bluuebunny/crossref_metadata_2025_split huggingface dataset:
Establishing an integrated and coordinated end of life care service – working in partnership
Authors: Heaps Kate , Jones Penny , Rattigan Carla , Howsam Alexis , Stokes Jackie , Williams Beth 
Published: September 2011

The Greenwich Care Partnership was established in November 2010 to develop and provide an integrated end of life care service for the residents of the London Borough of Greenwich. The service is provided by one NHS organisation and two charitable organisations working together to provide a seamless, responsive service for dying people at home. The service has initially been commissioned on a “test and learn” basis, to establish the potential risks, benefits and potential cost savings of providing such a comprehensive service based in the home.The service aims to:▶Provide planned and urgent care around the clock to people at the end of life▶Reduce admissions and length of stay for people who do not need or wish to be cared for in hospital▶Improve the quality of care provided, reducing duplication and the time that clinical staff spend on administrative tasks▶Provide support for the key worker and improve inter-professional communication 24 h a day▶Reduce unnecessary expenditure and allow investment in services which enhance patient experience and promote choice, dignity and control at the end of life▶Support informal carers before and after bereavement.Data will be presented as monitored against Key performance indicators of the project, this will demonstrate achievement of the aims, although the project remains in development on date of submission. Additionally, the presenter will reflect on the highs and lows of partnership working and make recommendations for others embarking on a similar venture.This presentation will provide information which will be of use to any organisation considering embarking on a partnership venture; this approach is likely to be much more common in the current political climate. As we try to increase quality and capacity for care at home, this service delivery model will be of increased interest.
Developing a clinical skills competency framework
Authors: Ebeling Sophie 
Published: September 2011

IntroductionIn this unique care environment, palliative and respite care is provided for young adults with a diverse range of life limiting conditions, who have complex and multiple care needs. Thus, the demands on healthcare assistants, with regard to the range and level of skill required to care for these patients, is equally diverse. In light of recent commentary on the debate surrounding the registration and regulation of healthcare assistants, the organisation began to consider how best to prepare for these likely changes. It was concluded that robust assessment and maintenance of competence would be essential. A review of competency based training packages currently available was undertaken. However, due to the diverse skills practised by healthcare assistants in this environment, these packages were not suitable to meet the training needs identified.AimsInspired by competency based training packages available locally, a clinical skills competency framework was devised as a practice based learning and assessment process. The clinical skills competency framework was developed as a single document that would serve as a record of competence and training for the organisation and the individual, a template for assessment of competence and also form the basis of a professional portfolio of clinical skills for the healthcare assistant.MethodsA focus group was formed in order to compile a standardised skill list for healthcare assistants within the organisation. Competencies were compiled, alongside evidence based training packages, by registered nurses with particular skill, experience or interest in the relevant area of care, thus acting as a development exercise for the nurses as well.ConclusionsThe collation and implementation of this training package has been the catalyst for a cultural shift within the organisation, towards integration of practice focused teaching and assessing into all aspects of clinical work.
“Together we care” – bringing hospice and school communities together
Authors: Bunce Alison , Lee Janice , Milligan Stuart 
Published: September 2011

IntroductionPublic education and health promotion are vital activities in every area of healthcare. The way society views death and dying can contribute to the experiences of people receiving end of life care and their carers. However both the End of Life Care Strategy and ‘Living and Dying Well’ highlight a lack of openness and discussion around death and dying. Both strategies call for national and local action to promote public awareness and challenge misconceptions.Ardgowan Hospice's ‘Together We Care’ schools project aims to dispel myths around and promote healthier responses towards death and dying.Aims/objectivesThe project aims to bring together two different organisations serving our local community in an innovative and purposeful way. It will raise awareness within three school communities of the role Ardgowan Hospice plays, and will help children to be less anxious about discussing and contemplating death, dying and bereavement.MethodThe project involves hospice staff:▶Developing innovative and purposeful relationships with our local schools▶Raising awareness of the role the hospice plays▶Bringing the hospice's key values to life through creative art projects▶Engaging with and enabling children to freely discuss any issues surrounding death, dying and loss.ResultsThe proposed poster will present data collected through the use of workbooks and evaluation forms.DiscussionEarly evaluation results have shown that there is an increased awareness of the work of Ardgowan Hospice at all three schools, and that the first meeting with the classes involved was invaluable. The focus of activities to date has been on the hospice's key values.ConclusionThe project has enabled excellent relationships to be established. It is hoped that this kind of innovative and creative approach will begin to change attitudes to death, dying and loss in our local community.
The intelligence hub approach to sharing and learning
Authors: Hodson Melanie 
Published: September 2011

IntroductionThe term ‘intelligence’ derives ‘from the Latin verb intelligere which in turn comes from inter-legere meaning to “pick out” or discern.’ Here it encapsulates the processing and sharing of gathered data, experiences and other information to develop knowledge, highlight innovation and demonstrate the impact of hospice care.AimsCase studies are a powerful example of those experiences which contribute to hospice care intelligence. Providing a practical approach to learning and facilitating networking, they encourage service development and the sharing of new ideas and innovation. We are developing a case study resource bank to share experiences and practical project learning with hospice colleagues.ApproachThis ongoing project is creating a new resource by collating existing and researching new case study materials for various audiences. The value and impact of access to this fledgling case study resource is indicated by the example of work done by the national fundraising support team in gathering case studies on income generation to share on the members' area of our website. A hospice adopted a new community engagement idea outlined in a case study from this resource. The activity raised significant additional income for the hospice and has now been incorporated into their annual income generation programme.To help raise the profile of hospice care and inspire innovation, the project team invite hospice and palliative care colleagues to contact us with activity updates and project news so that, together, we can more effectively share information on emerging work and ideas in hospice care delivery and development.
Clinical compassion
Authors: Palmer Eileen 
Published: September 2011

Sometimes, people coming into specialist palliative care units unexpectedly improve with simple, compassionate care. Is this a mystery? Or does compassion directly affect human biology in ways we are only just beginning to understand?There is a widespread belief that kindness and compassion matter. They are what we would want for ourselves, or our loved ones; central, across religions and across cultures; taken as “given” by patients and families; and required by NHS constitution. Yet they are often absent, education and policy documents, and from clinical care settings. Educating for compassion remains an uncertain art.A Masters thesis, (awarded a distinction by the University of Oxford, 2010) explores the biological impact of compassion on the brain and the body, including its effects on the μ-opioid receptor system and the autonomic nervous system, as well as its observable effects on distress. Compassion switches on the μ-opioid receptor system. Compassion directly affects the human body in ways that are conducive to healing and wellbeing. Moreover, the neural circuits of compassion are contagious via the mirror neuron system and they can be trained and developed using the brains inherent capacity to remodel its neural circuits with practice (neuroplasticity).A simple model of the neural basis of the primary compassion pathway, and its positive and negative modulators gives a starting point for developing more effective educational and organisational strategies for compassion. One promising approach to developing compassion is by using mindfulness training, such as mindfulness based cognitive therapy (MBCT). A small pilot study of MBCT training for Hospice at Home nurses shows acceptability, and measurable impact on wellbeing, self compassion and clinical empathy. Could this be one way of re-prioritising compassion in healthcare systems?
Hospice support services from diagnosis to infinity and beyond ….
Authors: Hewitt Linda , Green Carol , Bober Maggie 
Published: September 2011

Completion of a research thesis, as part of an MA in Hospice Leadership, led to the development of a new concept of Hospice Support, concordant with the North West End of Life Care Model.This brings together the diverse range of Hospice Services with the intention of Hospice moving from being complementary to the PHCT, to one which is prepared to take ownership and leadership on key areas of community based palliative and end of life care development.Develop a new concept of Hospice Support, by reforming services to work under one umbrella, including medical, social and psychological disciplines within the Hospice team, maximising the use of appropriately trained volunteers.Develop a protocol for family support, continuing into bereavement.Social, emotional, psychological, spiritual needs of patients, carers and their families were strategically reviewed.Creation of a new Hospice Support Services ‘Hub’, where the social, emotional and psychological needs of patients, carers and their families are reviewed on a weekly basis, taking cognisance of their medical needs.Allocation of a lead professional to liaise with the referred person throughout their involvement with Hospice Support.The development of a comprehensive and structured pre and post bereavement follow-up; following 40 h training time for Family and Bereavement Support Volunteers.A variety of new services are being developed, together with new opportunities for volunteers, including;▶Open-ended Support groups; Patients, carers and bereaved▶Creative therapeutic groups; patients, carers, bereaved▶Support volunteers; Patients, carers▶Family and Bereavement Support Volunteers▶Complementary therapies▶One to one support; Complex Cases▶Living for Today closed groups; Patients, Carers.Despite the challenge of change we are developing a continuing support service for patients, their carers and families who have varying individual needs at different times in the end of life trajectory of the patient.
The ABC to education: collaborating, coordinating and contributing to end of life care
Authors: Russell Sarah , Doyle Carolyn , Harris Emma Jane , Convey Vanessa 
Published: September 2011

IntroductionThe ABC End of Life Programme is a blended approach to end of life education across the East of England regions of Bedfordshire, Hertfordshire, Anglia and Essex. It has been funded by NHS East of England for 2 years. It represents collaboration across settings contributing to the improvement of the end of life care experience for staff, patients and families.AimsTo improve the end of life experience of patients and carers (including advance care planning) and reduce inappropriate hospital admissions.MethodsAn education programme using the specifically designed East of England Care Home education programme, ELCA modules and mentor support. Aim is to deliver over 2 years to 1800 care home staff and 5000 workforce B staff. Activity and impact is measured using a combination of benchmarking tools, patient notes audit, confidence questionnaires and educational activity.ResultsPre and post course questionnaires showed a confidence increase in end of life care. Activity measurement showed an increase in accessing other education sessions as well as in house end of life care policies and procedures (eg, bereavement policies). Data referring to inappropriate hospital admissions will be shown.DiscussionThe programme content and measurement was debated and designed through a combination of palliative care educators, clinicians, commissioners, lead nurses and EOE End of Life lead. This combined approach although challenging in terms of coordination enabled an approach to education that could then be measured across a much bigger geographical region.ConclusionIt is challenging to design education programmes across settings and borders – but it is worthwhile as it provides a systematic approach to delivery and measurement. Using a blended education approach (face to face facilitation/e learning) enables learning to be work based relevant and centred.
A pilot of a pathway for individualised care of the frail elderly at the end of life
Authors: Hirst Becky , North Christopher , Owen Janet 
Published: September 2011

IntroductionPalliative care has traditionally focused on those with a cancer diagnosis. For the frail elderly end of life care needs are often not identified or addressed, resulting in inappropriate admissions to hospital when they are dying. This pilot demonstrated that many frail elderly people nearing the end of their lives can be identified and by documenting preferences it is possible to promote quality of life and a dignified death in a person's chosen place.AimTo improve End of Life Care across Barnsley and increase documentation of personal preferences for care.MethodCare homes covered by two general practices were involved. Residents were assessed using the Gold Standards Prognostic Indicator Guidance and “The Surprise Question”. Once identified preferences were recorded using the Preferred Priorities of Care Document (PPC), information was shared with Out of Hours care providers and care plans and simple pre-emptive prescribing put in place.Results43 patients were identified as potentially being in the last year of life, had a PPC and a care plan in place. During the first 6 months of this pilot, 10 of the 12 deaths which occurred were in the patients' preferred place. Anecdotally, improvement in information sharing between professionals increased confidence of care home staff and quality of care, non-elective admissions and length of hospital stay reduced.ConclusionsLocal ownership by and drive from the health and social care professionals involved were key to the success of this project. Pro-active recognition of frail elderly at the end of life enables planning focused around individual wants and needs. Staff, families and patients found discussions positive. Recognition of need improved quality of care for this population. Resources now need to be identified in order to roll this initiative out across the locality.
What a waste! Futile prescribing and the cost of wasted medication at the end of life
Authors: Taylor Ros , Bryant Martin , Chadwick Sharon 
Published: September 2011

IntroductionPoor prognostication leads to continuation of potentially irrelevant, expensive and harmful medications when time is short, for example, statins.Similarly, necessary medications are over-prescribed in large amounts, when the patient may only have days to live.When a patient dies, all these drugs are destroyed, even those in original sealed packs.The cumulative cost of destroyed medication is huge – at a time when the NHS can ill- afford such wastage.AimsTo assess the extent of irrelevant prescriptions in a cohort of patients admitted to a hospice for terminal care.To analyse the annual cost of irrelevant prescribing and drugs for destruction after a patients death in a UK inpatient 12 bedded hospice.MethodsA retrospective survey of:▶All drugs brought into the hospice at the time of terminal admission▶Analysis of key medication groups, highlighting those irrelevant in a patient with weeks or days to live▶Cost analysis of medications deemed irrelevant by two experienced hospice physicians▶Cost analysis of drugs destroyed after a patients death.Expected outcomes:▶Prescribing patterns at the end of life, highlighting extent of futile prescriptions.▶Estimated cost to the NHS of destroyed drugs following a year of patient deaths.DiscussionPrescribing is an art, and medicines are harmful to patients if not relevant. Lack of continuity in primary care and infrequent review of dying patients may lead to prescribing of inappropriate and costly drugs. This a burden to the patient and to the NHS, with large amounts of medication being destroyed after death.ConclusionThe study is in progress – when finalised, a total cost of destroyed drugs in one UK hospice will indicate a massive national problem.Suggestions will be made as to how this cost burden could be reduced, underpinned by more appropriate prescribing when time is short.
Innovative approach by the hospice involvement in schools national curriculum
Authors: Freeman Wendy 
Published: September 2011

This project aimed to offer schools within the local catchment area and opportunity for the Hospice to work collaboratively alongside them with delivery of the National Educational Curriculum of Personal, Social, Health and Economic Education.A resource pack was produced and posted to 29 secondary schools and 1 college in the catchment area to offer a tailor made programme for their school curriculum focusing around Personal, Social, Health, Economic education and Sex and relationships Education related topics.The initial response from secondary schools was poor so the project had a second phase and this was to target 123 junior/infant schools in the catchment area.The delayed response to the project was due to postal issues and not being able to identify a key worker in each school who leads PSHE. Schools curriculum planning and demands on teaching staff also affected the timetabling of additional educational sessions. Many schools showed an interest but never progressed to planning sessions directly.From a further redesign of the project we have established direct links with 32 PSHE leads in our area and delivered training sessions to them high lighting areas of education which we are able to offer as bespoke sessions, developing interest already. One school has had two sessions delivered in the Hospice enabling staff and students to meet patients and learn about the Hospice and other topics. Another school has had sessions delivered in the school working with the Duke of Edinburgh students enabling fundraising for the Hospice. Two schools have had assemblies with question and answer sessions enabling us to dispel the myths of a Hospice.The findings indicate that schools are satisfied that the Hospice is able to support them in delivering individualised programmes. The collaborative working has had a positive impact on the schools and Hospice.
Electronic prescribing & drug ordering in palliative care – patient & healthcare professional benefits
Authors: Bunn Ray , Brayden Patricia 
Published: September 2011

St Catherine's Hospice has been ‘paperless’ since 2007 with all clinical notes and communications for hospice and community patients on Crosscare clinical management system (CMS) software (Advanced Health and Care) except the drug prescription and administration record card. The pharmacy has a secure live link to the CMS.We have now embarked on a project to implement electronic prescribing and drug ordering. The initial stage has been to identify potential benefits.Key patient benefits of electronic prescribing include:▶Increased safety at the point of prescribing – flags drug interactions, allergies, medicine information (MI) pop ups for drugs as prescribed.▶Handwriting and ‘inky scribbles’ eradicated.▶Dispensing turnaround times reduced.▶Consistent and ‘approved’ MI for healthcare professionals (HCPs) involved in care 24/7 and for patient education.Key benefits for HCPs include:▶Live up-to-date drug history and current regimen available 24/7 anywhere with web access.▶Education tool – EMIS datasheet pop up PLUS any local practice guidelines pop ups where appropriate.▶Audits facilitated via database interrogation and reporting.▶Major aid for ‘treatment re-capping’ at HCP/patient counselling and consultations.▶‘On call’ remote prescribing enabled eradicating ‘verbal orders’ issues.Key pharmacy specific benefits include:▶Enables remote prescription monitoring from any PC anywhere with web access. Clinical information conveniently available to pharmacist on screen.▶CDs consistently prescribed legally.▶Electronic stock requisitioning streamlines supply function and management functions such as invoicing and drug use and expenditure analysis.▶Up to date prescriptions, medication history and regimens live in pharmacy.Having identified numerous benefits, the next phase of the project will entail development of standard operating procedures and education of key staff.
A cooperative participative inquiry into the effectiveness of a bereavement drop-in service
Authors: Nash Seamus 
Published: September 2011

PurposeStarting from a position that users of a hospice based bereavement service reported that the current drop-in was assisting in their coping and movement through grief, a study was undertaken to examine in detail the service users claims and to ascertain what factors led to the drop-in being ‘effective’.Key concepts▶Cooperative participative inquiry▶Action research▶Phenomenology▶Epistemology▶Relational depthMethodsA Cooperative Participative Inquiry (CPI) model was used. Heron (1996) and Reason (2001) argue that CPI as a science of the person puts the emphasis on ‘first person’ research and thus locates the participant at the heart of the research inquiry.Drop-in users volunteered to become co research participants in the research. Ethical approval was sought through the hospice research committee. Four phases were identified-agreeing the area of activity, engagement in the actions agreed, observation and recording of process and outcome, immersion and engagement of experience and finally re-assemblage and discussion of the project in the light of the experience. Results were written up, discussed and agreed.Results▶As a form of assistance for bereavement support the drop-in was effective▶Peer support was considered vital▶Forming of relationships between users and staff was central to creating a ‘safe space’▶Drop-in was perceived as validating of users experience, non-medicalising of their grief.DiscussionThe research has implications for person-centred care and highlights the continuing medicalisation and pathologising of grief.ConclusionAlthough the process is intense, the results are a testament to the group. User involvement in research in this manner ensures the ‘voice’ of users are heard, that client experiences are accepted and validated and that stigma and pathology are reduced.