bluuebunny/crossref_metadata_2025_split huggingface dataset:
PROVISION OF INFORMATION IN THE RESPIRATORY UNIT
Authors: Jackson Isobel , Davies Helen 
Published: February 2014

IntroductionNICE guidance identifies the need to ensure effective communication of evidence-based information between patients and professionals to allow informed decision-making.AimTo assess patients' experiences of information provision within our Respiratory Unit and explore ideas for service improvement.MethodsA questionnaire was distributed to 50 patients (20 lung cancer, 20 COPD, 10 ILD).ResultsPatients with COPD felt more short of breath (mean NRS score 6.9; lung cancer 4.05; ILD 3.3; ANOVA p=0.001) and were more troubled by it (p=0.002). Patients with COPD and lung cancer experienced episodes of panic more than patients with ILD (80% vs. 70% vs. 40% respectively). 45% of the lung cancer group expected their condition to improve, compared to 16% and 10% of patients with COPD and ILD respectively; however overall there was no significant difference between the groups' expectations of their disease prognosis (p=0.09). 40–58% of patients could not recall being told about their future disease course – 20% of each group reported being told they would ‘get worse’. Most patients received information from their GP and Hospital Consultant (although Clinical Nurse Specialists (CNS) rated highly in the lung cancer group 55% (15% COPD, 10% ILD)); few patients accessed the internet for this purpose (10-15%).Patients were satisfied with their treatment however provision of more information about their disease and improved access to their GP and Hospital Consultant were identified as ways to improve care.DiscussionOur patients' experiences mirror NICE guidance that communication improves care. Patients recognise Hospital Consultants as the main source of information yet identify a need for more information to optimise care. This remains an area we can influence. Increasing access to CNS support and judicious use of the internet could help to alleviate this deficit.
IMPLEMENTATION OF A PILOT MULTIDISCIPLINARY TEAM MEETING FOR SUPPORTIVE CARE IN ADVANCED LUNG DISEASE ( SCALD MDTM)
Authors: McTague Laura , Al-khairalla Mudher , McCook Ruth , Edwards Debbie , Warner Dawn 
Published: February 2014

BackgroundLocally, only 12% of patients with advanced lung disease die at home. There is a significant rate of readmission to hospital in the last year of life. Most patients are housebound. Contact with Specialist Consultants and advance care planning is ad hoc.The idea to develop the Multidisciplinary team meeting (MDTM) arose from the Acute Hospital Senior Clinicians EOLC development project and a local review of COPD services. The pilot took place within current local resources.AimThe Supportive Care in Advanced Lung Disease (SCALD) MDTM aimed to support clinical staff in identifying the last year of life. The MDTM would review appropriate investigations, discuss and communicate advance care planning and optimal symptom control to all involved.MethodThe MDTM included a respiratory consultant, specialist palliative care consultant and community respiratory nurse specialists. Patients gave verbal consent to the community respiratory nurses or referrer for the MDTM discussion to take place. The meeting was held at monthly intervals. A template was designed to record the MDTM and a letter was sent out the same day by the MDTM lead. The referrer returned to the patient to discuss the outcomes.ResultsA survey of 20 patients was carried out. The majority of patients had severe COPD, were housebound and on long term oxygen therapy. Advance care planning including plans for appropriate ceilings of care and preferred place of death were improved as a result of the MDTM. Other outcomes included specialist palliative care consultant home visits and respiratory consultant clinic review.DiscussionThe SCALD MDTM design and implementation resulted in improved advance care planning and Consultant contact. A larger pilot and research would give increased knowledge about the impact of this service design on the experience of advanced lung disease patients in the last year of life.
USING LITERATURE TO INFORM VIGNETTES DESIGNED TO EXPLORE THE PERCEPTIONS OF IMPLANTABLE CARDIOVERTER DEFIBRILLATOR (ICD) DEACTIVATION AT END OF LIFE
Authors: Hill Loreena , McIlfatrick Sonja , Taylor Brian , Fitzsimons Donna 
Published: February 2014

BackgroundRates of ICD implantation are increasing and while international documents guide professionals on the management of patients with an ICD, recent evidence illustrates disparity in the application of guidelines to practice. Furthermore limited research on patient preferences and lack of clarity on the ICD's role at end of life are compromising the provision of optimal care.AimsA systematic review of evidence published between 2008 and 2013.MethodsA generic search strategy was developed, based on twelve key terms which were refined through an iterative process involving articles retrieved in a preliminary scoping review. Six electronic databases were selected and the search strategy adapted and applied. Studies were included if they met the inclusion criteria- Empirical studies published in English Language; primarily related to adults (above 18 years) with an implanted ICD; primarily related to the deactivation of ICDs at end of life. Citations and expert recommendation papers were checked for relevance. Quality of each study was assessed using the Hawkeret al., (2002) protocol and data were systematically extracted. Narrative synthesis led to the development of 3 key themes and identification of the salient factors or independent variables (IVs) in the ICD deactivation decision.ResultsWithin the literature there is considerable variation in patients' preferences concerning ICD deactivation. These were grouped under three themes- preferences for the discussion, the ethical and legal considerations and facing the future. The validity of this evidence will be further refined through qualitative exploration involving patients, carers and professionals to determine the most appropriate IVs to generate vignettes for a UK wide professional factorial survey.ConclusionsThis innovative factorial survey design combines qualitative exploration and quantitative survey techniques. Greater understanding of decision-making in this complex setting will contribute to the development of appropriate educational support and improved care for ICD patients approaching end of life.
AN AUDIT OF REPORTED OPIATE ERRORS IN NORTHUMBRIA HEALTHCARE TRUST, 2012
Authors: Grogan Eleanor , Norris Laura , Parker Rebecca 
Published: February 2014

BackgroundOpiates are frequently identified in medication incidents resulting in severe harm or death. The National Patient Safety Agency (NPSA) collects data pertaining to this and has made relevant recommendations.AimsTo identify and systematically review errors in high risk opiate prescribing and/or administration in Northumbria Healthcare Trust, 2012, in order to inform patient safety recommendations locally.MethodsThe audit identified all errors reported via the trust's electronic incident management system, the associated case notes were reviewed and data analysed using descriptive statistics/thematic analysis.Results34 (of 45) sets of notes were available for review (75%). 5 drugs were involved, of these 3 accounted for 91% of all errors (Morphine, 50%; Oxycodone 23%; Fentanyl, 18%).Administration errors accounted for 56% (n=19) of errors identified, prescribing 23% (n=8) and the remainder (21%;n=7) demonstrated errors in both domains.Themes associated with administration errors were variable but included:▸6 incidents related to Fentanyl (failure to remove patch, patch re-applied at inappropriate interval, incorrect patch applied).▸6 incidents of an incorrect drug being given;4 of which involved Oxycodone liquid and Oxycontin M/R.Other errors included administration without a signed prescription, incorrect doses, delays/omissions and inadvertent repetitions of doses.Themes associated with prescribing errors included incomplete or illegible prescriptions, incorrect drug/dosing and failure to prescribe regular medications.ConclusionsThe audit is limited by sample size, reporting practice and an incomplete data set. However, the data obtained demonstrated similar themes to data collected by the NPSA. A proportionally high degree of errors occurred within the context of Fentanyl and Oxycodone prescribing/administration.Specific interventions include:▸A trans-dermal patch administration and removal chart.▸An educational opiate ‘wall chart’ for healthcare staff.▸An alert sticker for high concentration opiate solutions.▸Recommendations may be applicable in other settings given the correlation the findings have with national data.
THE MODERN HOSPICE AND MEDICAL INTERVENTIONS
Authors: Gillon Suzie , Lowe Emma 
Published: February 2014

BackgroundThe modern hospice has to find a balance between providing traditional holistic palliative care, and up to date effective medical treatments and interventions. This has at times led to discussions that hospices are losing their unique identities and becoming akin to acute hospital wards.InterventionNo of patients (%)Fluids21 (15)Oral antibiotics19 (14)Intravenous antibiotics11 (8)Blood transfusion3 (2)Bisphosphonate infusion2 (1)Paracentesis2 (1)Other8 (6)AimsWe sought to objectively quantify medical interventions in a cohort of hospice inpatients from our 32-bedded city-based hospice, with around 600 admissions a year. Interventions included were: antibiotics (oral and parenteral); blood transfusions; bisphosphonate infusions; fluid infusions (intravenous (IV) and subcutaneous), and procedures such as paracentesis. We also noted the number of patients having blood tests at any time during admission.Results140 notes were available from 144 consecutive hospice admissions from Jan 1st2013. M=62, F=76. Mean age=72. Primary diagnosis: Malignancy=122 (87%). Mean length of stay=13.5 days (range 2 hours to 65 days). 84/140 (60%) of patients had at least one blood test during admission. 93/140 (66%) patients had no other interventions during their stay. 44 patients had interventions in the following categories:‘Other’ comprised: albumin infusion (2); IV hydrocortisone (1); IV proton-pump inhibitors (3); transfer for coeliac plexus block (1) and transfer for management of neutropaenic sepsis (1).ConclusionsAlthough hospice care is undoubtedly evolving, the majority of patients still do not undergo active or ‘invasive’ interventions. Regular review of this would allow discussion and goal-setting re future priorities for hospice care. It is important to create a balance between providing the best evidence-based care for patients while also not undertaking unnecessary interventions.
LONG-TERM OPIOIDS AND NALOXONE ADMINISTRATION IN A DISTRICT GENERAL HOSPITAL
Authors: Facey Caroline , Brooks David 
Published: February 2014

BackgroundRespiratory depression is a known side effect of opioid medications. Naloxone is an opioid antagonist used in the reversal of opioid overdose. The use of naloxone in patients on long-term opioids can lead to refractory pain and opioid withdrawal.ObjectivesTo determine the number of patients on long term opioids, admitted either electively or as an emergency, given naloxone in a district general hospital. To determine if naloxone use is in line with local guidance, which recommends naloxone should be administered to patients with respiratory depression, evidenced by a respiratory rate less than 8 and oxygen saturations less than 85%.MethodA retrospective audit for all patients administered naloxone over a 12 month period (January–December 2012) at Chesterfield Royal Hospital.ResultsA total of 21 patients on long-term opioids were administered naloxone. Of the 21 patients in whom naloxone was administered, 2 patients had had an opioid dose increase during their hospital stay and 4 patients had been given additional opioid. Of the 21 patients, 1 patient given naloxone had documented evidence of respiratory depression. 7 of patients given naloxone had no documentation to support respiratory depression while 13 of the patients given naloxone had documentation that supported no respiratory depression.ConclusionCurrent practice compared to the local guideline is not satisfactory. Patients on long-term opioids, without respiratory depression, are being given naloxone, which could lead to refractory pain. The main areas identified for improvement are staff education and changes to the electronic prescribing system. This would include an opioid reversal bundle with recommended guidance for evidence of respiratory depression.
PLANNING FOR THE FUTURE WITH PATIENTS WHO HAVE ADVANCED HEART DISEASE: DESIGNING A RANDOMISED CLINICAL TRIAL OF ANTICIPATORY CARE
Authors: Highet Gill , Cudmore Sarah , Robertson Shirley , Murray Scott A , Boyd Kirsty , Denvir Martin A 
Published: February 2014

BackgroundMany patients with advanced heart disease have a limited prognosis despite optimal medical, surgical and device therapy. These patients rarely receive coordinated, holistic care that acknowledges their individual needs and those of their informal carers.AimsThis study assesses the feasibility of a randomised controlled trial of a complex intervention that incorporates ongoing, holistic care with anticipatory care planning for people with advanced heart disease.MethodsWe conducted 11 interviews with a diverse sample of healthcare professionals and 2 focus groups comprising 12 patients and 5 carers. Participants were given a previously developed “Future Care Plan” and details of the trial before the interviews/ focus groups. These acted as focal points for discussion. Data were transcribed and analysed using standard software to extract themes related to the rationale and design of a clinical trial of anticipatory care planning in advanced heart disease.ResultsPatients and carers highlighted fragmentation of services, difficulty in accessing specialist care and inadequate time for future planning and preparation as key barriers to holistic care. A patient-held plan was welcomed. Healthcare professionals identified challenges related to uncertainty of prognosis, explaining mortality-risk to patients, and switching from curative to palliative approaches. These data informed patient selection (a combination of prognostic tools and needs for additional supportive care), the intervention (cardiologist review and nurse-led support delivered though a patient-centred care plan), and clinical trial outcomes that are robust but measurable in a frail population.ConclusionsPatients, carers and healthcare professionals share a number of common concerns in relation to providing high quality care for people with advanced heart disease. The findings of this exploratory study are informing the implementation of a phase II randomised clinical trial of an holistic, anticipatory care planning intervention for patients with advanced heart disease in line with good practice in end of life care.
MEDICAL HANDOVER IN NORTHAMPTONSHIRE HOSPICES: ROOM FOR IMPROVEMENT?
Authors: George Mariam , Brookfield Sam , Shah Sanjay 
Published: February 2014

BackgroundA rigorous medical handover system in a hospice is essential to ensure patient safety as well as quality and continuity of care especially in the face of changing work patterns of hospice doctors. A General Medical Council survey (2011) highlighted a lack of formal handover arrangements among palliative medicine trainees.AimTo review current medical handover system of weekend handover stickers (HSts) and to identify examples of good hospice medical handover practice.MethodWeekend medical HSts were audited at two Northamptonshire hospices, which share an on-call rota. Feedback from doctors exploring usefulness of HSts was obtained. To identify other hospice medical handover models, literature review, palliative care forums and informal discussions with hospice doctors at regional meetings were used.ResultsNinety-eight weekend HSts were audited. Background medical details and weekend management plan were recorded in 98% and 93%, respectively. Although HSts were useful, documented information was variable and did not always contain necessary details to inform complex decisions involving life-prolonging and life-sustaining treatments in addition to the psychological, emotional and spiritual factors influencing clinical manifestations of the dying. Occasionally HSts were complimented with poorly documented verbal handovers. The audit highlighted the need for descriptive information to address the question “what to do in the event of deterioration”. Though a few electronic handover systems in other hospices were identified, the common underlying theme was the need for a standardized medical handover system.ConclusionHandover does happen among hospice doctors, albeit in a different format to that of acute medical specialties. Though our weekend handover stickers are used regularly, effective ways to capture information to inform complex decisions need to be identified. The new electronic health record systems being rolled out in Northamptonshire will need to incorporate the facility to extract such information.
HANDOVER OF PALLIATIVE PATIENTS TO OUT OF HOURS CARE
Authors: Murray-Brown Fay 
Published: February 2014

BackgroundCancer patients spend 90% of the last year of their life at home. At least two thirds of the working week is out of hours. The Gold Standards Framework aims to optimise care for patients nearing the end of their life in the community, with consistent care coordinated effectively across all settings and delivered by practitioners who are aware of the person's medical condition, care plan and preferences.AimsThis audit aimed to establish, in August 2013, how many of the patients known to the Specialist Palliative Care Team (SPCT) at St Luke's Hospice, Plymouth, were also known to Devon's GP Out of Hours (OOH) coordinator, DDocs, in the form of Special Notes. The standard was set at 85%.Results461 patients were known to the SPCT, but 79 were excluded as were not end of life. Of 382 patients remaining, 90% had cancer and 10% had MND or chronic diseases. 290 patients (76%) had Special Notes. Smaller numbers had further information highlighted, including Diagnosis (72%), Resuscitation Status (54%) and Advance Care Plans (9%). 235 patients (62%) had contacted DDocs in the last 6 months, almost all for a palliative problem.ConclusionsThe audit standard of 85% was not met, however, this is an improvement from 2011, when 63% had Special Notes, and is better than other counties, i.e. Dorset, where only 22% of patients were flagged in 2011. A Dorset GP survey revealed that the majority of GPs thought they had flagged patients to OOH, yet only 22% had. A survey of Devon GPs is underway to establish attitudes to handover of patients to OOH, and identify why Devon is better, though not meeting the standard. One hypothesis is that GP cooperatives are run differently across counties, with Devon GP practices taking a more active role in OOH care.
RELEVANT, RESPONSIVE AND REALLY USEFUL
Authors: Howarth Susan , Coackley Alison , Griffiths Ann , Noble Agnes , Hampton-Mathews Julian , Foulkes Margaret , Lee Heather 
Published: February 2014

IntroductionNurse-led clinics are recognised as an important part of health care provision as service demand across the UK continues to escalate. The End of life Care Strategy recommended that all palliative care patients should have access to rapid specialist advice and clinical assessment.Cancer centres cover wide geographical areas. Patients attending for treatment are often unable to access their local palliative care services. This can lead to inadequate assessment/management of physical, psycho-social and spiritual problems.Aims1. To ensure that patients attending for cancer treatment have access to appropriate, timely specialist palliative care2. To improve liaison with other healthcare professionals and provide support/information.3. To ensure seamless co-ordinated care by excellent communication with local palliative care teams.MethodA twice weekly nurse-led palliative care clinic was set up in a cancer centre with clear referral criteria. Joint reviews with nursing/ medical colleagues were encouraged. There was input available from a Consultant in Palliative Medicine. Clinic letters were produced and faxed at the end of each review. Evaluation forms were sent to all healthcare professionals.ResultsClinics run for two hours. 180 patients have been reviewed over 18 months. An increasing number of joint reviews have been undertaken. Flexibility is key as 50% of referrals are seen as emergencies. 93 % were for pain/ symptom control. 70 % for psychological support 30% were for spiritual support. 50% of referrals came from medics, with 50% from clinical nurse specialists. The majority of patients were managed as out-patients. 25% required admission to the Unit. A full breakdown of clinic activity and outcomes will be available in the final report.ConclusionNurse-led clinics are an excellent way of delivering care to patients attending a tertiary cancer centre. Improved joint working and creation of educational opportunities are also significant benefits of the service.
ONE STEP AT A TIME, THEN GO FOR IT! IMPLEMENTING A 16-WEEK WELL-BEING PROGRAMME IN A HOSPICE DAY THERAPY UNIT
Authors: Capewell Claire , Green Debra , Salt Susan 
Published: February 2014

BackgroundIn common with many other hospices, our Day Therapy Unit has been changing from a service used largely by a ‘long-term’ cohort of patients who may have attended for months or years. Over an initial period of around 2 years, work was done to facilitate the discharge of stable patients and to gradually change the ethos of the Day Therapy Unit in moving towards a 16- week, goal focussed attendance.AimsBuilding on these changes our aim was to design a 16-week rolling programme, which would help patients to meet their goals and to provide strategies for maintaining well-being.ResultsWe searched the notes of current patients to gain understanding of the most common reasons for attending Day Therapy Unit. The prominent themes were: to counter social isolation, provide emotional/psychological support and to improve mobility and pain.A programme was devised covering 8 sessions over 16 weeks. Topics were chosen based on the domains in the ‘Holistic common assessment’ document. The domains are: physical well-being, social and occupational well-being, psychological well-being with spiritual well-being and life goals. Titles of our sessions include ‘Bucket list and beyond’, ‘Controlling your pain’, ‘Resilience’ and ‘There is life after Day Therapy Unit’. Sessions will promote group discussion and individual reflection. Patients will be provided with written material to accompany the sessions. Delivery of the programme is truly multi-disciplinary: facilitators are nurses, doctor, physiotherapist, clinical psychologist, social worker, chaplain and counsellor. We continue to offer physiotherapy, complementary therapies and art therapy alongside this new programme.Our hope is that this programme will enable us to promote a culture of enablement amongst our current patients and to reach larger numbers of patients. Once the programme is established, we intend to investigate whether there is a demonstrable improvement in markers such as Quality of Life.