bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of community palliative clinical nurse led clinic
Authors: Cobb Ann-Marie , Peplow Karen , Shevlin Breeda , Waterman David 
Published: March 2012

BackgroundThe Department of Health End of Life Care Strategy (2008) recommends the delivery of high quality and accessible specialist palliative care. The Quality, Innovation, Prevention and Productivity (QIPP) programme highlights that patients should have access to services that our personalised, compassionate, effective and efficient. These drivers have led to a service improvement in our locality (pop. 300,000) with the development of a bi-monthly afternoon community clinical nurse specialist led palliative clinic. Aims: The aim of this study was to evaluate patient experiences / satisfaction when attending the clinic. There was also a review of the clinic impact on overall savings in travel time and mileage.MethodOver a 2 month period, all patients attending the clinic were offered an opportunity to evaluate the clinic using a structured electronic questionnaire. The questionnaire focused on contentment with the quality, timeliness and location of the services received. Nine months of data was also collated regarding mileage costs and travel time savings.ResultsAll nine individual clinic attendees, over the evaluation period, completed the questionnaire. All described that they were listened to; given the time they required and received clear communication. Eight felt the clinic was the appropriate location for their assessment. The service perspective is that the clinic also provides an ideal setting for patients to receive an appropriate introduction to the service. Over eighteen clinic sessions, 28 clinical assessments occurred, which provided more capacity than would have been possible in their home environment. The clinic has saved 18 h of travel time alongside a travel cost reduction of two hundred and ninety miles.ConclusionThis pilot service improvement fulfilled the patient's needs, whist working within current resources of our service. A more in-depth research study is planned to explore this area further.
A survey of patients with palliative needs on an acute medical admissions unit
Authors: Quibell Rachel , Armstrong Leonie , Jaafar Ahmed , Muir Michelle , Price Ashley , Woolley Sara 
Published: March 2012

AimsTo identify any current issues for patients with palliative needs being admitted to an acute medical admissions unit To inform and prioritise the work of the Specialist Palliative Care Team (SPCT) for emergency medical admissions. To map the pathway for patients with palliative and end of life care needs. This work was prompted by a Marie Curie Delivering Choice Programme report1.MethodsTwo week Pilot Survey followed by a 6 month CNS led Project with data collection. Pilot Survey Patients, with palliative care needs, irrespective of diagnosis were identified by consulting nursing and medical staff and all medical notes each day. Data collected via notes analysis- Demographics GP Reason for admission and any known patient history DNAR Status Discharge Packages of Nursing and Social Care at home Medication Specialist palliative care involvementResultsFrom Pilot Survey Themes: Palliative Care Needs in unit. 24 patients identified in 2 weeks 25% were actually referred to SPCT. 3/24 patients commenced on Liverpool Care Pathway for the Dying and died on unit. Out of Hours Need: 62.5% admitted OOH Referral Source: 29% care homes, 50% A&E Documentation and Information: 71% had DNAR documentation in notes 4% were documented as on GP Palliative Care Register 6 month Project data will be available for poster, and this will contain additional information on palliative care needs and symptoms.ConclusionThere are significant palliative care needs on an acute medical admissions unit. This survey will inform the direction and design of palliative care provision on a busy acute medical admissions unit. It also gives invaluable information regarding the patient pathway prior to admission and after discharge from medical admissions to a base ward.
Audit on NHS fast tract applications: prognostic prediction & preferred place of care/death
Authors: Thirukkumaran Thiru , Subramaniam Siva , de Nogla Sinead , Cawley Declan , Fisher Simon 
Published: March 2012

Background‘NHS fast tract’ enables urgent care allocation to a patient whose primary health need is classified as ‘rapidly deteriorating condition with an increasing level of dependency and approaching end of life care’. The guidance states clearly that life expectancy does not form a part of the eligibility criteria under fast tract route. This approach aims to ensure that the individual in question with get the care they require and this be their preferred place of care and be in place within 48 h.AimTo explore the possibility that the fast track process can act as a useful aide memoire when professionals are trying to predict prognosis in individuals with progressive, life limiting conditions.MethodologyA retrospective case note review as well as fast track documentation within a hospice setting over 3 months.ResultsFourty-two patients identified who applied for the ‘NHS fast tract’ process with 41 applications approved. In 39/42 (93%) applications a decision was reached within 48 h with the remaining applications getting a decision in 72 h. In terms of accuracy of prediction: 36/42 (86%) died with 12 weeks of approval.28/42 (67%) achieved their preferred place of care (PPoC) and death (PPoD) with 6/42 (14%) not able to have the conversation regarding PPoC/D.ConclusionThe possibility that the Fast Track process may help clinicians in trying to build an approach in aiding prognostication and facilitating individuals to be cared for and die in their preferred setting is promising. The use of an existing process that can timely facilitate end of life care in individuals with the helpfulness of timelines can only help manage resources that are currently so limited. We aim to use this approach with additional data methods to try and gain further knowledge in best planning end of life care.
Evaluation of a hospice specialist palliative care nurse secondment to the acute setting
Authors: Conn Meriel , Kerr Linda , Sherry Kathleen 
Published: March 2012

BackgroundAs specialist palliative care services are evolving and reasons for admission to hospice are changing, the Ayrshire Hospice has developed an innovative model of practice within the In-Patient Unit (IPU) senior nursing team. One of the senior Hospice Specialist Palliative Care Nurses (SPCN) in this team identified in her personal development plan that experience in the acute setting working with the Hospital Specialist Palliative Care Team (HSPCT) would be of benefit. In collaboration with the local district general hospital a structured SPCN clinical secondment to the acute setting was developed and evaluated.ObjectivesDevelop understanding of the role of the HSPCT and of challenges specific to clinical practice in the acute setting. Develop and demonstrate skill and competency in multidimensional patient assessment. Manage own patient caseload. Develop skill in writing clinical letters. Increase awareness of key priorities of communication between the acute hospital and the community setting.MethodTwo month secondment; clinical experience; working with the HSPCT; new patient and ward reviews; multidisciplinary team meetings; informal ward teaching; integrated liaison with hospice community team and multidimensional assessment of acute transfers to hospice. Electronic and letter communication, attendance at team development and clinical governance meetings.ConclusionThe acute hospital presents different challenges in day-to-day practice when compared to the specialist palliative care unit. This secondment facilitated and supported the development of autonomous practice and fulfilled the objectives. These are transferrable skills. On returning to the hospice the aim is to maintain and demonstrate this level of clinical assessment while encouraging staff to develop their own assessment skills further and continue to develop a workable SPCN patient caseload in the IPU. This will also support the opportunity to mentor hospital and community staff undertaking the ‘Nurses with a Specialist Interest in Palliative Care’ education programme during their hospice clinical attachment.
‘Thinking differently’ to redesign community specialist palliative care services
Authors: Traue Dee 
Published: March 2012

BackgroundIsabel Hospice provides care for a population of 350,000 across eastern Hertfordshire. To enable the hospice to meet the challenge of an increasing demand for community services at a time of financial constraint, we utilised the NHS Institute for Innovation and Improvement ‘Thinking Differently’ programme. This provides a range of practical approaches and tools which enable fundamental rethinking of pathways of care and service delivery.AimsTo think creatively about how we give people nearing the end of their life, and their family/carers, the best possible support and care in the place of their choice.MethodsThe ‘Thinking Differently’ three part process was adopted: Stop before you start – an initial focus group for hospice staff to reframe our challenge and consider it from a number of different perspectives. Generating ideas – four focus groups for stakeholders across our catchment area which used divergent thinking techniques to produce a large quantity of innovative ideas. Selecting and testing ideas – a final focus group for senior hospice staff using convergent thinking techniques to identify the ideas most likely to make a difference.ResultsA total of seven focus groups were held, three for hospice staff and four for external stakeholders, including patients, carers and a range of health and social care professionals. From over 30 innovative ideas generated, four projects have been identified for further development: ‘Isabel Urgent Care’ – a rapid response hospice @ home service ‘Hospice Direct’ – an enhanced 24/7 advice line for patients and professionals ‘Living Well With Isabel’ – a Patient and Carer Self-Management Programme ‘The Mobile MDT’ – Multi-professional community clinics.ConclusionUsing the ‘Thinking Differently’ toolkit enabled the hospice to undertake a robust consultation process with our key stakeholders and identify approaches to transform the services we provide.
‘Five things i would like a community specialist palliative care service to provide’ – a novel approach
Authors: Traue Dee 
Published: March 2012

BackgroundIsabel Hospice provides care for a population of 350,000 across eastern Hertfordshire. Changes in our population and an increasing focus on choice in place of care have resulted in a growing demand for services to support patients to live and die at home. To inform future community service development, the hospice organised a series of focus groups for patients, carers and professionals. However, it was recognised that this method of engagement would only reach a limited number of stakeholders.AimTo identify the priorities for community specialist palliative care service development of both stakeholders from local health and social care organisations and hospice staff.MethodsA postcard was developed asking the respondent to list ‘five things I would like a community specialist palliative care service to provide’. The postcards also captured basic demographic data about the respondent. Over 300 postcards were distributed, with a covering letter, to local stakeholders including primary care teams, acute and mental health trust staff, adult care services and local voluntary sector organisations. Electronic versions of the postcard were distributed to all hospice staff and volunteers.ResultsExternal respondents – 43 cards were returned, including 17 from district nurses and 14 from GPs. These included a total of 171 suggestions for what respondents would like the hospice to provide. The most popular themes were provision of ‘hands on’ care and access to advice and support 24/7. Internal respondents – 52 cards were returned, 17 from clinical staff and 31 from volunteers. These included a total of 157 suggestions, with the majority focusing on the development of day hospice and outpatient services.ConclusionBy adopting the novel approach of distributing the ‘five things’ postcard, the hospice was able to gather much wider stakeholder feedback than would have been possible by the use of focus groups alone.
Experiences of end of life care of patient's with motor neuron disease on non invasive ventilation
Authors: Steel Kimberley , Hodgson Aruna , Waterman David , Harrison Sophie , Bentley Andrew 
Published: March 2012

BackgroundIn July 2010 NICE developed guidance on the use of non-invasive ventilation (NIV) in patients with Motor Neuron Disease (MND). In the North West of England the University Hospital of South Manchester (UHSM) provides a tertiary Long Term Ventilation Service (LTVS) which establishes NIV for patients in the region. The NICE guidance means increasing numbers of MND patients are being commenced on NIV and subsequently the number of patients reaching the end of their life on NIV is increasing.MethodAs part of the service review UHSM LTVS carried out a postal survey of GP's whose patient's died between July 2010 and December 2010 to evaluate the end of life care of MND patients on NIV.Results12 GP's were contacted and 8 returned feedback. •Place of death: 5 at home 2 in hospital 1 in a hospice •There were multiple professionals involved in the patients' deaths; 5/8 of the patients had 3 or more professional disciplines involved. •5/8 patients had an Advance Decision to Refuse Treatment (ADRT); 3/5 related to the patient's ventilation – 2 relating to withdrawal and 1 stating a wish to die on NIV •5/8 patients died on NIV (including 2 with an ADRT for NIV withdrawal) •GP's confidence in dealing with NIV was variable.ConclusionThere is increasing number of MND patients reaching the end of their lives dependent on NIV. The confidence of GP's is variable and the number of healthcare professionals involved with these patients is substantial. Although the majority of patients had ADRTs, these did not always relate to NIV. Even if it did, NIV was still continued. In light of these findings UHSM LTVS has recognised the need to develop multi-disciplinary ‘end of life care’ guidelines for patients with MND who are using NIV.
A children's hospice funded team to develop transitional pathways between acorns and adult providers
Authors: Reed Christopher , Turner Pat 
Published: March 2012

MotivationAcorns has previously identified through a feasibility study that there is little proactive coordination in respect of planned transition to adult services for our clients. There are circa 110 young adults using Acorns presently facing the prospect of transition to adult care.Problem statementAt a time when many young people are at their most vulnerable Acorns would provide on-going support that would address the future aspirations of every young person we care for, as well as ensuring that their palliative care needs are met. The Transition Team will enable young people to access services for adults through the familiar organisation of Acorns. There would be no abrupt end of services and young people would be enabled to make choices about their future supported by an organisation they know and trust.ApproachThe 36 month target to complete transition from Acorns to adult services requires 3 P/T workers and F/T manager to work across the Acorns region. Working alongside existing community workers, preparation for adulthood will take place to enable discharge from the children's service and engagement with the adult sector. This involved liaison/partnership with external ‘adult’ agencies offering services to life limited young people. Delivery of this service will follow a care model devised from the ACT Transitional Pathway.ConclusionLife Limited Young people need options and choices for future care. There is a need to empower life limited young people and their families to advocate for themselves. Previous project work carried out by Acorns highlights the need for an appropriately (transition) worker. Life limited young adults with profound physical and learning disabilities need comparable services in the adult sector in order to monitor and maintain health. Health needs are not the only component of transition which requires addressing.
Advance care planning for renal patients
Authors: Ackroyd Rajeena 
Published: March 2012

BackgroundThere is increasing evidence of the benefits of advance care planning in patients with advanced kidney disease. End of life care in Advanced kidney disease (2009) A framework for implementation has also recommended their use.MethodSince 2008 in Calderdale a renal palliative care clinic has been established. All conservative care patients (not for dialysis) are seen by a palliative care consultant providing an ideal opportunity for advance care planning. In October 2010, an advance care planning document was introduced within the trust and used within the clinicResultsFrom October 2010 to April 2011, 20 Patients were reviewed in the clinic (average age 82 years and average eGFR=13.8 (range 6.3-18.5) During this 6-month period, 5/20 patients had formally completed an advance care plan which had been circulated and 7/20 patients were in the process of completing an advance care plan. One patient had completed an advance decision to refuse treatment. Therefore 65% patients were actively involved in the process and all had involved a family member.ConclusionThe renal palliative care clinic is ideal for the integration of advance care planning for patients with advanced kidney disease as it allows the opportunity to develop a good relationship with the patient and their family. It supports the need for chronically ill patients to think about the future direction of their medical care, preparing them for death and gain a realistic understanding of the services available. Advance care planning does take time but can empower patients to achieve a sense of control and relieve the burden of decision making from relatives. Further evaluation of outcomes is important.
Improving links between specialist palliative care and the motor neuron disease team
Authors: Smith Jenny , Waldock Joy 
Published: March 2012

BackgroundMotor neuron disease (MND) is a progressive neurodegenerative disease. The incidence of developing MND is approximately 2 per 100,000 people with 7 per 100,000 people living with the disease worldwide. The MND Association of standards of care document recommends that referral is made to the Specialist Palliative Care (SPC) Team for all patients soon after diagnosis and for psychological support at the time of diagnosis. A recent all-party parliamentary group inquiry found that: good specialist palliative care provides value for money by reducing interventions, reducing calls to emergency services and reducing hospital admissions. Unfortunately access to SPC varies greatly across the UK and there are no standardised referral pathways.AimsCurrently the mid-Yorkshire SPC team see only a few patients with MND each year. This audit was intended to establish the common symptom management problems and determine which patients are referred to SPC, and by which methods. An additional short survey to both the Palliative Care and MND Teams was performed to highlight staff views with regards to access to appropriate expertise and services at the appropriate time.Results/ConclusionA small number of patients with MND are referred to the SPC team in mid-Yorkshire and consequently confidence levels among the SPC staff looking after them can be low. Introducing the role of specialist palliative care soon after diagnosis would allow these patients to have choice regarding their care and educate them that palliative care is not just about death and dying but about enhancing quality of life.RecommendationsMore collaborative working between the two teams, review of current referral pathways and SPC attendance at MND clinics to improve communication and also the holistic care for these patients. A formal education programme is also needed with refresher/update sessions for all staff to improve confidence and skill levels.
Developing and implementing a guideline for deactivating implantable cardioverter defibrillators
Authors: Seaman Siwan , Pease Nikki 
Published: March 2012

BackgroundRecommendations from NICE technology appraisals would suggest that the number of patients meeting the criteria for implantable cardioverter defibrillator (ICD) implantation is far greater than the current implantation rate in the UK. With an increasing number of centres implanting ICDs we can expect to see an increasing number of patients with ICDs in the palliative care setting over the next decade. Although for some patients their life-limiting illness will be of a cardiac nature, others will require palliative care for an unrelated pathology for example, advanced cancer. The impetus for this project came after noting an increasing number of patients at our regional cancer centre with ICD devices. A telephone survey of 8 specialist palliative care units (SPCUs) across South Wales was undertaken, where medical directors were asked if either guidelines or a policy for managing patients with ICDs were available to them. The survey identified a complete lack of guidelines for managing patients with ICDs at the end of life. Hence the need for concise and practical guidelines for the management of ICDs in palliative care inpatient settings was identified.Aims and MethodsTo develop a guideline that would simplify the science of ICDs to non-cardiologists, provide information to help a palliative physician discuss available options with patients and their families and deliver practical advice on ICD deactivation both in an emergency setting and after death. Cardiologists from the two device implanting centres in South Wales were consulted and provided input throughout the guideline development process. The medical illustration department were approached to provide images to demonstrate emergency deactivation.ConclusionFollowing development and national ratification of the guideline it has been introduced together with an education tool to the medical directors of SPCUs across Wales for implementation.