Sharing Current Scottish Practice

Recent work within NHS Lothian has reinforced the need for effective Anticipatory Care Planning (ACP) and reliable communication to facilitate quality person-centred care for the high proportion of patients across settings who are at risk of deterioration and dying. The concept of Information Reconciliation is used to illustrate the need for clear documentation of a multi-professional Goals of Care plan and sharing of information across care settings with key opportunities for sensitive discussions and review of these plans throughout.

A breakthrough series collaborative is underway to implement a Deteriorating Patient Change package across in-patient areas to optimise the recognition and management of deterioration and enable reliable, bespoke structured review and response.

In alignment with this collaborative, a forum has been formed to bring together key stakeholders who are undertaking Quality Improvement initiatives linked to Information Reconciliation/ACP within a range of specialties and settings.

This forum has senior leadership and aims to share learning, provide support, discuss barriers and opportunities and importantly optimise the impact of related interventions on care outcomes for patients and families.

This presentation will discuss projects from member teams and illustrate the impact of the collaborative approach on improvements in ACP across our system.

A Quality Improvement Journey in Palliative Care: Reliable person-centred care through Information Reconciliation

Author(s)Patricia Brooks Young; Tracy Burton

Recent research identified that 29% of patients in hospitals are at risk of deterioration and dying. The need to improve anticipatory care planning (ACP) for such patients require innovative and system wide approaches.

Aim: To ensure patients in pilot areas receive care aligned to their needs and wishes through integration across settings.

Methods: Innovative quality improvement approaches are used to explore the current system and test changes regarding:

• identification of patients at risk and reliable response
• communication with patients and families regarding realistic goals and treatment options, benefits/burdens of interventions, their wishes and concerns
• integration of ACP within routine clinical processes
• clear documentation of a multi-professional Goals of Care plan and sharing of information across care settings: information reconciliation.

Initial outcomes: Findings from pilot areas indicate that ACP is appropriate for over 75% of patients, therefore is core business for clinicians. This presentation will include the impact of interventions on care processes and outcomes including acceptability of ACP approaches.

Additional output:

• Exploration of a core skill set for staff
• Glossary of terminology to enable a consistent approach.
• Collaboration to expedite progress.
• Testing of quality improvement approaches in palliative care.

Acupuncture in Palliative Care-What’s the Point?

Author(s)Suzanne Young

Acupuncture is increasingly being used in palliative care to treat a variety of symptoms. Although trials for acupuncture are difficult, there is a growing evidence base for the use of acupuncture to treat symptoms such as pain, fatigue, dyspnoea, anxiety and sweats.

The Hospital Palliative Care Team in St John’s Hospital has recently started offering acupuncture to both in-patients and community patients in West Lothian. This innovative nursing initiative is proving highly successful.

Anticipatory care planning in a rural setting is improved by addition to the GP palliative care register