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Sharing Current Scottish Practice

Poster abstracts of the month: July

The SPPC Annual Conference in 2014 featured 40 poster displays, sharing work and research underway across Scotland. Each month, this blog focuses on the content of a few of these posters. This month, we focus on:

Preferred Place of Death: What are we documenting and what are we achieving?

Author(s) of poster: Victoria Beveridge, Audra Cook, Dr Alistair McKeown

When a patient has a requirement for Palliative care, a needs assessment should be undertaken and their wishes explored. This audit examined the recording of preferred place of death (PPoD) in patient documentation and the number who achieved PPoD.

A representative, retrospective review of 48 Hospice patients who died between January and March 2014 was undertaken to evaluate the following:

1.To review a sample of Hospice users and establish the percentage with documented PPOD.

2.To review place of death and whether PPoD was/was not discussed/achieved and any documented reasons.

Overall, 79.17% of patients had PPOD recorded, 6.25% patients had no PPoD recorded but reasons documented and 14.58% had no documented PPoD without reasons recorded. By service:

  • 66.67% of Outpatients had PPoD documented; 50% achieved PPoD.
  • 88.89% of Day Hospice users had PPoD documented; 75% achieved PPoD.
  • 73.33% of IPU users had PPoD documented; 100% achieved PPoD.
  • 83.33% of Community services users had PPoD documented; 80% achieved PPoD.

Within the hospice we have been successful in several areas with regards recording and achieving PPoD, while other areas still require further examination. This poster will expand further on the above data and discuss barriers to achieving PPoD.

Provision of Lymphoedema Risk-Reduction Information by Health Care Professionals to Women Undergoing Gynaecological Cancer Treatment

Author(s) of poster: Allan Thomson

Poster highlights and describes that the problem of lymphoedema following gynaecological cancer treatment is under recognised in a Local Health Board by HCPs. It displays the results of a project looking at awareness of this type of lymphoedema and provision of risk-reduction information to at-risk patients by the HCPs who provide care to them along their cancer treatment journey. It concludes with a possible model for who should provide this information and when. Barriers and facilitators to providing risk-reduction information are discussed.

Reflections on the Treatment Decisions and Patient Journey in a Case of Lymphoedema and May-Thurner Syndrome: Case Study

Author(s) of poster: Margaret Anne Garner

When we think of lymphoedema, we generally accept that this long term condition can be a side effect of cancer treatments, venous disease, trauma and injury (Lymphoedema Support Network, 2014). Despite ongoing advances in the diagnosis and management of lymphoedema, it is sometimes difficult to ascertain the true cause when there is a co-existing rare venous disorder. This poster presentation highlights a rare case of May Thurner Syndrome which developed in a 34 year-old woman in week 34 of her first pregnancy. May-Thurner Syndrome (MTS) also known as iliac vein compression syndrome (IVCS) occurs when there is compression of the left iliac vein by the overlying right iliac artery, due to an anatomical variant (Kibbe et al 2004, Hayer et al 2012) The symptoms include left leg swelling and pain and it occurs more frequently in women. This case highlights MTS as a possible differential diagnosis for left leg swelling and pain and it demonstrates the benefits and potential burdens to the patient in the role of main co-ordinator of their care. The patient journey, particularly with regard to ongoing management of lymphoedema are described using comparative photographs and a graph recording the improvements in the leg measurements throughout the last 2 years.

Role of the nursing in palliative care within A&E

Author(s) of poster: Audrey Colman, Staff Nurse A&E Department, University Hospital Crosshouse; Josaleen Connolly Macmillan Project Lead, NHS Ayrshire and Arran.

I undertook an education programme in palliative care because I have a special interest in caring for patients who are nearing end of their life but I recognised that improvements within our clinical area were required. The education programme consisted of an online Practical Palliative Care module which was developed by the University of the West of Scotland (UWS) and linked with our local Ayrshire Hospice to provide a 5 day placement. After undertaking the education programme I knew that patients at end of life were often brought to the emergency department and rarely offered any palliative care services. I returned to my workplace and looked at how we in A&E could cater for this group of patients in the future. Since then, I have had various opportunities to enhance care for patients nearing the end of their life. Knowing that colleagues in specialist palliative care are accessible, we have worked collaboratively to influence the quality of care that our patients and families deserve to receive. The case highlighted sets out how changes were made in the emergency department to ensure palliative care services offered to patients at end of life met their wishes and eased distressing symptoms.

Supporting the needs of People with Learning Disabilities through the Palliative Care Journey

Author(s) of poster: Liz Smith, Allison O'Donnell

The Learning Disabilities and Palliative Care: Building Bridges-Supporting Care project is based at The Prince and Princess of Wales Hospice and is now in its 3rd year. Part of the work currently being done through the project is the development and pilot of a care pathway for people who have learning disabilities and palliative care needs. A very important part of the pathway looks at the choices and decisions that need to be made by people with Learning Disabilities approaching end of life and how staff and carers can be supported to help them do this, in particular through the use of advanced care planning. The poster will illustrate how through the use of advanced care planning patients can be supported to do this which is an integral part of the care pathway.

Tailored care for end of life patients and their carers in Fife

Author(s) of poster: Karen Sandeman, Diana Hekerem, Karen Nolan, Valerie Maxwell

Traditionally, improvements in health and social care and support services focus on individual services - often without understanding or addressing the complex relationships between them. This poster will describe how the new Fife Marie Curie Service works in harmony with NHS Fife and Fife Council Social Care Services, developing care plans that work best to suit the needs of the patient and family/carer. This new partnership service offers tailored care and support for terminally ill people and their families through facilitating hospital discharge, a flexible home nursing service and support from volunteers. All referrals to the service are managed by Marie Curie Senior Nurses and a Marie Curie Helper Volunteer Manager.

Key outcomes the service aims to deliver include:

  • Supported discharge from the acute/hospice setting allowing 130 new patients to be cared for at home.
  • 30 new community service users supported by Marie Curie Helper Service.
  • 28% increase on the previous year in the number of patients supported through planned care.

It is envisaged that the development of this partnership service to meet the growing need for both palliative and end of life care in the community will deliver significant benefits for patients and families/carers in the Fife area.

The experiences of caregivers of patients with delirium, and their role in its management in a palliative care setting

Author(s) of poster: Jean Lugton, Anne Finucane, Catriona Kennedy, Juliet Spiller

Background: Delirium remains the most common and distressing neuropsychiatric complication in patients with advanced cancer. This study examines the experiences of caregivers of patients with delirium and their role in its management. It explores evidence for interventions that improve support for these caregivers and which help them support the patient.

Method: An integrative literature review was undertaken. Four databases were searched using the terms ‘delirium’, ‘terminal restlessness’ or ‘terminal agitation’ combined with ‘carer’ or ‘caregiver’, ‘family’ or ‘families’. Twenty five papers were included in the final review.

Results: Distress is experienced by many caregivers of patients with delirium. Fear, anger, disappointment and sadness are common. However, caregivers potentially play an important role in caring for patients with delirium in (i) prevention and detection of delirium ii) acting as advocates for patients, and iii) assisting in monitoring patient symptoms. Caregivers desire more information about delirium and advice on how to behave towards patients during a delirium episode however there is little evidence for specific interventions in this regard.

Conclusion: Caregiver focused interventions need to be developed and evaluated to determine the type of approaches that help the caregiver support the patient, and increase support for caregivers themselves.

The Role of an Occupational Therapist and Physiotherapist with a Hospital Palliative Care Team: An Impact Assessment

Author(s) of poster: Rosemary Cairns, Michelle Lennox, Lesley Goodman

Funded from Macmillan Cancer Support, this is a three-year project looking at the addition of an Occupational Therapist (OT) and Physiotherapist (PT) to an already established hospital palliative care team of nurses, doctor, social worker, pharmacist and complementary therapist. Inspiration for the project came from complex patient discharges. The team wanted to explore what difference there would be by having an OT and PT educated specifically to a specialist palliative care approach. Both the OT and PT brought a wealth of knowledge and experience to the service and in turn they have gained an enormous amount. For example enhanced communication skills to enable advance care planning discussions, the ethos of thinking ahead and recognising the individual needs of patients to a specialist level. A key role is to liaise with generalist OTs and PTs and provide advice to support palliative care patients. Both the OT and PT are now studying towards the Graduate Certificate in Palliative Care.

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