bluuebunny/crossref_metadata_2025_split huggingface dataset:
‘Do Not Attempt Cardiopulmonary Resuscitation’ discussions at the point of discharge: a case note review of hospice practice following local integrated policy implementation
Authors: Hall Charlie Christopher , Mark Kathleen , Oxenham David , Spiller Juliet Anne 
Published: September 2011

BackgroundAn integrated ‘Do Not Attempt Cardiopulmonary Resuscitation’ (DNACPR) policy was implemented across Lothian in 2006 (for ease of reading the terminology ‘DNACPR’ has been used throughout the paper where the original Lothian Policy used ‘DNAR’). Patients were, for the first time, able to be discharged home with their DNACPR form after discussion about cardiopulmonary resuscitation (CPR).AimsTo ascertain the number of patients who, following a discussion, were discharged with a DNACPR form and the reasons for not holding discussions with certain patients.MethodsTwo retrospective case note reviews of 50 patients discharged over two 4-month periods (2007 and 2009).ResultsThere was a high proportion (78–80%) of CPR discussions for patients discharged from the hospice. Reasons for not discussing CPR were: potential for excess distress (10–12% 2007 and 2009) and lack of time (4% both years). Of those discussing CPR on discharge, 90% took forms home in both years. The reasons patients did not take forms home were: form not taken in error (two patients in 2007); patients refusing a form at home (one and three patients in 2007 and 2009); form to be arranged by general practitioner and one incomplete discussion. The proportion of patients with forms already at home increased from 10% (2007) to 28% (2009).ConclusionIt is possible to discuss CPR with a high proportion of hospice patients prior to discharge from a hospice. Following the introduction of an integrated policy, more patients have DNACPR forms prior to admission. Most patients receiving specialist palliative care find DNACPR discussions acceptable and understand the benefits of having a DNACPR form.
Enriching the experience of patients on a hospice ward with volunteer carers
Authors: Carpenter Jane 
Published: September 2011

IntroductionWe are working in a difficult global economic climate, increasingly caring for patients with complex needs. As a local charity we need to make best use of our resources, spend donated money in the most responsible manner while continuing to expand patient care services, maintaining the highest quality of patient focused care.AimTo develop volunteers to undertake clinical activity and enhance the inpatient experience, making better use of all resources.MethodsThe ward volunteers were approached with a proposal to expand their role. The staff were informed of the plans and their concerns addressed at an early stage; they were involved throughout the project.The plan followed was:▶A consultative approach▶Volunteer skills portfolios developed▶Ward competencies, supervised practice and classroom based training for volunteers▶Initial focus – patient nutrition and oral care▶Subsequent introduction of hygiene care.ResultsAn increasingly confident and flexible volunteer workforce with more involvement in clinical patient care. An efficient use of resources, releasing staff to focus on complex aspects of care, Volunteers are now offering ward administrative support, helping patients with creative activities and are becoming integral to all aspects of ward activity.Discussion and conclusionDeveloping volunteers in this way has taken investment of time and staff resources, resulting in an increased richness to the inpatient environment. Volunteers now utilise other skills so that they can participate more fully in the ward domain. Ward nurses now appreciate the volunteer input and rely on their presence; the changes have enhanced our skill-mix and increased our staff: patient ratios.
Motor neuron disease and music therapy – a holistic approach
Authors: Mackinnon Helen 
Published: September 2011

This is a case study presentation of working through music therapy with a 66 year-old lady (L)who has been living with motor neuron disease (MND) for 5 years. At the start of the therapy sessions she had already reached the stage of tetra paresis and was increasingly concerned about her deteriorating speech and breathing and felt hopeless as well as helpless.Searches reveal very little of the potential role of music therapy in MND – this presentation will open up the possibility of working through music in several different ways with people who live with this progressive life-limiting condition.As a former healthcare professional with 20 years experience of working with people with MND, L is uniquely placed to comment on the benefits of music therapy on all aspects of her life – physiological, psychological, emotional, social and spiritual.She felt her voice control improved through singing and she was able to reduce night time panic about her breathing by using musical relaxation techniques. L will describe in her own words the subsequent far-reaching effects of the music therapy sessions.DVD clips and audio recordings will provide evidence of her musical creativity – she had never composed music before but over a 6 month period was able to write a significant amount of choral music. The initial motivation was to leave a legacy for the family at her funeral – what resulted was a joyful service of thanksgiving with her family and friends in which everyone heard the beautiful music she had written.Through her powerful and moving testimony in words and music she shows how someone living with a condition that often seems overwhelmingly hopeless can experience great joy and creativity and reclaim a sense of purpose and achievement.
Care quality commission compliance and frequently asked questions
Authors: Ruthven Tracy , Blackburn Maddie , Ellis Jonathan 
Published: September 2011

As part of the Department of Health initiative – £30 million funding for children's palliative care in 2010/11, Children's Hospices UK successfully submitted a proposal with Help the Hospices relating to Care Quality Commission (CQC) registration and compliance with the statutory Essential Standards of Quality and Safety.The project ran between December 2010 and March 2011 developing guidance and best practice examples for hospice services in England.The project assisted children's and adult hospice services by providing information to:▶Inform future development and planning of services to ensure best practice▶Identify current services and gaps in current compliance▶Work with our partner ‘Help the Hospices’ to share project outputs and support the transition agenda between children's and adult services.The project required a mixed methodology to ensure effective delivery of the project objectives. Methodologies employed included an online questionnaire, stakeholder visits and interviews, delivery of three educational workshops, academic review of compliance techniques and partnership working with stakeholders to complete exemplar compliance assessments.The project enabled a number of outputs and analysis and these were shared with member organisations via the extranet services of both Children's Hospices UK and Help the Hospices.Outputs included:▶Establishment of information relating to registered activities across hospice services▶Provision of educational workshops led by the CQC in relation to compliance, inspection and the Judgement Framework▶The development of a ‘Compliance Toolkit’ providing information and advice relating to meeting the Essential Standards including exemplar compliance assessments▶Partnership with ‘Help the Hospices’ to further improve transition for life limited young people by understanding the population of children and young people with palliative care needs who will be moving to adult services.The presentation will focus on some of the learning from this joint venture and consider next steps.
Sharing clinical audit
Authors: Skilton Carolyn 
Published: September 2011

IntroductionClinical audit is a cyclical process that forms part of clinical governance and determines whether national standards are met and changes in practice have improved outcomes.An audit group was established in 2008, to encourage healthcare professionals to undertake audits of practice, but there were a number of challenges:▶How to go from collecting the data to disseminating it and making it add value to day to day clinical practice?▶How to inspire others to undertake audits?▶How to share the results in an informative and constructive way?Aim▶To ensure that hospice clinical audit results and recommendations were shared to as many healthcare professionals as possible to inform clinical practice▶To inspire others to undertake audits and embed it as part of day to day activities.MethodA structured audit feedback meeting is held quarterly, open to all staff, volunteers and external healthcare professionals.Following the feedback meeting a leaflet is designed and distributed to illustrate the presentation and actions to take forward.Results▶Four feedback sessions have been held with an average of 4 audits being presented at each▶Feedback sessions are lively and well attended▶The results of audit are widely spread throughout the hospice • Clinicians understand the audit process better▶The number of audits has increased▶Improvements to patient care have been identified in:▶Management plans in Hospice @ Home respite care▶Improvement in documenting psychosocial information on the inpatient unit (IPU)▶Identifying trends in patient falls.ConclusionAudit feedback sessions and leaflets have had a positive effect on clinician's understanding of the audit process and favourable outcomes in regard to their willingness to complete them, thus fulfiling one aspect of clinical governance while improving standards and patient care.
Prebereavement assessment: identifying vulnerability and resilience in parents of children with a life-limiting condition
Authors: Hopper Liz , Bennett Helen 
Published: September 2011

IntroductionUnderstanding the ways parents cope with grief prebereavement is as important in the bereavement care pathway as how they may cope after death. Within a framework of practice development the authors identified, modified and piloted the Adult Attitude to Grief Scale (AAG) (Machin 2001) to assess how families were coping prebereavement.AimsThe aim of using the assessment tool was to enable parents to tell their story and to recognise and further understand their grief experience prebereavement; to identify what kind of support might be offered so that resources could be targeted more appropriately.Method▶Literature review▶Survey of children's hospices▶Reflective diaries▶Action learning groups within a framework of practice development to identify and modify the AAG scale▶An initial pilot with 40 families▶Evaluation to determine the ongoing integration of the tool in practice.ResultsThe assessment revealed a therapeutic value that enabled individuals to tell their story and parents reported a sense of being understood. Findings indicated those individuals who required additional support which helped in the management and provision of services.DiscussionThe pilot revealed two important dimensions:▶The impact on the organisation in relation to service procedures – this included implementing the tool in practice as well as the professional development of staff.▶The assessment process encouraged a stronger therapeutic engagement with parents.ConclusionThe modified AAG scale when used with parents can add significant information in understanding their grief experience prebereavement. The assessment alongside clinical judgement has enabled the identification of possible vulnerability as well as resilience, which can enable healthcare professionals to support families appropriately and target resources effectively.
User involvement in establishing a new young people's hospice
Authors: Kipling Ray , Amos Vicky , Goldsmith Julia 
Published: September 2011

We propose that this presentation will involve life limited young people who have shaped a new hospice service for teenagers and young adults.Transition from children's to adult services is much discussed, little understood and poorly supported. It poses a set of unique challenges for life limited young people.Prime among these is the sharp discontinuity, described by many as like “falling off a cliff”. The aim of the consultations was to shape a new service was to provide stability and continuity while facilitating transition across external health and social services.By engaging user groups in a series of semi structured discussions, their needs were better understood and a new hospice service was established to support them. Each themed discussion had a facilitator. The format was kept loose to allow subjects to emerge that were important to the young people. In addition to focus groups of communicative users, carers were consulted on behalf of non-communicators, and there was a joint carer/young person session.The results were that information was gathered on both physical and emotional needs. Three themes emerged; independence, dignity and privacy. In some areas, the young people's views were at odds with other stakeholders, such as parents/cares and care professionals. It became apparent that young people's aspirations are often drowned out by carers and professionals.Because the new hospice was founded on user involvement, it now provides a safe space for honest and open discussions. As trust is built, more profound subjects, such as relationships with peers and parents, advance care plans, death of friends and anxiety about sharing bad news, are being brought out.The best source of information for shaping young people's service is the young people themselves. Developing best practice, based on both their hopes and needs is a rewarding journey for all concerned
How effective is our telephone triage service at providing specialist palliative care?
Authors: Stananought Nicola , Sutherland Jane 
Published: September 2011

IntroductionIn 2006, we enhanced our specialist telephone triage service to keep pace with the increasing demands of providing accessible specialist palliative care to all with life limiting illness. Early statistical analysis revealed that the service was invaluable in coping with increased demand but were telephone triage patients receiving an effective service? In August 2010, a retrospective caseload analysis was undertaken to establish this point.AimsTo determine the ability of the telephone triage service to reduce patient STAS (Support Team Assessment Schedule, Higginson 1993) scores or to refer on appropriately. To compare results with the community team's ability to reduce patient STAS scores. To highlight trends in types of care provided for patients managed by the telephone triage service.MethodsThe telephone triage service uses an adapted version of the Support Team Assessment Schedule tool to assess patients. 50 randomly chosen patients were recruited, with at least one problem scoring STAS 3 or above at triage first contact telephone assessment. Analysis of STAS scores was undertaken at subsequent contacts, along with referral patterns and time lapses between contacts.ResultsAt the second telephone triage contact, the number of problems scoring STAS 3 or above had reduced by 60%. A third telephone contact reduced the number scoring STAS 3 or above even further. Outcome scores for the community team were very similar.ConclusionThe very nature of palliative care means that as initial STAS scores are reduced, new and often more complex problems develop. However, results clearly demonstrate that our telephone triage service is effective in palliating symptoms. Introducing telephone triage into our service has successfully reduced our waiting lists by providing a flexible, responsive service appropriate to need. We are now able to confidently evidence the effectiveness of this service in terms of providing high quality specialist palliative care.
Online education toolkit for members of National Association of Palliative Care Educators
Authors: Becker Bob , Moss Bridget 
Published: September 2011

AimTo harness the vast range of knowledge, experience and skills implicit within the membership of NAPCE and publish on the website in an acceptable format so that a toolkit of education resources is created, available to NAPCE members only as a direct benefit for membership. The toolkit will be of interest to anyone working in palliative and end of life care. Teaching and learning is at the heart of many roles and colleagues would benefit from being able to access resources from other educators.Purpose▶Support and disseminate good practice▶Provide readily available and resources in a wide range of topical areas in a ‘one stop shop’.▶Promote ideas for future development of education resources▶All resources will be regularly updated and checked for accuracy and▶copyright acknowledged where appropriate.How▶The structure of the toolkit and the core information will be published on the new NAPCE website in Spring 2011▶NAPCE members requested to submit their resources electronically to a published email addressThese are then reviewed for:▶Content – Suitability for publication▶Classification – what category the material goes into▶Clarity – scanned documents, pictures and other material▶Copyright – all authors are acknowledged appropriately.Resources are then uploaded to the identified website sections in an agreed format.Why do?▶It fits with the constitution of NAPCE▶And also with the End of Life Care Strategy, -promotion of quality education for health and social care professionals▶No such resource exists either online or in hard copy▶No other organisation has taken this on nor would they be in a position to do so▶It promotes NAPCE's name and provides a tangible benefit for the membership▶The details of the content and process, as well as the benefits would be expanded if submission successful.
The gold standards framework: an audit of local practice from a hospice perspective
Authors: Palmer Zoe , Brayden Patricia 
Published: September 2011

The Gold Standards Framework (GSF), developed in 2000, has been an important resource designed to strengthen the organisation and quality of primary palliative care. The aim of this audit was to gather information (from the hospice perspective) about the extent to which local General Practices were meeting GSF standards. Structured interviews (based on a PCT questionnaire that had been designed to examine the levels to which practices had implemented the GSF) were undertaken with the hospice community clinical nurse specialists. Results showed that locally the majority of practices appeared to have adopted basic GSF standards, with 53 of 58 practices holding palliative care meetings and 45 practices maintaining a palliative care register. However a third of practices held GSF meetings less frequently than every 6 weeks. Given the frailty and changeability of the palliative care population, meetings held this infrequently are less likely to be effective for monitoring patients or planning care.Adoption of higher levels of GSF was more variable. The majority of practices needed prompting to send clinical information to the out of hours service did not use significant event analysis of palliative care patients as a learning tool and recorded data inconsistently on the palliative care register.Key challenges identified from this study are:Maintaining the current level of engagement with palliative careEnsuring that palliative care meetings and palliative care registers are used effectively to enhance the quality of patient careEngaging GP practices who are not using the GSFSupporting those who are using the basic level of progress to intermediate and advanced levelsPromoting the GSF for a wider range of non-cancer conditions.
Professional user views of a specialist palliative care service
Authors: Senior Management Team  
Published: September 2011

IntroductionThe End of Life Care Strategy promotes a whole systems approach to care at the end of life. Following significant service changes (including an increase in catchment area due to the closure of another local provider, and the introduction of 7/7 working and ‘hands-on’ nursing care in the community) since 2009 St Catherine's Hospice conducted a professional users' survey in early 2011.19 health and social care professionals (a mix of doctors (mostly GPs), nurses, therapists and a spiritual leader) who work across the geographical area where St Catherine's Hospice provide specialist palliative care participated in semi-structured telephone interviews.The survey focused on the working relationship with the hospice, and any suggestions for improvement or future development.DiscussionParticipants viewed the overall experience of working with the hospice as positive and the service was considered to enhance care for people at the end of their lives both through direct care provided and by supporting other professionals.Participants cited the introduction of hands-on nursing as particularly positive – enabling increased shared care between NHS providers and the hospice. Communication with and response from the hospice were generally reported to be good particularly in urgent situations although some areas for improvement were noted. Those who had worked with the previous provider, reported that they had been anxious about St Catherine's taking over the service but their anxieties had not been realised.There was no apparent dissimilarity between the views of different professional groups and all seemed to be very willing to extend and build on opportunities for working together. There were varying on views on the role of the hospice – and of other professionals – in providing more ‘generalist’ end of life care.Many recommendations emerged for further exploration and action and these will be highlighted in the presentation.
Day hospice audit to establish a baseline prior to piloting the preferred priorities for care document
Authors: Douglas Denise , John Kate , Skinner Katy 
Published: September 2011

In 2010 a baseline audit was conducted to establish what proportion of Day Hospice patients were aware of, had discussed or had completed a Preferred Priorities for Care document (PPC). The audit was done in preparation for piloting the PPC, as a tool for advance care planning. The aim of the audit and piloting of the document was that all Day Hospice patients within the last 12 months of life (GSF) would have been offered a PPC document as part of their advance care planning. This was in support of the recommendations from the End of Life Care Strategy 2008.The methodology used was a retrospective audit of the patient notes documentation and Day Hospice patient interviews to identify relevant information with regard to advance care planning. The audit was repeated 3 months later.The audits clearly demonstrated that Day Hospice does provide an excellent opportunity to discuss and give information about advance care planning. However, the audit demonstrates that most patients appear to prefer to complete a PPC document at home with assistance from either a family member or Healthcare professional. It also identified that staff needed to have an increased familiarity with the document and in initiating the conversations.Practice change resulting from the audit relate to a need to continue to raising staff and patient awareness every 3 months and to develop a patient information leaflet outlining choices for advance care planning, which is to be inserted in all new patient notes to promote discussion.All these changes have now been implemented. Empirical evidence suggests that the audit process has been highly successful in facilitating change through team involvement. A repeat audit will be conducted to provide hard evidence of that success.