bluuebunny/crossref_metadata_2025_split huggingface dataset:
NHS south of Tyne and Wear's supportive and palliative care standards for end of life care in care homes
Authors: Watson Louise , Richardson Jackie 
Published: March 2012

Around 500 000 people die in England each year. The vast majority (around 99%) of deaths occur in adults over the age of 18 years. Most deaths occur in people over 65 years and this group is expected to increase in numbers over the next decade as our population ages. The Improving supportive & palliative care for adults with cancer (National Institute for Clinical Excellence 2004) defined service models required to ensure that people with cancer, their families and other carers receive support to help them cope with cancer and its treatment. In response to this, NHS South of Tyne and Wear (Organisation's name predating Transforming Community Services) developed a set of standards adopting a coordination model. This was developed as an alternative to Gold Standards Framework. The standards support the delivery of high quality end of life care in the care home setting; ensuring people living in a care home with ANY condition (including older frail and illnesses other than cancer) will receive the best quality care in the last 12 months of life. These standards have been developed to reflect national end of life publications and to ensure local recommendations are aligned with national guidance. Set of six standards mapped against EoL care strategy quality markers for care homes and National EoL Care programme's route to success for care homes. Furthermore, they complement the locally-owned document supportive and palliative care standards for end of life in the primary care setting and compliment the MPET funded training programme with care home staff. Process:Care Home agrees to participate and nominates key worker(s)Baseline self assessment completedIdentify areas for improvement/changeInterim review and supported development of an action planPeriod to implement improvement/change.Collection of evidence to support changesVerification/accreditation.
Developing a rapid discharge pathway for end of life care
Authors: Ball Patrick , Mason Louise 
Published: March 2012

BackgroundAchieving preferred place of care at end of life is a core component to national and local end of life care strategy. The specialist palliative care team at Brighton and Sussex Universities Hospitals NHS Trust introduced a pilot document and process to facilitate the discharge of patients in the final days of life. There were no formal audit process of the discharge process prior to introduction of the dedicated pathway but there were numerous complaints and feedback from patients, carers and professionals that the usual discharge process was not responsive enough for end of life care patients.PathwayA work stream group of the Trust's end of life care development group was set up with relevant stakeholders and a pathway created to identify and clarify keys steps in successful discharge. One of the main features of our pathway is it is multi-discipline and highlights each individuals role for example, ward nurse and doctor, discharge co-ordinator and members of specialist palliative care. The pathway serves as key co-ordinating document.PilotIn November 2011, two wards were piloted between the trusts two hospitals for 3 months. This was then extended in another ward for a further 2 months to provide more data. The Rapid Discharge Pathway was used in addition to the usual discharge documentation when a patient thought to be in the final days of life was being discharged to their home or care home with nursing.ResultsTwenty-one patients were initiated on the rapid discharge pathway; of these 17 (81%) were successfully discharged to preferred place of care (11 home; 6 to Nursing home). Four patients died prior to discharge, three rapidly declined during the process and in the other difficulties arose in deciding preferred place of care. The pathway is now being rolled out across the Trust.
Comparison of conservative management and renal replacement therapy in the Elderly with CKD stage 5
Authors: Hussain Jamilla , Russon Lynne , Mooney Andrew 
Published: March 2012

BackgroundThere is limited data on the outcomes of older patients with chronic kidney disease (CKD) stage 5 undergoing renal replacement therapies (RRT) or conservative management (CM).AimsThrough conducting the largest study in patients over 70 years old we aimed to establish key factors influencing survival and quality of life of patients who chose either RRT or CM at CKD stage 5. This information is essential to ensure patients and professionals can make informed decisions regarding management in such complex cases.MethodsA retrospective observational survival study comparing both groups was conducted.Results441 patients were included (172 CM, 269 RRT). The RRT group survived for longer when survival was taken from the time GFR <20 ml/min (p<0.001). This remained the case when survival was calculated from GFR 15ml/min (p=0.02) and 12 ml/min (p=0.02). However when stratified for age (greater than 80 years old), Charlson comorbidity score (greater than 8) and WHO performance score (greater than 2) RRT no longer had a statistically significant survival advantage. In terms of quality of life, the RR of an acute hospital admission comparing RRT to CM was 1.6, p<0.05, 95% CI (1.14 to 2.13). 47% of CM patients died in hospital, in comparison the Renal Registry states 69% of RRT patients die in hospital. The CM group also had greater access to specialist palliative care (SPC) resources. 131 CM patients accessed community SPC services versus 0 RRT patients. 85% of CM patients had a SPC consultant review versus 4% of RRT patients.ConclusionFor patients over 80 years old, with high comorbidity scores and low performance status RRT did not offer a survival advantage over CM. Additionally, through accessing a dedicated CM pathway patients have greater access to SPC services and are less likely to be acutely admitted to or die in hospital.
Getting to the other side: improving palliative care transfers from a tertiary cancer centre
Authors: Noble Agnes , Coackley Alison , Griffiths Ann , Howarth Susan 
Published: March 2012

BackgroundA syringe pump is a portable battery-powered device used to deliver a Continuous Subcutaneous Infusion (CSCI), and is used in the delivery of subcutaneous medication to patients in order to optimise symptom control. A tertiary cancer centre can experience huge challenges when transferring patients to alternative care settings as the distances to be covered can be great, and the time taken for the patient to travel can be considerable. At Clatterbridge Centre for Oncology, the system for transferring patients receiving medication via a CSCI was inadequate, as the CSCI would be discontinued and the patient's symptom management could be compromised during the journey. This is especially important during end of life care when a patient is being discharged in the final few days of life.AimTo develop a process where patients could be transferred to an alternative care setting with a pump in situ in order to maintain an optimum degree of symptom control during the patient's transfer, with no disruption to medication delivery.MethodFive pumps were designated specifically as transfer pumps. Documentation was designed to track the pumps and to monitor their return. A padded addressed envelope is sent with the pump for return, with accompanying details for the receiving healthcare professional regarding discontinuing the pump.ResultsSyringe pumps were used for the transfer of palliative care patients on 42 occasions, with 6 being used for patients who were on a rapid discharge home for the dying patient pathway. All patients suffered no disruption to medication delivery.ConclusionThis innovative system of transferring patients with a syringe pump in situ to maintain an optimum degree of symptom control has been very successful. Staff found the process easy to use, and there was significant benefit to patients.
Lost in translation? Madrid Integrated Palliative Unit
Authors: Merino Teresa García-Baquero , Martínez-Cruz Belen , Ruiz-López Diego , Terrón-Barbosa Raquel 
Published: March 2012

BackgroundDeveloping and implementing an effective palliative care programme is a strategic priority. Madrid's first PC Unit opened in 1991, within mainstream heath system. 2005 saw an important impulse to PC Teams for a 6.5 m population. 2008–2010 was a period during which to consolidate and develop PC with a strategic plan to stress appropriately trained multidisciplinary teams, robust organisative and clinical models.AimTo assess whether Madrid's interpretation of the traditional British model is fit for purpose.MethodOur model of care (UIMCP), for a population of 1m, incorporates ‘all the services patient and family may need to meet -expertly and timely- their palliative care needs’ with 24 h access to patient's information and uninterrupted access to palliative human and structural resources and collaboration from Primary Care, Hospitals, Independent sector, Patients Liaison Services and Information Systems under Palliative Care Department leadership. Implementation is gradual due to the huge professional training needs and complex integration of technical systems. Evaluation through structure, process and output indicators, cross sectional assessments is regular. Data are continuously collected, analysed by the Regional PC Observatory.Results and ConclusionsAll A99 (terminal illness), episodes programmed activities and telephone calls are recorded. Several 100 protocols have been created including Adult and Paediatric referral forms, Pain (assessment), nursing plans, SD, out of hours calls. (1) Preliminary data show the effectiveness of a seamless clinical model. (2) 24 h specialist PC makes a huge impact on this population. (3) It achieves strategic regional goals ϖ organising all end of life services and resources ϖ setting all technological advances at the service of its population ϖ offering a seamless, wall-less pc clinical unit. (4) Adapting and translating the British hospice/specialist PC Unit to our own reality seems to be successful but only possible by electronic palliative care records.
Improving support upon discharge from a hospice in-patient unit using a discharge pathway
Authors: Lennon Rebecca , Banks Eileen , Seed Jessica 
Published: March 2012

An audit and staff survey, about discharges from our hospice inpatient unit, highlighted areas for improvement; delayed discharges, lack of training and delayed discharge letters. It also showed a lack of understanding around discharge procedures among staff and therefore confidence at moving the process forward. The authors devised a discharge pathway that includes sections for doctors, nurses, physiotherapists, occupational therapists, social workers and carers. The sections contain comprehensive instructions for each role, to ensure we are considering all aspects of the patient's needs. It also helps staff understand what is required of them in the discharge process. The section for carers was created after consultation with a hospice carer support group and produced because the authors wanted to make sure the authors were meeting their needs as well.A separate pathway is being used for rapid discharges, to account for the different circumstances of such discharges. Within both pathways is a sheet that includes important contact numbers. This is given to the patient on discharge and can be used by the patient, carer or health professional, for information about who is involved in care and provides the preferred priority of care. To improve the length of time it takes to send a discharge letter out, the authors are typing instead of dictating them. The whole process has given us the opportunity to train all our staff, on the discharge process, when the authors implemented it. The discharge pathway has improved staff understanding and confidence in the discharge procedure and therefore our discharges are more robust. The authors still have delayed discharges, but the reasons for these are often out of our control; mainly due to equipment delivery. The discharge pathway now comprehensively covers the needs of a patient being discharged from a hospice inpatient unit, who potentially has unstable disease and therefore needs regular support.
Audit of thromboprophylaxis decision-making at three independent hospice inpatient units
Authors: Powell Amanda , McMunnigal Fiona , Dymond Emma 
Published: March 2012

IntroductionPalliative care patients should be considered for thromboprophylaxis, given they are often at risk of thromboembolic events. However many have significant contraindications and therefore decisions require careful consideration of risk/benefit burden.AimTo identify how medical staff consider and document decisions regarding thromboprophylaxis in patients admitted to three inpatient units (IPU).MethodologyInitial retrospective review of medical case notes, examining entries within 48 h of admission. 100 case notes (30–40 from each hospice) were reviewed for patients admitted to IPUs from 01 May 2010. The second cycle prospectively reviewed 150 case notes (50 from each hospice) after implementation of thromboprophylaxis education, guidelines and alteration of admission notes to incorporate a thromboprophylaxis prompt.ResultsDocumentation of thromboprophylaxis improved from 15% in cycle 1 to 93% in cycle 2. Nine (53%) and 26 (68%) patients already on anticoagulant treatment, remained on treatment, in cycles 1 and 2 respectively. Eighty-three patients (83%) in cycle 1 were not on anticoagulation treatment compared to 112 patients (75%) in cycle 2. Thromboprophylaxis was initiated in 0% and 11% of these patients in cycles 1 and 2 respectively. In cycle 2, 96 patients did not receive thromboprophylaxis. Reasons were documented in 88 patients. Fourteen patients had more than one reason. Documented reasons were: 29% no indication or not wished, 27% approaching end of life, 17% gastrointestinal bleeding, 8% anaemia, 6% on medication with additional bleeding risk, 5% bleeding other than gastrointestinal, 4% coagulation defects, 2% cerebral bleeding risk and 2% injection site problems.DiscussionIt was clear from cycle 1 that documentation of thromboprophylaxis decisions was poor. Although decisions may have been contemplated, the process was not documented. Education, guidelines and changes to admission notes led to significant improvements in the documentation and transparency of decisions regarding the therapeutic dilemma of thromboprophylaxis in hospice inpatients.
Palliative care provision for those with non-malignant respiratory disease: a literature review
Authors: McVeigh Clare , Porter Sam , Reid Joanne , Hudson Peter , Larkin Philip 
Published: March 2012

BackgroundIt is recognised that those suffering from a malignant disease have access to excellent palliative care (PC) provision. It is less clear if the same standards of PC services are available to those with non-malignant respiratory disease (NMRD). There is therefore a need to explore the needs of people suffering from NMRD and their carers.ObjectivesThe purpose of this review was to determine the experience that those with NMRD have of current PC provision, and identify gaps and needs that require to be addressed.DesignA comprehensive search of the literature was undertaken, using key terms, of the following databases; CINAHL Plus, MEDLINE and the Cochrane Database of Systematic Reviews. 622 articles were sourced and inclusion and exclusion criteria were applied to highlight the most relevant literature.Results22 studies were reviewed using a systematic approach. Five themes emerged from the literature. (1) symptom management – greater PC support is needed. (2) palliative care provision – patients with NMRD have the same palliative care needs as those with MRD, however they do not receive the same standard of PC service provision. (3) health service provision – there is inadequate PC health service provision for those with NMRD. (4) family care givers – family care givers of NMRD sufferers have a range of unmet needs. (5) communication and information – lack of information can lead to anxiety and fear for their future.ConclusionPalliative care is required by all those suffering from complex and persistent symptoms resulting from a non-curative illness. Those suffering from a non-malignant disease are not having their needs recognised effectively and therefore not receiving the appropriate palliative health service provision. Further research is required into the palliative healthcare provision available to those with NMRD. This research is currently being carried out by the author.
Electronic palliative care co-ordination systems improve information provided to out of hours teams
Authors: Smith Clare , Hough Libby , Whitmore David , Cheung ChiChi , Riley Julia 
Published: March 2012

The UK Department of Health (DOH) End-of-life care strategy advocates Electronic Palliative Care Coordination Systems (EPCCS) to improve communication across providers in acute and community sectors 24 h a day. The Royal Marsden NHS Foundation Trust was an EPCCS pilot site. This audit compares the information available to the London Ambulance Service (LAS) on the EPCCS to the information previously provided by a faxed paper form.AimTo determine if the EPCCS improved the quality of the information shared.MethodsFaxed Palliative Care Handover Forms (PCHF) held at LAS at one time point prior to EPPCS were compared to all EPPCS entries 10 months after implementation.ResultsWhen comparing the PCHF to the EPPCS, the average age of patients (78 years) remained the same. The proportion of patients with a diagnosis other than cancer increased (33% PCHF vs 48% EPPCS) and the number of GPs completing information increased using EPCCS (29% PCHF vs 39%). Consent improved with consent evident on 49% of PCHFs and mandatory (100%) on EPCCS. The EPCCS was designed with mandatory fields leading to improvements in data completion of the following; • ‘Has the patient been prescribed strong opioids?’ 85.1% (n=135) PCHF vs 100% (n=145) EPCCS • ‘Has resuscitation been discussed with the patient?’ 64.9% (n=100) PCHF vs 100% (n=145) EPCCS, • ‘Has resuscitation been discussed with the carer?’ 66.9% (n=103) PCHF versus 100% (n=145) EPCCS. EPCCS also improved completeness of non-mandatory fields; • ‘Is there a signed Do Not Attempt Resuscitate form in the house?’ (91% vs 77.9%), • ‘Are there emergency drugs left in the home?’ (95.2% vs 50%), • ‘Is death anticipated?’ (96.6% vs 85.1%).ConclusionEPCCS does improve data quality covering aspects of care including resuscitation and the end of life phase. This provides support for EPCCS on a wider scale.
Further development of the rapid discharge integrated care pathway (RDICP) hospital to home
Authors: Gambles Maureen , Cannell Lynne , Curie Deborah Murph Marie 
Published: March 2012

The ‘rapid discharge pathway’ (RDICP) was developed by the Palliative Care Team at the Royal and Broadgreen University Hospitals NHS Trust (RLBUHT) in response to an identified clinical need to enable imminently dying patients to die in their place of choice. The original RDICP was reviewed and refined in line with Version 12 of the generic LCP. Stakeholder meetings were held to gain consensus and to overcome bottlenecks/blockages in the system and the RDICP was launched in April 2008.AimTo undertake an audit of the first year of use of the amended pathway. An audit of outcomes for all 31 patients in 2008/9 who were transferred home supported by the RDICP was undertaken. The RDICP was used on 21 wards, within 5 directorates General Medicine (20) Care of the Older (2) Haematology (2) General Surgery (5) Renal Unit (2). Twenty-one patients had a diagnosis of cancer 61% were Male Mean time from discharge to death=8 days; median 5 days; IQR 2–10 days. No patients were re-admitted to the hospital prior to their death. The RDICP provides a structured and coordinated process to enable a dying patient to go home to die. It is crucial to the success of the framework that specialist palliative care services take a lead role in the use of this pathway. While numbers are small, the authors feel that this framework could be utilised by other health providers with local networking to achieve a rapid discharge of a patient to enable a home death. The RDICP is one means of facilitating choice at the end of life helping to ensure optimum care for dying patients and their families. However, while District Nurses support this process, families have to agree to provide the main bulk of care.
Treatment escalation plans – a tool to aid end of life decision making?
Authors: Paes Paul , O'Neill Cate 
Published: March 2012

BackgroundThe number of patients dying in hospital continues to remain high. One of the challenges in combating this is deciding when to actively manage a patient and when to withhold/withdraw treatment. Advance Care Planning concentrates on patient-driven decisions, planning ahead in case they lose capacity to make decisions. Less attention has focused on clinician-led decisions, especially anticipating problems and planning for clinical deteriorations. Treatment escalation planning is one mechanism of planning the care of a patient at risk of deteriorating.MethodTreatment escalation planning was introduced as a pilot in the following settings in a general hospital: Respiratory, Cardiology, Care of the Older, Medical Assessment Unit/General Medicine, Critical Care and Palliative Care. Audits were carried out in each setting, looking at decision making, before and after the pilot were carried out. The outcomes were measured and feedback obtained from staff in relation to ease of use, issues encountered and practicalities.ResultsThe use of Treatment Escalation Plans was popular with junior doctors, especially out of hours. Advantages of using the plans included: creating a culture of thinking ahead, a simple format, and in a few cases patient decisions were affected by the plans. Disadvantages were that most patients during their admission did not need the plans created; the decision making and communication of decisions took extra time.ConclusionTreatment Escalation Planning is a potentially powerful tool in trying to deliver appropriate levels of patient treatment. Dilemmas arising from this study include whether to implement this process for all patients (most will not benefit) or for a selected group (at present the authors are not good at predicting patients who will deteriorate acutely). In addition, it raised a number of ethical questions around the communication of decision making, and the level of patient involvement in clinical decision making.