bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk register: an integrated governance approach
Authors: Haywood Chris , Coackley Alison 
Published: September 2011

IntroductionWhile risk management is an integral component of high quality care it can be difficult to demonstrate effectiveness. A key aim of the Hospice Business Plan was to devise and develop a Risk Register that could incorporate Fundraising and Clinical activities as part of an Integrated Governance Framework.Aims▶To produce a Risk Register to identify areas and work practices most at risk▶To implement a Risk Register to minimise risks that could affect the running of the Hospice▶To use a Risk Register to monitor effectiveness of actions/initiatives.Methods▶Literature review▶Risk Matrix▶Risk scoring process▶Audit cycle.ExampleRisk Date GovernanceArea Description ofRisk concern(x,y,z) Potential Impact including current controls Risk Score(Pre) Risk control processes to reduce or transfer riskDate for completion Risk Score(Post) Likelihood rating Impact rating RISK.Clinical effectivenessAdministration of bisphosphonate infusions without adequate checks causing harmPatient condition compromisedDevelop hospice policy on bisphosphonate infusions with flow chartTraining and education for nursing and medical staffDistribution of new regional audit guidelinesAudit to check on processResults▶Organisational risks were identified and scored using likelihood and impact ratings▶Risks were categorised into seven key themes▶Potential impact including current controls were described▶Risk control processes to reduce/transfer risk were shown for each individual risk▶Following intervention 86% of high risks were significantly reduced within a 7 month period.Conclusions▶Use of a Risk Register clearly demonstrates effectiveness▶Heightened awareness; risk is everyone's business▶Audit has shown improvements in identifying risks▶Strengthened communication across fundraising and clinical services.Recommendations▶Understanding of Risk Register to be part of induction training▶Use of Register needs to be an ongoing process and should be regularly monitored and updated.
Memories, trajectories and bereavement
Authors: Mills Penny , Griffiths Frances , Munday Dan 
Published: September 2011

IntroductionMuch attention has been given in recent years to the concept of illness trajectories and their potential use in the planning of services provided to those with life limiting illnesses. This study examines how trajectories are experienced by bereaved individuals and whether the memories retained by the bereaved or the experience of grief differ according to the disease trajectory of the deceased.Aims and methodsThe aim is to investigate whether the trajectory of dying influences the experience of grief or the memories held by the bereaved of the death and prior biography of the deceased.One to one unstructured in depth interviews have been conducted with bereaved relatives between 3 months and 2 years after the death, followed by thematic analysis of the narratives produced.Preliminary resultsWhile it is possible to identify key stages in the dying trajectory as experienced by the bereaved, there is little uniformity to trajectories and key events are often not related to the medical status of the deceased.Considerable sacrifices are often made by the bereaved in order to achieve a’good death' as defined by the deceased and there appears to be a need to integrate the trajectory of dying with the memories of the deceased and their prior biography.DiscussionThere are a wide variety of experiences, with differences between the medical and the experienced trajectories of dying.Research is ongoing, but it seems that the needs of the bereaved can be (willingly) overridden in the desire to provide an appropriate death and retain coherent memories of the deceased.This may have future implications for the assessment of need and the provision of services and support of the bereaved both prior to and following the death.
South west region clinical incidents benchmarking project
Authors: Stevens Alison 
Published: September 2011

The Hospice Nurse Managers in the South West have worked collaboratively to develop a tool to monitor clinical incidents within hospice Inpatient units. This tool forms the basis of a quarterly benchmarking exercise. The tool currently in use is based on the national nursing metrics system and consists of an excel spreadsheet detailing numbers of clinical incidents against 1000 bed days including falls, pressure ulcers and medical incidents (Drug errors). Each hospice Nurse manager has an electronic copy of the tool and is responsible for submitting quarterly returns to Dorothy House Hospice Care. The results are then collated and a regional average is produced. Results are shared at SW regional Nurse Manager meetings and possible reasons for variation discussed and good practice examples highlighted. Each hospice has the option to share their individual results and the regional average with their local commissioners or other interested parties.Challenges in setting up the benchmarking system have included ensuring consistency in reporting and the variation in database systems currently in use for data collection/analysis.Benefits have included the opportunity to benchmark against other hospices rather than acute or community providers, the routine of regular discussion with colleagues on how improvements may be made to reduce incidents and demonstration to the Care Quality Commission of a proactive approach to managing clinical incidents.South West Region Forum for Hospice Nurse Managers. March 2011.
Measuring clinical outcomes for hospices
Authors: Roberts Michelle , Stott Lisa 
Published: September 2011

In 2009 the West Midlands hospice group worked with Help the Hospices to establish a set of measures that would demonstrate the value of the work of hospices to healthcare commissioners.An important domain of this work was to accurately measure the outcomes of the care that hospices give through the eyes of those receiving the service – patients and carers. It was felt that the only true measure of a satisfactory outcome is in the eyes of the service receiver so we used that basis to devise an accurate measure of the outcomes of hospice work. We decided to do this by asking patients and carers what they thought the hospice had achieved using a methodology which could be statistically validated.The DMH worked with other hospices to formulate questions which would most accurately reflect the user's views on the outcomes of hospice treatments as against their goals and expectations. The work was then used to run a series of pilot surveys which helped to test the validity of the questions used and the methodology for calculation of the outcome results and scores. The result was a complete suite of surveys carefully designed to accurately measure service outcomes in hospice care. After some further testing and amendment the surveys were launched in autumn 2010.These outcome measures are calculated from the results of the surveys and cover both patients and carers for the following services:▶In Patient Unit▶Day Hospice▶Community Clinical Nurse Specialist service▶Hospice at Home▶Bereavement Services.Resultsof the first full surveys are now available and there are plans to benchmark with other hospices in future. This will enable us to use the results to continue to work towards improving the quality of the services we deliver.
Does respite care address the needs of palliative care service users and carers? An exploration of their perspectives and experience of respite care
Authors: Wolkowski Anna 
Published: September 2011

IntroductionThere are clear indications that over the coming years, an increasing amount of support for carers of patients with palliative care needs will be required. In recent UK policy and guidance respite care is frequently mentioned as a key factor in supporting carers. However, little is known about respite care services for people with palliative care needs and their carers and services appear to have developed on the assumption that they are a “good thing”. This study addresses this gap in knowledge. It is located in a professional doctorate study where parallel application in practice is encouraged.AimsTo explore the perspectives and experience of palliative care service users and carers of respite care.MethodThe participants were hospice service users and carers who had experienced respite care in that hospice and other settings. The approach was qualitative and data collection was carried out by unstructured informal interview and analysed in accordance with Grounded Theory strategies.ResultsAnalysis of the data showed that there is nothing straightforward about respite care and the concepts of need and acceptance, vulnerability and resilience, risk and enablement, loss and gain all emerged.DiscussionThis study confirmed that respite care suffers from a problem with definition and is often talked about in a trite way which doesn't reflect the complexity of the caring relationship it is supposed to be sustaining.ConclusionRespite care is valued by palliative care service users and carers. The articulation of respite care needs and the insights gained in this study have the potential to influence practice and provide a platform for service development and improvement.
Developing an electronic records system, SystmOne, to meet the needs of children's hospice services
Authors: Leese Carolyn , Rennie Tracy 
Published: September 2011

With the challenges set by the Department of Health National Strategic Programme, in 2009 Children's Hospice Services in the East of England started an ongoing major strategic development; the implementation of an electronic care records management system, SystmOne. The system is designed to improve management information to inform the development of services, improve sharing of information and enhance the quality and consistency of records.The project has required a long term commitment by the organisation to ensure the system is developed effectively to meet the organisations' needs. During the last year, the main aim of the project has been focused on the development of care and support assessment tools and care plans.An innovative approach to the development of the assessment tools and care plans has involved:▶Collaborative working with external experts▶Recruitment of a SystmOne Manager▶Use of expert knowledge of key care and support professionals▶Engagement of all staff▶Involvement of Family Forums▶Appointment of Champions.The initial trials of the assessment tools and care plans proved instrumental in their successful implementation across the three hospice localities. However, there were some initial challenges to overcome including the:▶Resistance to change resulting in the lack of recognition by some staff and managers of the need for electronic care records▶Managing momentum and the lack of some staff and managers' commitment to dedicate time for using SystmOne.The development of assessment tools and care plans will enable the creation of shared clinical care records with other healthcare providers, who are also users of SystmOne improving functioning and co-ordination between agencies. The sharing of records will enhance interagency working and communication, immediate availability of information, timely communications about changes to care and care needs.
Developing a carers group
Authors: Haskins Dorothy , Chaddock Becky , Ashton Wendy 
Published: September 2011

IntroductionIt was identified that there was a need to support carers within a multidisciplinary environment. The group enabled carers to meet and share experiences.It is important to care for the carers.Aims▶To provide a structured programme for carers.▶To impart knowledge and information to carers on a variety of topics.▶To have a holistic approach to providing support for carers, and to incorporate all members of palliative care team to contribute to the programme.Methods▶Evaluated existing service for carers.▶Visited carers group in another locality.▶Informally interviewed carers at Day Hospice re: need and content of the programme.▶Developed a 12 session programme over 6 weeks, meeting weekly at the Hospice.▶Pilot included Day Hospice patient carers, and then expanded to open referral system.▶Evaluated each session and then the entire programme.ResultsFeedback from evaluation shows carers felt supported, gained motivation and benefitted from useful information.From pilot session:-▶10 sessions scored 100% very satisfied▶1 session scored 20% least useful, 20% most useful, 60% very satisfied.From 2 sessions:-▶67% were women▶33% were men.Informal comments were positive. several would like an avenue to continue to meet after group has finished.Discussion▶Results show that the need to support and provide information to carers was met▶At the end of the programme carers reported they felt more supported and better informed▶Established peer support continues with some carers▶Feedback showed that it would be more beneficial to have longer sessions over an 8 week period▶Referrals avenue to be extended to other teams and programme to be more widely publicised.ConclusionWith user involvement we have developed a support service to carers with a focus and structure. This supports and enables carers to care for themselves while caring for others.
Commissioning end of life services using care profiles
Authors: Gandy Rob , Roe Brenda , Rogers Jean 
Published: September 2011

The Department of Health (DH) required local reviews of End of Life (EoL) services in England ahead of the publication of its National EoL Strategy in 2008. Related cross-sector work undertaken by Liverpool Primary Care Trust (PCT) stressed the need for a means of specifically commissioning EoL services.It was proposed that care profiles could enable service requirements to be set in respect of skill mix, delivery, quality and outcomes for each stage of the EoL pathway. The DH had used care profiles for a variety of services in the 1990s. Therefore, during 2010, Liverpool PCT undertook a project to establish whether the methodology could be used to commission EoL services (other than those delivered to inpatients in hospitals) by adapting the original structure and tailoring it for commissioning purposes.An iterative approach was applied through a series of four workshops, based on action learning events, which sought consensus among participants from across a full cross-section of commissioning, provider and service user interests. The outputs were evaluated by an external reference group.The project was a success. Its recommendations were subsequently used to commission EoL services across Liverpool. One conclusion was that the basic service requirements for EoL care are the same irrespective of the related disease. Care profiles are simple and flexible, and they complement and augment integrated care pathways. By requiring the recording of outcomes throughout the care process, they aid quality and audit processes. They offer the potential to cost EoL services, and should be transferable to other conditions.Care profiles can support GP commissioning by providing clinically relevant and detailed information to specify services.Subsequent work established how the EoL care profiles can support advanced care planning, by assuring the range, quality and consistency of information given to patients and carers, with any potential choices highlighted.
The impact of a new end of life care occupational therapy post in a community rehabilitation team
Authors: Wisbey Kathy 
Published: September 2011

IntroductionA newly funded EoLC occupational therapy post was recruited to in 2010 to work within a multi-professional generic adult community rehabilitation team. It was evaluated after 1 year.AimsThe post was created to support the EoLC strategy by increasing access to palliative and EoLC services for patients with both malignant and non-malignant conditions and to improve the quality of care provided. The post sits with the NHS community rehabilitation team and is supported by the hospice based community palliative care MDT.MethodsThe post holder carries a specialist palliative care caseload, acts as an expert resource for colleagues, provides education, consults and helps ‘skill up’ generic therapists who may have had little or no exposure working with a palliative care population.Review after 1 year of new service developments, structured feedback from colleagues within the service and in partnership organisations.ResultsIncreased understanding of the role and value of rehabilitation services in palliative and EoLC. Increase in number of palliative care patients treated by the team. Improved clinical care and patient satisfaction. Better coordination of care. Admission avoidance (on non-medical grounds). Key role enabling PPC to be achieved. Increase in advance care planning discussions and activities.DiscussionThere has been an increase in access to adult community rehabilitation services and also improved quality of care provided to patients with a range of life limiting diseases through new service initiatives, sharing good practice and expertise and targeted education and training for team members.ConclusionThe existence of the EoLC post has demonstrably supported local and national EoLC strategy by broadening access to palliative and EoLC services. Professionals within the team have developed skills and specialist knowledge thus improving their competence and confidence. Enhanced quality of care has improved the experience of patients, their families and carers.
Grief and bereavement – supporting siblings of a children's hospice service
Authors: Dempster Tracie , Cooper Lynn , Petty Glynis 
Published: September 2011

Children and young people's palliative care is an increasingly recognised specialty for life limiting and life threatening conditions. These children often have a difficult life filled with hospital appointments and strange professionals invading their homes. The siblings of these children may often be forgotten about or neglected, as the focus is on the sick child. The siblings have their own grief and bereavement and very often need support in getting through this.Our children's hospice at home service offers pre and post bereavement support to the whole family, but recognised that more could be done to meet the specific needs of siblings.There was a review of the caseload to identify possible siblings ranging in age from 5 to 19 years. Family's views were sought, and discussion was had at the multidisciplinary team meetings to identify appropriate participants. Following a successful bid to the Department of Health children's palliative care funding, two separate age-appropriate support events for siblings were organised. The older children (11 – 19) did not take up the opportunity for a place, so only one event was held for the younger age group. The day was structured and therapeutic group work formed the basis for the sessions, led by specialist children's palliative care nurses, the play therapist and support staff.It was recognised that the older children regularly attend a youth group which offers them ongoing support. The day was very well evaluated by the children attending, and subsequently their parents. More sibling events will be organised for the future, as the day proved to be an effective way of meeting their needs. Due to the success of the day, there is also a plan to open up future days to the children of our adult palliative care service, who have some similar needs.
Nurse-led palliative care clinic: optimising choice for patients
Authors: Cowan Margaret-Mary , Cardy Claire 
Published: September 2011

Clinics at the hospice have been largely medically-led with patients attending on an ad-hoc basis with eligibility restricted to existing patients. This project aimed to set up weekly nurse-led clinics with access to all patients; thus allowing patients to access our service at an earlier stage and enabling a more seamless transition to our Specialist Homecare Team when their condition deteriorates.The clinic was established by an Advanced Nurse Practitioner with appropriate training using Hatchett's (2008) guidelines and aimed to offer a less threatening option to access palliative care in a clinic environment instead of a home visit. The clinic sees patients at initial referral and for ongoing support and fulfils both the DH (2010) suggestion to offer more choice to patients and widen intake to non-cancer patients as well as advancing nursing practice.Evaluation was facilitated using a questionnaire completed by patients attending. Data was evaluated and comments collated in themes for analysis by the researcher.This clinic was evaluated highly by patients with 100% saying appointment length was appropriate and 67% stating that their symptoms were fully assessed. 100% of attendees felt satisfied about being seen by a nurse rather than another healthcare professional.After 1 year referrals for assessment have steadily increased with one fifth from outside agencies. Presently the service has a caseload of clinic-only patients which is a step towards increasing choice and shows greater access to existing hospice services.The findings confirm that the clinic is an effective use of time and skills and is well received by patients. It offers another dimension of service for patients and this data reinforces the need to extend and develop this service.
Taboo or not taboo: a collaborative hospice/theatre/schools project
Authors: Withell Bridget , Irvine Nicola 
Published: September 2011

IntroductionDuring their school years, an estimated 22 000 children and young people will lose a parent. Many others will experience the death of close relatives or friends, yet schools and society struggle to know how to support them because talking about death is ‘taboo’.PurposeThe purpose of this exciting project is to enable students and their teachers to talk openly about dying in a way that dispels some of the euphemisms, myths and fear associated with death and bereavement and to promote the recognition of death as a natural part of living.PreparationThe theatre company has agreed to create, write and perform a multimedia drama using video and live performance as an integral part of a half-day interactive workshop for schools on death and bereavement. It is aimed at Key Stage 4 students, and in addition to relevant lesson plans, schools will be supplied with information packs for teachers, students and parents. Schools will be required to have some counselling support available for students.The hospice undertook the original groundwork for the project and continues to be closely involved as advisor on the content of the drama, and with the schools liaison work.Current progressA light-hearted sketch has been created which uses humour to address this serious issue; it will be performed by about eight young student actors. The first six schools who expressed an interest in the project have been selected to take part in the initial phase. Funds for the project will be raised by schools.Ongoing plansThe project includes plans to record the theatre piece on DVD for use in other schools and general release to a national body such as Help the Hospices.