdominal malignant cyst, confirmation of hydronephrosis, biliary stent placement & locating nerve in real time neural blockade. The poster includes detailed analysis of use.ConclusionOn each occasion a definitive clinical question was answered. Patients report greater satisfaction from a speedier service, families feel that patients are less fatigued by the interventions and staff feel able to give a better, more responsive, safer service, adhering to current best practice guidance. Being able to ultrasound patients in the home or in outpatients has prevented unnecessary admissions where the cause of abdominal distension had previously been in doubt.
P156 Lung clinic to meet the needs of patients with non malignant lung disease at Garden House hospice
Authors: Wallis Diane 
Published: October 2013

IntroductionIn 2011 the Department of Health Outcomes strategy for COPD suggested that the needs and preferences of patients for care at the end of life were not being met.The model of Day Hospice did not meet the needs of this group of patients; therefore a proposal was put forward with the support of the local chest physicians to provide a service accessible to COPD patients and their carers.A pilot clinic was set up for twelve months. Staffed by a nursing Sister, a physiotherapist and trained volunteers.AimsThe aim was to develop an accessible multidisciplinary service that met the individual needs of the patients, family and carers. This included transition to palliative care services, psychosocial support, symptom management and advanced care planning.MethodDuring the pilot and the following year the numbers of patients attending was monitored. Also the source of referrals was examined. Some anecdotal feedback was gained from the referrers. The service was adjusted overtime to maximise accessibility for the patients.A qualitative questionnaire was produced in December 2012 to find out the perceived benefits for patients attending the clinic and if there was anything else that could be provided. Nine questionnaires were completed.ResultsThe results of the questionnaire suggested that the patients were fearful of attending the hospice beforehand, however, once attendance had commenced their psychosocial and symptom control needs were being met. The results of the questionnaire will be made available.ConclusionThe clinic is meeting the patients’ needs, therefore it will continue in its current format. There is a need to discuss and consider strategies to educate the referrers on Hospice philosophy and the aims of the clinic so they can help change the fearful expectations of the patients on referral.
P157 A palliative care intervention for patients with advanced non-malignant respiratory illness
Authors: Mackay Marjory , Christie Janice , Moodie Alison , Lynch Deborah 
Published: October 2013

IntroductionPatients with advanced respiratory disease do not routinely access palliative care services and given that many are unable to attend hospital appointments, they are even less likely to receive quality palliative care support in their last year of life. This collaborative project between an NHS Respiratory Team and a Hospice aimed to address this inequity.AimsThe specific project aims were to: improve symptom control; raise patient and carer awareness /understanding of illness and prognosis; explore patients’ wishes about future treatment and care and establish an advance care plan (ACP); communicate patients’ wishes across health care settings; reduce inappropriate hospital admissions and inappropriate treatments.MethodsUsing a convenience sample over a 12 month period, all patients who met inclusion criteria (adapted from Gold Standard Framework prognostic indicator guidance) were referred by the respiratory team to specialist palliative care (n = 49). The planned intervention comprised three visits to the patient’s home by a palliative care nurse specialist.Data collection aimed to evaluate the outcome of visits; the follow-through of ACP wishes during hospital admissions; patient experience; GP feedback; impact of project on specialist respiratory nurses and patterns of hospital admissions.Quantitative data was analysed using descriptive statistics and Qualitative data was collated into themes.A favourable ethical opinion was granted for the project.ResultsResults to date suggest that 1) selection criteria were effective, 2) the intervention had a positive effect on patients’ wellbeing and engagement with the ACP process, 3) purposeful communication and treatment across healthcare settings were enhanced. Some challenges are also emerging, all of which will help shape future service provision. It is anticipated that this collaborative model of service is transferrable to other non-malignant specialties and could be adapted by other hospices /palliative care servcies. Final results are due to complete by June 2013.The project was part funded by the Burdett Trust for Nursing.
018 One Step Beyond: Working in partnership with CCGs to extend access to Bereavement Services
Authors: Patel June , Helm Sarah Popplestone , Westwood Debbie 
Published: October 2013

AimsThe service aims to - Provide access to bereavement support for all bereaved people irrespective of age, culture disability and gender - Assess bereavement need and signpost people pre and post bereavement to bereavement services within their locality - Extend access to advice 24/7 supported by the development of a bespoke bereavement websitewww.bereavementsupportworcestershire.org.uktelephone help-line service, Counselling and Social Work support - Raise professional awareness about grief by providing bespoke education and training - Raise awareness of the bereavement process and coping strategies of bereaved individuals and families by education and group support. Approach A formal tendering process resulted in securing a three year NHS contract. A multi-agency project group was formed, including a service user, to develop the operational service model in accordance with the NHS service specification. Outcomes - Widening access of bereavement support to adults and children experiencing sudden death from suicide, RTAs’ and unexpected deaths - Multi-agency engagement in shaping operational model - Rapid access to social work and counselling social for the bereaved following self-referral and referrals from Primary Care - Positive evaluations from services users and GPs’ - Service user involvement in the formal media launch with South Worcestershire CCG - 193 professionals have attended education programme and positively evaluated - 7401 hits to access information on bereavement website.
P158 A hospice motor neurone disease clinic: challenges and benefits of a new service
Authors: Bywater Jane , Butt Jo , Mathias Caroline , Smith Jean , Gaffney Rachel 
Published: October 2013

Background/contextThe Hospice in North Hampshire had offered support and care to MND patients but in an unstructured way. Close working between the Palliative Medicine and Neurology Consultants led to a recognition that both early and advanced care could be improved if services were to work more closely together.AimThe aim was to set up and run a montly multi-disciplinary clinic for people with MND in the Hospice, allowing access to all members of the multi-disciplinary team (neurologist, consultant in palliative medicine, care centre co-ordinator, hospice at home team, social worker, physiotherapist, OT, speech and language therapist, Association Visitors) via one clinic. The clinic link with the MNDA would improve access to information about services. The outpatient hospice setting allows informal support for pts and carers from Assoc Visitors.OutcomesTo improve the patient and carer experience.To ensure access to hospice services early in diagnosis.To improve both peer and carer support through joint working with the MNDA.To develop a specialist skill base with opportunities for support and training of other professionals.To develop patient professional relationships which allow easy transition in the end stages of illness.Application to hospice practiceMany centres across the country run a multidisciplinary MND clinic but traditionally in the hospital settling. Evidence is good for improvement in patient care from a hospital model of service delivery model. Hospices have many advantages with their experience in coordinating care and community focus. The early links with the Hospice allow continuity of care throughout the patient journey.
P159 Changing a Lymphoedema Service through Service Redesign
Authors: Murphy Debbie 
Published: October 2013

BackgroundWell established Lymphoedema service facing number of escalating issues:Increasing referralsOver budgetFrustrated staffLack of care pathways and long term managementLack of innovationAimReduce financial strainProvide clear care management strategyIntroduce self-management strategiesEnsure full access for individuals with Lymphoedema.Approach UsedPoor team work - looked at strengths and the weaknesses of each team member as a teamCost reduction – compression garment formulary assessed on cost effectiveness, size of range, availability on FP10, education supplied by the company.Care pathways – patient journey plotted dependent on severity of condition.Discharge policy developed, packs sent to the GP and to patient.Long term self-management - six week education programme combined with fun exercise class (Le Bed), gives patients tools to manage own condition.Following discharge from Le Bed, Lymphoedema Information Fun Event (LIFE) established after feedback from patients - provides ongoing information about service development. Group used as patient reference and involvement group e.g. feedback on leaflets etc.Investment in new technologies (lymph assist machines, lasers, oscillator) - enhances treatments offered, produces quicker results.Kinesio tape introducedChildren’s Lymphoedema Service initiatedBra fitting service developed.OutcomesGreater sense of team - clear lines of reporting, goal setting and monitoring.Expansion of team with a clear mix of skillssupport worker undertaking more routine work, specialist nurses concentrate on more complex casespart time specialist appointedLymphoedema physiotherapist (still to be appointed)training and development - manual lymphatic drainage, Le Bed instructor training, bra fitting, wound management, child protection training etc.Number of new patient referrals has increased year on year (see table)Negotiated and secured contracts with three additional CCG’s2008/2009 = £23k overspend, 2011/2012 break even (including reinvestment in new technologies and education)Number of intensive treatments increased from 27 in 2010/2011 to 119 in 2012/2013Patients self-managing - the discharge pathway and Le Bed class – leading to greater self esteemLymphoedema manager recognised as Lymphodema nurse of the Year 2013, British Journal of Nursing
P160 Think again! Treatment changes for patients with head, neck and facial swelling
Authors: Norris Julie 
Published: October 2013

BackgroundFew patients referred for head, neck and facial lymphoedema as widely viewed that very little could be done, apart from prescribing tight fitting compression garments which are very constrictive and have a low patient compliance.AimImprove access for patients experiencing lymphoedema to the head, neck and face.Identify alternative treatment methodsDevelop closer working relationships with the Speech and Language, Dietician and Head and Neck services.Approach UsedFour cornerstones of care used:-Skin care: application of regular skin cream to hydrate skin, prevent infection and encourage self-managementManual Lymphatic Drainage (MLD): specialised gentle massage to aid and stimulate drainage.Simple Lymphatic Drainage; patient learns to move the build-up of fluidExercises (facial):- Encourages muscle movement, aids movement of lymphatic fluid. Breathing exercises stimulate deeper lymphatic vessels in chest and abdomen to enhance lymph drainage.Compression worn to maintain shape, reduce swelling.New treatment modalities (accompanied by modified MLD):Low level laser therapy: infra-red wavelength penetrates deep into tissues, aids softening of fibrosis and scar tissue, useful in treating cording.Deep oscillation therapy: - penetrates deep into body tissue triggering lasting resonanceKinesio Tape: increases body’s ability to drain lymphatic drainage to healthy lymph nodesThese innovative treatments have proved to be an effective adjunct to our existing specialist knowledge and enhanced treatments offered to patientsMeasurements pre and post treatment compared using photographsPatients complete questionnaire after each session, record any immediate changes to symptoms.OutcomesIncreased referrals for treatment to head, neck and face2011/2012 - 5 referrals2012/2013 – 17 referralsDevelopment of a closer working relationship with the surgical head and neck multidisciplinary team at hospital.Patient commentsI don’t feel that everyone is looking at my face as they did before, I felt like I was the elephant man, much happier and I went for a walk with the wife, I wouldn’t have done that a few weeks ago.I was able to eat normal food after treatment for that day
P161 Meaning of pain for patients with advanced cancer and how it influences behaviour: A qualitative research study
Authors: Jennings Rebecca 
Published: October 2013

BackgroundHealth related quality of life incorporates physical function and independence which are high priorities for patients with advanced cancer. These two inter-related domains can be compromised through the experience of cancer-related pain. Patient-held meanings of cancer pain may have potential to influence behaviours which determine functionality and quality of life.Study aimTo explore the meanings of pain among patients living with advanced cancer and to understand how these influence functional behaviours, with the aim of developing clinical recommendations to inform patient care.DesignParticipants underwent in-depth, semi-structured, qualitative interviews. Data was analysed using Interpretative Phenomenological Analysis to identify emergent themes.Setting/Participants:Ten patients with advanced stage cancer experiencing cancer–related pain were recruited from an Inner-London hospice palliative care service.ResultsMeaning of pain in advanced cancer is inextricably linked with loss and bereavement. Meaning of pain is a dynamic, temporal process underpinned by the following themes: (i) nature of cancer-related pain, (ii) multidimensional impact of pain on patients’ function and behaviour, (iii) ‘Web of Loss’: a complex network of losses that perpetuates cycles of further loss and (iv) hope and appreciation of life. The data suggests meaning of pain has an indirect influence on behaviour mediated by the coping strategies patients adopt. Meaning of pain has potential to promote both constructive and maladaptive responses in functional behaviour.ConclusionsFindings further our understanding of the experience of cancer-related pain and inform bio-behavioural approaches to pain management in palliative care. Recommendations include (i) tailoring pain management to dedicate greater attention to the behavioural dimension of cancer-related pain (ii) timely identification and management of preparatory grief in patients with advanced cancer and (iii) promotion of constructive coping strategies to support patients to make sense of their pain and maintain functionality within the limitations of advancing disease.