bluuebunny/crossref_metadata_2025_split huggingface dataset:
Documenting advance care planning in the hospice setting
Authors: Russell Sarah , Willoughby Janet 
Published: September 2011

IntroductionThe Hospice of St Francis piloted advance care planning (ACP) documentation (September 2010 – February 2011). The pilot was in four phases including a consultation group, agreement re documents to be used, staff training required, target areas and numbers (up to 10 patients per In Patient Unit, Day Care and Community Specialist Nursing team).AimTo establish whether there was a need for Hospice of St Francis specific ACP documentation.MethodsPhases▶Multiprofessional working group to discuss, produce and pilot ACP documentation▶Evaluation of pilot and amend documents▶Implement amended documents over 6 months▶Evaluation and re-evaluate documentation.ResultsDocumentation was implemented with two community and three day care patients.Discussion▶Do the results reflect the need for more staff education or more confidence in using the skills and documents?▶Do the results relate to the voluntariness or fragility of patients in the advance care planning process or reticence of staff to use ACP documents?▶What is the impact of other ACP work in the hospice on this pilot (eg, ACP letters for patients with advanced respiratory and cardiac disease, ACP research interviews as part of a doctoral research programme).ConclusionThe ACP document pilot shed light on the process and documentation of ACP. Further work has subsequently been done to look at an ACP education model for Beds and Herts as well as ACP resources for care homes. It is important not to make assumptions about the skills and confidence of hospice staff in ACP as well as looking at the context of the patient's voluntariness and fragility. The pilot helped us look at the education needs of our staff.
Investing in a weekly lottery – does it work?
Authors: Freeman Ruth 
Published: September 2011

Investing in a weekly lottery can seem like a significant financial risk for a small to medium sized hospice and paying an external canvassing company to recruit members a step too far. In this time of economic insecurity, however, Lottery continues to be a very attractive and affordable fundraising proposition for a wide range of donors and is therefore worthy of significant consideration.The Myton hospices ran a lottery recruitment campaign in 2009 using an external canvassing agency – the target was to recruit 12 000 new donors over 12 months, results outlined belowYear 1Income; £ 574 080, Cost; £ 360 000, net income; £ 214 000Year 2Income; £ 505 191, Cost £ 165 000, net income; £340 191AttritionYear 1 = 8%, Year 2 = 12%Predicted net income over 5 years = £ 1 450 000In addition to the above the increase to the Donor database of 12 000 new names has resulted in over £ 50 000 in Raffle income and £13 000 in donations.The secret to making a campaign work is as follows;▶Train the external canvassers in – house and to keep them up to date▶Negotiate the recruitment costs with the agency – ensuring that a 3 month “drop out “clause is built in▶Ensure that recruitment costs are phased over the expected life time value of the member / donor, that is, don't pay the full costs up front but make sure that there are anniversary reviews▶Build a solid business case and make sure the Trustees buy in to the campaign!
Service user evaluation of the benefits of complementary therapy in hospice care
Authors: Hunt John , Margaret Ayres 
Published: September 2011

Complementary therapy (CT) is now a key component of care and support in hospice services and can be offered singly or in combination with other interventions, for example, emotional or bereavement support.Service user evaluation is the best measure of effective outcome from care and support programmes.The hospice offers Reflexology, Simple Massage and Reiki currently, in Day Hospice, Outpatient and Home settings.The hospice introduced a self-completed user evaluation questionnaire in 2008 and has modified that to measure the benefits of combined therapies.The questionnaire is offered to all CT service users after four completed therapy sessions.The evaluation is structured to seek the user's views on overall benefits, length of effect and frequency of treatment to maximise quality of life.Resultsto-date (from 54 questionnaires offered and 44 returned; a response rate of of 81%) indicate that 43% of participants felt that the therapy had offered benefits in addition to having an effect on the problem that they had initially.32% of service users stated that the benefit had lasted for longer than a day.77% of respondents commented on the benefits of therapy; themes were increased relaxation (47%), reduced anxiety (44%) and improved sleep (26%).59% of respondents had reflexology in courses of 4–6 treatments.“It helps because I feel more relaxed; sleeping is improved and my pains are not so bad”Additionally, 16 questionnaires have been offered to those receiving complementary therapy in direct combination with other interventions (‘Back to Back’ therapy). In this group, 10 individual returns is a response rate of 63%. All those offered ‘Back to Back’ treatments had complex needs. In commentaries, respondents remark on physical benefit, but also indicate emotional support and well-being.
Establishing a patient self-administration scheme for medicines in the hospice setting
Authors: Crowther Jeanette , Wanklyn Steven , Johnston Mel , Skinner Charles 
Published: September 2011

IntroductionSelf administration of medicines has been an area of nursing and pharmacy development. Literature reports have shown that it is feasible, provided appropriate checks are in place and that these happen on a regular basis. Implementation can maintain the patient's independence which is important in the respite setting. It also provides a valuable opportunity to explore adherence where this may be a problem and which could prevent unnecessary admission and the patient being denied the opportunity to be cared for in the place of their choice. Self-administration of high risk drugs such as opioids is an area where further work is required so that inclusion in self-administration schemes is risk-assured and possible.AimsTo establish a framework that facilitates patient self-administration while minimising patient risk.To further inform governance priorities for self-administration schemes particularly those involving high risk drugs.MethodA multidisciplinary team was formed representing pharmacy, doctors and nurses in order to develop a clinical protocol. Incident surveillance data was used alongside consensus opinion to identify critical stages along the medicines trail and the appropriate control measures to risk manage them.The protocol manages screening for patient eligibility, consent, monitoring and subsequent management of patients suitable for self-administration. Staff eligibility to undertake this protocol is granted following workshop attendance and completion of evidence-based competencies.Results and discussionIn order to quality-assure the scheme protocol compliance will be audited on a regular basis, results of which will be assessed against incident surveillance data. This will provide ongoing risk management and identify areas for improvement.ConclusionTrinity hospice has approved this protocol. Staff eligible to undertake a role have been accredited to do so. Under the terms of the hospice's approval an audit of compliance and critical risk assessment will inform the further development of this medicine system.
A 3 month pilot of the distress thermometer within community specialist palliative care services
Authors: Thomas Andy 
Published: September 2011

IntroductionThe Distress Thermometer (DT) as a brief holistic screening and assessment tool has been introduced, validated and widely adopted within Oncology Services and cancer networks internationally. Supportive and palliative care guidance recommends the use of a screening tool to identify and signpost appropriate services.AimTo modify the existing distress thermometer to fit hospice and palliative care needs, and pilot within specialist community palliative care services.MethodA working party of individuals providing nursing, emotional, psychological and spiritual support within the specialist palliative care service formed to amend the DT to fit the needs of community palliative patients. The tool was piloted by two community clinical nurse specialists (CCNS) and qualitative information collated regarding the tools appropriateness. Furthermore both qualitative patient and nurse experience was considered. Patient demographic and illness information was gathered as a possible variable influencing appropriateness of use. Finally DT training was delivered to all hospice inpatient health professionals and evaluations collected regarding the appropriateness of the DT's use with new inpatient admissions.ResultsOf the 63 new referrals to two CCNS, 21 completed the tool. No age / malignant versus Non-malignant difference in those able/willing to complete the tool were identified. Qualitative experiential information supported the use of the tool within the community setting. Difficulties with usability were identified from both perspectives. Training evaluations were favourable with inpatient staff recommending the DT's use as part of the hospice admission process.DiscussionThere are relative benefits and drawbacks of adopting this tool from both patient and nurse perspectives. However, the modified DT appeared to meet service needs. The training format and evaluations will be discussed in detail.ConclusionBoth pilot and training feedback supports the use of the DT within this palliative care service.
The resilience programme for staff & volunteers
Authors: Clitherow Rebekah 
Published: September 2011

This Hospice recognises the benefits of fostering resilience in its workforce so that we become more effective in delivering compassionate care on the journey towards the end of life.The lead counsellor, responsible for co-ordinating staff and volunteer support and training in self care, took formal and informal opportunities to explore the concept of resilience with staff and volunteers. Ideas about resilience and factors within the organisation that undermine resilience were collated following focus group style sessions. This was combined with a review of the literature concerning resilience.A model was developed together with a questionnaire and training programme that would enable staff and volunteers to explore and develop their levels of resilience. The model considers the emotional, psychological, physical and spiritual aspects of resilience and encourages individuals to explore how their identity, patterns of communication and personal values impact on resilience. The model holds different aspects of resilience in tension such as realism and hope. The training programme includes exercises that support the development of resilient responses to difficult situations. It considers communication and relationships.4 cohorts of staff and volunteers, totalling 30 individuals, have now accessed the programme and evaluation has shown that they consider themselves better prepared to cope with the nature of their work and better prepared for the change and loss that might lie ahead in their own lives. They reported greater understanding of how they might foster resilience in the patients, carers and families that they work with.We are keen to present a poster to share good practice in the area of staff support and personal development with other Hospices. Sharing our learning would also provide the opportunity to gain feedback from other Hospices, strengthening the model and programme.
An independent evaluation of a neonatal end of life care pathway
Authors: Crozier Kenda , Lindsay Bruce , Wray Jo , Leeson Janet , Andrews Luaren 
Published: September 2011

IntroductionThe neonatal end of life care pathway, implemented in 2008, provides a coordinated planning approach for rapid discharge of babies from Neonatal Intensive Care Unit (NICU) to hospice or home for end of life care.AimsThe evaluation aimed to assess the effectiveness of the neonatal pathway from families' and staff perspectives.MethodsTo ensure the evaluation drew on a spread of voices, we recruited participants who had used and provided care pathway. Eight families, 10 internal and 10 external staff were interviewed using a guided conversation technique. Thematic analysis was undertaken and data was further clustered into subthemes.Findings42 babies have been referred on the pathway since 2008. Staff and parents expressed a supportive view of the pathway and demonstrated an appreciation for the underlying principles. There is a need for wider understanding of the pathway and care it offers. Bereavement support for families evaluated very well but needs of fathers could be further investigated. The impact on other aspects of hospice activity emerged.ConclusionThe pathway is an innovative service, probably the first in the UK. It represents an increase in service activity of the hospice and contributes to the breadth of service on offer. The experiences of staff and parents outlined in this evaluation should be useful in contributing to the knowledge base about end of life care for very young babies. The knowledge and expertise of staff who have developed and worked with this pathway over the last 3 years should be acknowledged and the model disseminated widely.RecommendationsMore regular training opportunities for staff of all levels should focus on case studies rather than simply pathway documentation. Further consideration should be given to managing the demands of respite care when bereaved families are resident. Joint meetings should be used to anticipate and plan.
Creating a sustainable high quality hospicecare service
Authors: Ryan Alison 
Published: September 2011

IntroductionDemographics, increased patient aspirations for choice of type of care and our potential funding base, mean our current monolithic service structure and business model, which we share with many other hospices, is not sustainable. The project is to create a coherent service and financial system which will deliver high quality care to all who need it and be affordable in an uncertain future.Aims▶To understand what patient determined high quality outcomes are▶To reconfigure services to be able to deliver these outcomes▶To improve integrated working internally and with external agencies▶To be able to measure cost effectiveness in service delivery▶To increase our financial autonomy▶To develop new income streams.Methods▶Researching patient determined quality outcomes▶Challenging assumptions about existing, and exploring alternative, service delivery systems▶Consultation with staff about the requirements of different systems▶Developing sharper costing mechanisms to allow measurement of effectiveness in service delivery▶Development of financial modelling and sensitivity analysis to allow differential decision- making about investment.ResultsA reconfigured integrated service delivery structure based on delivering the right person in the right place at the right time with the right skills to meet patients needs.A business turnaround programme to create sustainable flows of income and expenditure into the future.DiscussionThe planned change involves structure, training development and financial remodelling but above all the cultural change required to put patient care and patient choice genuinely at the heart of service provision. The implementation has a 5 year timeline.ConclusionMany other hospices face the challenge of maintaining quality while facing rising demand and uncertain income streams. This presentation shows a possible way ahead and the issues which may arise.
Why carry a file or pick up a pen? All our records are paperless!
Authors: Higgs Joanna , Walford Carole 
Published: September 2011

Our three services, inpatient, community and day care had separate notes and records for the same patients. We agreed to create a joint approach to assessment and an integrated record that could be viewed in real time at any site. Access over N3 enables us to interact with our GP practices, community hospitals and access records and imaging results in real time.AimIn late 2006 we set the goal to be paperless within 3 years.Method▶Discussion with Crosscare and many meetings to gain mutual understanding of possible problems in implementation▶A pilot with the community team was started, for a year, to test the design▶Roll out across our service to follow within the next 6 months▶Close liaison and feedback on the project to Crosscare team enabled us to problem solve and keep to our timescale.Results▶We are now paperless apart from electronic prescribing; this has taken slightly longer due to logistics▶We are now exploring connections with other healthcare agencies and partners in care.Discussion▶Advantage of staff being able to see a patient record in real time and review it▶Uniform inputting by staff is quicker and more accurate▶We expect to develop better partnerships through closer interaction with GP practices and other community hospitals▶With access over N3 the expected norm is to easily see test results, imaging and consultants letters etc▶The audit trail tracks all alterations and so covers us for legal issues.ConclusionThis work is imperative as the organisation looks to improve interdisciplinary communication and patient care. The organisation is currently reconfiguring and expanding to the North of Dorset. As such Crosscare will compliment the planned video conferencie facilities in North, Central and South Dorset.
Study of patients known to a hospice service: hospital versus home deaths
Authors: Parr Ann , Hodgson Aruna , Duddle Chris , Carby Jo 
Published: September 2011

BackgroundIt is well recognised that most patients state a preference to die at home, yet the majority die in hospital. If the proportion of home deaths is to be increased it is important to understand the reasons why this is not being achieved currently.AimsWe sought to:▶Identify any differences between patients known to hospice services dying in hospital or at home▶Identify gaps in service provision▶Identify ‘predictors’ of hospital admission.Method▶Comparison of 2 groups of 49 patients, one group dying in the local hospital and the other at home within the period October 2009 – April 2010▶Patients were identified from the Hospice database▶Data collected included demographic characteristics, services involved, family support, and knowledge of of the patients' preferred place of care▶Questionnaires were completed by the Hospice Palliative Care Nurse Specialists▶Hospital notes were checked▶Supplementary information was obtained from GP practices, the Primary Care Trust and Hospice records.Results▶Most hospital admissions were precipitated by a sudden deterioration of an existing condition or an acute episode▶There were slight demographic differences between the two groups, with elderly females living alone being the most likely to die in hospital▶Hospice and community services seemed less actively involved with the patients who died in hospital.Conclusions▶The majority of patients dying in hospital seemed to have a more rapid terminal decline, with a potentially treatable cause, than those dying at home.▶No factors were identified that could have prevented these admissions but timely access to Hospice beds could have prevented a few patients dying in hospital.
A care pathway to support extubation within a children's palliative care framework
Authors: McNamara Katrina 
Published: September 2011

The need for this work was identified by a number of clinicians who asked ACT to develop a resource following an initial trawl for information about existing guidance and resources via the online global forum PaedPalCare.This guidance on best practice for professionals in supporting families' decision making and the practical aspects of extubation, will lead to an improvement in the standards of care delivery and the choice offered to families. There is also an information leaflet for families which will help them reach an informed decision about the care they wish their child to receive.The resource is appropriate for use in a variety of settings, including critical care, palliative care and community settings such as the child's home or a children's hospice. There are three sections to the resource▶Part One provides an introduction to children's palliative care and ACT's care pathway approach. It discusses the need for a dedicated pathway approach and outlines the principles that ACT recommends in adopting and delivering the care pathway to support extubation within a children's palliative care framework.▶Part Two takes the reader through the pathway to support extubation within a children's palliative care framework. There are three stages to the pathway: the journey towards a decision to withdraw life-sustaining ventilation; the practicalities of withdrawing life-sustaining ventilation; and care at the time of death. Each stage of the pathway includes sentinel standards: key goals and useful resources to support care.▶Part Three provides useful reference information, a glossary of terms and definitions and a directory of useful organisations.While considering the need for the pathway, it became apparent that an additional resource of an information leaflet for families was required which will help them reach an informed decision about the care they wish their child to receive.
Sign on the dotted line: opioid agreements in patients with a history of substance misuse
Authors: Finnegan Clare , Brown Susannah , Coackley Alison 
Published: September 2011

IntroductionThe management of pain in palliative care patients with a history of substance misuse can be challenging. Patients may have a low pain threshold, feel ill at ease in unfamiliar clinical environments and consequently compliance can be poor. Doctors may feel ill at ease prescribing opioids due to fears of exacerbating the addiction or contributing to overdose. Following a regional audit of the management of this patients group, regional guidelines were developed recognising the importance of close working between disciplines and the use of opioid agreements. The development of opioid agreements with patients can improve compliance and quality of life.AimsA reflection on our experiences introducing verbal and written opioid agreements within the palliative care setting.MethodsOpioid agreements were utilised with two patients with cancer pain and a coexistent history of substance misuse, in both inpatient and outpatient settings. Written and verbal contracts were used detailing expectations of the patient, role of healthcare physicians, and the plan of care.ResultsThe staff observed improvement in compliance with medication, relationships with staff members and symptom control. The agreements facilitated communication between the hospice, primary care, community pharmacy, and the addiction team.ConclusionIntroducing opioid contracts to this group of complex patients▶Set clear boundaries for the patient and staff involved in their care▶Improved compliance and consequently relationships between patients and staff▶Empowered patients to take responsibility for their own analgesic management▶Facilitated clear communication between the numerous healthcare professionals involved in the patients care.We feel that the use of opioid agreements with patients with a history of substance misuse has improved the patient experience.