bluuebunny/crossref_metadata_2025_split huggingface dataset:
Do patients referred to specialist palliative care (SPC) die where they prefer? A network-wide audit
Authors: Scholes Carol , Allan Rebecca 
Published: March 2012

Background‘There is currently a significant gap between preferred and actual place of death, with over half not dying where they would choose, too many dying in hospital and too few in their own home, care home or hospice’ Gold Standards Framework.AimTo perform a network-wide audit of the Preferred Place of Death (PPD) of patients known to SPC to ascertain whether their wishes were fulfilled. Method: Data was collected from SPC clinicians regarding last expressed PPD, actual place of death, and reasons for discrepancy for all patients known to SPC teams (communities, hospices, hospitals) across the Mount Vernon Cancer Network. The study period was 3 months.Outcomes708 consecutive patients were included – 320 (45%) died in hospital, 179 (25%) at home, 172 (25%) in hospice, 28 (4%) in care home and 9 (1%) unknown. (a) Outcomes where PPD known: 426 (60%) had a PPD which were 184 (43%) home, 159 (37%) hospice, 53 (13%) hospital, 30 (7%) care home. 349 (82%) achieved their wishes. 77 (18%) died elsewhere due to unexpected deterioration (34), physical condition (14), continuing healthcare delays (13), lack of family agreement (6), no available bed (3), unknown (7). A patient was 5.5 times more likely to die at home. (b) Outcomes where PPD unknown: 282(40%) had unknown PPD. 215(76%) died in hospital, 35(12%) hospice, 18(6%) home, 10(4%) care home, 4(1%) unknown. A patient was 3 times more likely to die in hospital.Conclusion82% of patients with known PPD achieved their wishes. Physical symptoms and unexpected deterioration were the primary reasons cited for those dying elsewhere. 40% of patients had no known PPD and of these 76% died in hospital. Extension of discussion and documentation of PPD to more patients would increase patient choice and is likely to reduce numbers of patients dying in hospital, and increase deaths at home across this population.
How to provide consultant peer support – the south coast new consultants group
Authors: Ford-Dunn Suzanne , Barclay David 
Published: March 2012

IntroductionPeer support is identified though the NHS appraisal process and national bodies such as Royal Colleges, as being essential for the on-going wellbeing and professional development of consultants. It is recognised that the early years as a consultant can be particularly stressful and that palliative medicine consultants have difficulty obtaining peer support since many work in isolation. We identified a lack of peer support within our area.DescriptionA new consultants group was formed in 2009, using loose geographical boundaries of the Sussex Cancer Network – involving 10 ‘new or soon to be’ consultants. The group meets 4 times per year, topics relevant to new consultants are agreed and organising each meeting is shared. Meetings either have invited external speakers or are run by one of the members. The meetings aim to provide CPD (topics include Commissioning, managing CNS's in difficulty, writing a business case etc) but also to provide members with time to discuss any issues that have arisen, clinical or non-clinical. The group is cost effective in that SPA time is used for the meeting, with costs for speakers/meeting rooms etc covered by sponsorship if needed.BenefitsConsultants in isolated posts have found the peer support invaluable. Feedback from members is highly positive – further evaluation is underway to produce data to support its effectiveness. The presence of our group has been used by local units to enhance the attractiveness of new consultant posts. Future plans: As some members reach the end of their first 5 years in post, and Consultant vacancies in the area are filled, debate is occurring as to the terms of reference of the group. The support has been so effective it is proposed to continue meeting, but extending membership to become a generic doctors' professional development meeting.
An audit of rehabilitation input for patients with brain and spinal tumour within the Greater MancheSTER
Authors: Robson Sara , Emerson Julie , Connor Neil 
Published: March 2012

BackgroundIn 2008, the National Cancer Action team started a cancer rehabilitation workforce scoping exercise. As a result of this, eight cancer disease group rehabilitation pathways and four symptom specific pathways were published in 2010. The pathways were written following all available evidence and examples of best practice, where evidence was not available. (National Cancer Action Team; Briefing Paper 2 CRWP September 2008) As part of our role we were given the task of introducing the Brain and CNS rehab pathway to our local cancer network (Greater Manchester and Cheshire Cancer Network). We were required to localise the pathway and examine how closely the rehab provided for the brain and CNS tumour patients was following the suggested ‘best practice’ in the rehab pathway. We had assistance of the local Supra District Audit office to audit the existing pathway and rehabilitation interventions prior to our input, and re audit following a year of education and promotion of the pathway.Aim of the presentationThe aim of the poster is to detail the processes that led to the production of a successful audit tool, and to discuss the ‘trials and tribulations’ of carrying out a regional audit of patient notes which spanned numerous separate agencies. We aim to make others aware of some of the pitfalls surrounding multi agency audit.MethodologyA retrospective audit of medical/allied health professional notes was carried out on a sample of randomly selected patients diagnosed with a primary brain or spinal tumour within a specified period. All agencies involved have been made aware of the audit and each individual Information Governance Team has had to give approval. As the audit did not involve discussion with patients, ethical approval was not required.
Implementing the LCP ICU Version 12 across a regional critical care network
Authors: Parsons Dawn , Gambles Maureen , Chapman Laura 
Published: March 2012

A pilot project is currently underway within the 11 intensive care units within the Mersey an Cheshire Critical Care Network (MCCCN) to implement the recently developed Liverpool Care Pathway for the Dying Patient in Intensive Care Version 12 (LCP ICU). Funded by the Merseyside and Cheshire Cancer Network, this project will provide a mechanism to support units to robustly implement and sustain the LCP ICU Version 12.AimTo implement LCP ICU Version 12 into 11 sites with the MCCCN to ensure that: •Appropriate processes and policies are in place to support care in the last hours or days of life •Staff are appropriately educated and trained to deliver that care •A mechanism for the on-going collection/sharing of data (to promote and sustain the delivery of quality care into the future) is developed The Project involves the identification of Key Champions within each participating site who will take responsibility locally for the implementation process. They will be supported by the Project LCP ICU Facilitator to deliver robust education and training to staff and to facilitate and monitor the implementation process. Key Champions will meet monthly with the LCP ICU Facilitator to discuss progress and to share challenges and opportunities. Contextual organisational information from each unit will be collected prior to and post implementation. Alongside this, data from LCP ICUs completed within each site during the project will be collated and analysed descriptively to provide a comparative benchmark of care delivery across the network. Key Champions and the LCP ICU Facilitator will keep reflective diaries throughout the process, which will be analysed thematically to derive an understanding of the process of implementation, including facilitating factors, barriers and challenges. Findings from all facets of data collection will be presented, discussing the implications for wider implementation of the LCP ICU Version 12.
Implementing the GP palliative care register ‘how to’ pack
Authors: Rushbrooke Sarah , Kendrick Elizabeth 
Published: March 2012

BackgroundThe palliative care registers were introduced as a quality and outcome framework measure to try to improve the care of people at the end of their life. Research and local experience tells us that the registers are used in very different ways within and between GP practices. Carers frequently tell us about poor coordination of care for people at the end of their life and one of the outcomes within the new NHS outcomes framework to be measured is carers' satisfaction with their loved ones end of life care.AimsThe purpose of this guide is to support GP's to make the palliative care register work for their patients and improve their outcomes in palliative and end of life care. The SHA End of Life Clinical Innovation Team (CIT) and the North of England Cancer Network (NECN) have worked with a number of dedicated clinicians and IT experts to develop the ‘How to Guide’ to support GP's to use their registers effectively. A Rapid Improvement Workshop (RPIW) was held, which is a service improvement method, to look at the process of the palliative care register and gathered data from other parts of the UK to write the guide. In addition, the agreed GP Palliative Care pack will be shared with the national QIPP and End of Life team with the explicit aim of working with the Care Quality Commission (CQC) to adopt the process as part of the inspection of GP practices. The pack will be implemented across the SHA and network from October 2010 to all GP practices and an audit of compliance will be completed.OutcomesIt is envisaged that all GP practices will adopt the ‘How to’ Pack and the project team will work with the individual practices to ensure it is embedded in every day practice.
Impact of a local enhanced service agreement for end of life care on collation of a palliative care
Authors: Westwood Debbie , Baghsaw Kerry , Curtis Claire , Hospice Kemp , Blaine Kidderminster Felix 
Published: March 2012

BackgroundThe Local Enhanced Service agreement (LES) for End Of Life (EOL) care was started by Worcestershire Primary Care Trust in 2009, and is now in its 3rd year, with the aim of developing good practice and improving EOL care in Worcestershire. GPs have been asked to sign up to and fully adopt the Gold Standards Framework (GSF), including collating a palliative care register, use anticipatory prescribing, use the Liverpool Care Pathway for all dying patients, apply the GSF surprise question to all care home residents. All GPs in participating practices were expected to complete 2 h-long learning modules, and each practice had to nominate a lead GP to attend a 1 day study day each year.OutcomesIT software from MSDi installed on all GP surgeries to collect data. Practices were offered 50 pence per patient on the practice list. 60 out of 68 GP practices signed up for the first 2 years, and 339 GPs completed education modules. The number of people on the palliative care register increased from 500 in 2006/7 to 1983 in 2010/11. The proportion of deaths in acute hospital has reduced from 45.4% in 2007/8 to 42.0% in 2010/11. 27% of patients on the palliative care register who died at home or in a community hospital were placed on the LCP.ConclusionAlready data shows that a patient on a palliative care register is more likely to die at home than someone not on such a register, and we have achieved a 3.4% reduction in the proportion of deaths happening in the acute trust since 2007/08, which equates to a 5% reduction in the numbers of people dying in the acute.
Clinical innovation through leadership development
Authors: Coackley Alison , Bonwick Helen , Chapman Laura , Wrigley Kim , Powell Paula , Mayland Catriona 
Published: March 2012

BackgroundSenior clinicians and managers are at the forefront of innovation within Palliative Care. This places significant demands on professionals who need specific skills to maximise their effectiveness and their impact in the clinical workplace. Merseyside and Cheshire Cancer Network funded a Leadership Impact Programme for Consultants in Palliative Medicine. This links leadership style directly with engagement, wellbeing and performance which in turn helps individuals to encourage change and innovation in their organisation.MethodDiagnostic management tools, participation in a coaching centre with feedback, development workshops, and peer support. Subsequent Action Learning Sets over 12 months then facilitated participants to use their skills to produce change and innovation in their workplace.Discussion/ConclusionThe course was designed to meet the needs of the individuals and the group in general. Participants included seven senior clinicians and two senior clinical managers Evaluations were extremely positive with many specific examples of how learning and experiences from the course had impacted on clinical services across a range of organisations. 100% of participants felt the programme had met their personal objectives either very well or completely. All reported a marked improvement in strategic awareness and ability to influence. Results included enhanced team development and leadership leading to integration and improved communication; ability to deliver significant change in an organisation; sharing of new ways of tackling challenges and the commitment to collaborative ventures which were both cost effective and innovative The success of the programme has encouraged the Network to support a second 12 month course for a further cohort of senior clinicians.
Audit of LCP anticipatory medicine prescribing at a large teaching hospital
Authors: Dyer Jen , Dickman Andrew 
Published: March 2012

IntroductionThe (LCP) is a programme within the Marie Curie Palliative Care Institute Liverpool (MCPCIL) portfolio and should be undertaken and managed by a multi-disciplinary team. It is an integral part of the End of Life Care Strategy. The aim of the LCP is to ensure that all dying patients, and their relatives and carers, receive a high standard of care in the last hours and days of life. The LCP template can be adjusted to enable the creation of local guidelines for use within a clinical setting. The LCP incorporates treatment algorithms for five of the most common symptoms experienced by the dying patient that is, pain, agitation, respiratory tract secretions, nausea/vomiting and dyspnoea. The algorithms stipulate that anticipatory medicines should be prescribed pro re nata (PRN) in case these symptoms develop and to avoid unnecessary delay in their treatment.Aim and ObjectiveTo assess the current level of LCP anticipatory medicine prescribing compared to local Trust guidelines and identify any potential training needs.MethodThis retrospective audit was performed over a period of 1 month, with a total of 32 patient records being identified.ResultsOnly 37.5% (12/32) inpatient charts adhered to the Trust's LCP guidelines. The remainder contained one or more prescribing errors (n=53 identified). The most common error identified (68%) was omission of one or more of the anticipatory medicines. Confusion as to which opioid to prescribe was also evident; diamorphine is presently the first-line choice.Discussion and ConclusionThis audit showed that 62.5% of LCP anticipatory medicine prescribing was non-compliant with Trust guidelines. Additional training needs have been identified and a programme of education and training can be developed. Once this has been established, the inpatient charts should then be re-audited to check for improvement and compliance.
Goal setting in palliative care: a structured literature review
Authors: Boa Sally , Wyke Sally , Duncan Edward , Haraldsdottir Erna 
Published: March 2012

ObjectivesTo identify and synthesise existing literature on goal setting in palliative care, with a view to identifying a conceptual framework to underpin the process.MethodsSearches were conducted using MEDLINE, PSYCHINFO, EMBASE, CINAHL, ASSIA and Google Scholar data bases between November 2010 and January 2011. Additional articles were located by screening the reference lists of those which were included. Papers were included if they focused on patient centred goal setting for patients with palliative care needs. Included papers were categorised according to type (quantitative, qualitative, mixed methods, literature review, conceptual, opinion or practice based). Research papers were quality appraised. Critical interpretive synthesis was used to analyse and synthesise data.Results16 papers about goal setting in palliative care were included (four quantitative, one mixed methods, three qualitative, one literature review, three conceptual, one opinion based and three practice based). Research papers varied in quality and primary focus. There was no clear definition of goal setting. Three themes emerged: what goal setting is; challenges and factors that affect goal setting and emerging theory/conceptual underpinning of goal setting.ConclusionsPatient centred goal setting is recognised as an important component of palliative care and is described as beneficial for patients, families and professionals. It is proposed as a method of ensuring that care is patient led, giving patients a sense of control and bringing meaning. Goal setting appears to be slightly different in palliative care as compared to general rehabilitation settings, primarily because palliative care patients are dealing with deteriorating conditions, often at unpredictable rates. Hope theory and adaptation to life threatening illness provide useful adjuncts to already established theoretical goal setting literature.
National care of the dying audit hospitals (NCDAH) round 3 results
Authors: McGlinchey Tamsin , Mason Stephen , Gambles Maureen , Murphy Deborah , Ellershaw John 
Published: March 2012

BackgroundThe UK Department of Health (DH) published national guidance in end of life care for the first time (DH 2008/2009), highlighting the Liverpool Care Pathway for the Dying Patient (LCP) as a best practice model of care in the last hours or days of life. After an extensive 2 year consultation process, resulting in important amendments around more explicit goals on hydration, nutrition and skin integrity, communication and guidance for diagnosing dying, the current LCP (Version 12) was published in 2009. The Marie Curie Palliative Care Institute Liverpool, in collaboration with the Royal College of Physicians, has undertaken round 3 of the National Care of the Dying Audit Hospitals (NCDAH). The NCDAH allows submission of data against 2 elements – organisational (all NHS Trusts) and clinical (LCP) elements of care delivery in the last hours or days of life. Data driven Key Performance Indicators (KPI) were developed for organisational and clinical elements of the audit. The NCDAH Round 3 has been included in the ‘Quality Accounts’ list of national audits promoted by the DH in 2011-2012, and is the first round to measure care delivery against outcomes on LCP V12.AimPresent findings of the NCDAH Round 3: • Organisational elements of care delivery and KPI's • Clinical Outcomes: against core elements of care (LCP V12) • National implications for policy.MethodRetrospective audit cycle: organisational and clinical elements of care in the last hours or days of life in hospitals in England.Findings131 NHS Trusts have submitted organisational data, and 178 individual hospitals have submitted outcome data from 7058 patients whose care was supported by the LCP. Participation has increased by 13% from round 2.ConclusionResults will be discussed with national implications for policy, education and training, and key recommendations for improvements into the future.
Routine sedation at the end of life
Authors: Frew Katie , Exley Catherine , Hughes Julian , Paes Paul 
Published: March 2012

BackgroundSedation is a controversial issue in palliative care. Previous research has explored aspects of administration, concerns of relatives and staff and also ethical issues, predominately in retrospective studies. These studies suggest that we require prospective observational research into the day to day use of sedation.AimsThe aim of this research was to describe the normative underpinnings of current hospice practice with respect to the use of sedation in palliative care.MethodsThis is an ethnographic study of the use of sedation in a palliative care inpatient unit. The primary research methods were participant observation and indepth interviewing. Data was analysed taking a constructivist grounded theory approach.ResultsThrough data analysis 3 overarching concepts were developed. These were (1) the concept of ‘routine’ sedation; (2) the relationship of sedation to ensuring a good dying and death; (3) the fundamental role of values in the use of sedation. This paper will consider the first of these. A ‘routine’ form of sedation was observed in the fieldwork and developed into a conceptual model of how sedation was used in the hospice. This form of sedation enabled sedative drugs to be used with the acceptance of a reduction in patient consciousness when imminently dying. A model of the use of sedation in relation to the patient's dying trajectory and sequence of dying has been developed and forms the outcome for this part of the research study.ConclusionRoutine sedation is integral to the palliative care approach to the dying patient; this study delineates the ways in which this form of sedation becomes acceptable in the context of a UK hospice. This research contributes to the international debate about the use of sedation in palliative care and specifically, is the first study to identify a routine practice of sedation in the UK.
Palliative care for those with non-malignant disease: beyond cancer
Authors: Fowell Andrew , Johnstone Ros , Cadwalader Betsi 
Published: March 2012

The Integrated Care pathway (ICP) for the last days of life was developed in the 1990's and designed to deliver high quality end of life care in all care settings. The original concept incorporated expected deaths and consequently the tool was applied to cancer patients: the current picture is quite different. The ICP for the last days of life was implemented on an all-Wales basis in 2000 with take-up of the ICP occurring in adult hospices, hospitals, specialist in-patient units and community care settings. The Welsh pathway also has a centralised system for the collection, analysis and feedback of the ICP variances which record instances of goals not being achieved, actions taken and subsequent outcomes. This has resulted in a large database (n=19,000) reflecting end of life care delivered through the ICP across Wales. The proportion of non-cancer patients receiving end of life care through the ICP has changed notably over the past 10 years. The first 500 ICP variance sheets indicated that 8% of the sample were non-cancer patients, in 2005 the sample (n=607) showed 9% to be non-cancer patients, in 2011 non-cancer patients represent 29% of the sample. Non-cancer patients present with a variety of diagnoses such as renal failure, ischaemic heart disease and COPD. There are no differences between cancer and non-cancer patients on the length of time they are cared for on the ICP or in any aspect of symptom management variance.ConclusionAlthough developed with cancer patients in mind the ICP for the last days of life is transferable to other dying patients ensuring that they receive best quality end of life care regardless of diagnosis and care setting.