Sharing Current Scottish Practice
This blog provides an opportunity for people to share examples of current Scottish palliative care practice that might be of interest to the palliative care community more widely. If you know of work underway that might be relevant for sharing on our website, please get in touch.
Poster Abstracts of the Month: September
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:
- Using an Outcome Measure in a Palliative Day Care Unit
- Volunteer support to improve well-being for patients and carers
- Volunteers - vital to hospice viability
- Widening Access to Services for Children of Palliative Patients
Using an Outcome Measure in a Palliative Day Care Unit
Author(s) of poster: Joyce McNaught, Elaine Blair, Mairi Ann Higgins, Susan Jackson
Palliative day care can play an important role for people who are living with a chronic, life limiting illness by providing opportunities for social interaction, reducing social isolation and also promoting a sense of control. In today's climate of clinical governance and scrutiny it is vital for staff within Day Therapy Units (DTU) to be able to demonstrate the value of their service. Outcome measures are one such way of achieving this however within palliative care can pose significant challenges due to the declining function of the patients that confuse the apparent efficacy of the interventions. The Therapy Outcome Measure (TOM), a validated tool which allows therapists and nurses to describe the abilities and difficulties of patients in the domains of impairment, activity, participation and wellbeing to monitor changes of time was introduced within DTU at Accord Hospice. A retrospective review of 16 patient case notes was carried out to determine whether the tool was indeed an effective way of measuring outcomes and whether it influenced staff when making decisions about discharge. It also allowed staff to review their processes and documentation.
Volunteer support to improve well-being for patients and carers
Author(s) of poster: Susan High, Anne Marie Toland
Background: It has been observed that carers experience a level of illness or disability which is more than twice the level of the general public (Carers Scotland 2011).There is also evidence that early intervention offering emotional/practical support to carers at end of life improves confidence and resilience, supporting preferred place of care. (Princess Royal Trust for Carers/Crossroads 2011). Method Volunteers were recruited via Volunteer Action North Lanarkshire, existing hospice volunteers and local media. Training was given in befriending, boundaries and self-care. Ongoing training included communication skills, moving/handling, relaxation techniques, dementia friendliness, supporting reminiscing. Results 134 referrals were assessed by CNS. Support provided included information about other services, complementary therapy, befriending and short carer respite. The most frequently provided support was complementary therapy. Many accessed a combination of services 31 volunteers were trained in first 6 months. Feedback from service users and volunteers has been very positive. ‘It makes me feel I want to go out – I can relax for a few hours’ ‘My volunteer befriender takes away my fears – I feel like part of society again’ Discussion Evaluation is ongoing but this model provides a sustainable means of supporting carers which is transferable to other geographical locations.
Volunteers - vital to hospice viability
Author(s) of poster: Ros Scott, Richard Carling, Jean Hindmarch
Background: Volunteers play a significant role in hospice and palliative care enabling services to offer a wider range of care and support to more people with life-limiting conditions. This poster summarises the findings from a research study that explored the relationship between volunteering and independent hospice sustainability in the UK.
The purpose of the study was to:
• explore the influence of volunteers on four key organisational sustainability factors in UK hospices
•gain an insight into how volunteering is understood by senior staff, volunteers and trustees;
•consider the relationship between volunteering and independent hospice sustainability.
Methods: Data was gathered using a self-administered online questionnaire from trustees, senior staff and volunteers from a total of 32 adult and children’s hospices.
Findings: Findings indicate that volunteers:
•are central to the variety and quality of services delivered
•are important to patient care and family support
•help to reduce taboos around death, dying and bereavement
• make services viable.
Conclusion: Hospices should recognise the strategic significance of and their dependence on volunteering in planning for the future. As a key component of the workforce hospices should also consider the sustainability of their voluntary service, including the role of trustees.
Widening Access to Services for Children of Palliative Patients
Author(s) of poster: Julie Marshall
We looked at widening access to services for children and young people affected by the life-limiting condition of someone close to them. Current services available in Ayrshire and Arran and hospices (including Ayrshire) in Scotland and England were scoped. There were consultations with teaching staff from 12 primary schools and small informal consultations with bereaved parents and children. Joint fundraising and education pack was designed in consultation with teachers in order to start engaging with school communities and create deliberate funding streams to provide the service. A study day explored the needs of bereaved children. As a result of this a Children & Young Person’s Service has been set up and piloted. The service provides: 1:1 support for primary aged children upwards to 16 Family work when children are under primary age Group work Information and advice to any family affected by any illness or death, regardless of the circumstances Advice, guidance and support to other agencies and professionals The service has also contributed to the public health promotion that being more open about death and dying leads to better mental health (www.goodlifedeathgrief.org.uk) evidencing that professional knowledge in supporting the needs of this particular group of children has increased.
Poster abstracts of the month: August
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:
The Role of the Social Worker in Palliative Care
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.
The Role of the Social Worker in Palliative Care
Author(s) of poster: Kirstie Barke, Social Worker, University Hospital Ayr; Josaleen Connolly, Macmillan Project Lead, NHS Ayrshire and Arran
Social workers operate within a multi-disciplinary team and assess individuals care needs and where possible offer practical solutions. Social workers operate within the local community and the hospital setting however they are not trained in specialist palliative care. I have undertaken a distance learning degree module with the University of the West of Scotland – Practical Palliative Care. This module gave me an opportunity to increase my knowledge in palliative care and provided me with 5 days shadowing various members of specialist palliative care teams in the hospice, hospital and the community. My experiences of this programme have included learning more about the importance of communication between different disciplines and that palliative care is not only applicable in the care of patients with a malignant disease diagnosis. I have increased my knowledge and understanding of recognising when palliative care can be of benefit in advanced diseases as well in the management of common symptoms including pain. I have gained insight into the advantages of advance care planning and I also have a better understanding of bereavement services and the services and support that are available.
The Use, Effectiveness and Acceptability of Telemedicine Interventions in the Provision of Palliative Care in Rural Populations
Author(s) of poster: Zoe McQueen, Anne Finucane, Claudia Pagliari
Inequalities in the provision of palliative care have been well-documented between urban and rural populations, with rural areas experiencing poorer accessibility to specialist services. With increasing prevalence of chronic conditions, this disparity will only increase, and it is, therefore, essential to find methods which will enhance available resources. Telemedicine has been a proposed solution. The aims of this systematic review were to identify the use of telemedicine interventions within palliative care in rural settings, assess their effectiveness, and identify provider and user acceptability, to then inform and guide service development in Scotland. An electronic search of MEDLINE, EMBASE, PsychINFO and CINAHL was performed. A total of 3112 papers were identified and 16 papers were included in this review. A range of telemedicine applications have been found to be effective and acceptable and there appears to be a perceived need for telemedicine across palliative rural communities in Scotland. However, there is lack of evidence besides users’ subjective perceptions. Future research needs to move from qualitative, descriptive studies to clinical trials in order to assess the effectiveness of these interventions. To optimise their use, the needs of the targeted populations must be assessed and each specific intervention tailored accordingly.
This Is Me
Author(s) of poster: Stirling, I., Baird, L., Campbell, S., Carmichael, L., Cassidy, M., Follett, M., Irvine, F
Critical reflection on two MND case studies highlights how communication difficulties threaten the quality of care. Further reflection and a review of the literature by the multidisciplinary team emphasises the need of a person-centred document, ‘This Is Me’; which enhances the scope and depth of communication between patients, their families and the multidisciplinary team from the time of initial diagnosis through to end of life care. The ‘This Is Me’ document is developed, and piloted across all areas of the organisation to enable timely conversations to take place, key information to be shared, improve collaboration in decision-making, create solid foundations for care plans and offer person-centred care.
Results: On-going evaluation, using both questionnaires and interviews, so far indicates the positive benefits of ‘This Is Me’ as a communicative tool throughout the illness trajectory. It is being used in the community, in day services and in the In-Patient Unit.
Conclusion: The ‘This Is Me’ project is enhancing the depth of communication between patients, their families and the multidisciplinary team within the Ayrshire Hospice. ‘This is Me’ allows staff, patients and carers to enjoy timely conversations, share key information, improve collaboration, create solid and offer person-centred care.
Understanding the barriers to identifying carers of people with supportive and palliative care needs in primary care
Author(s) of poster: Emma Carduff, Anne Finucane, Marilyn Kendall, Alison Jarvis, Nadine Harrison, Jane Greenacre, Scott Murray
Background: Caring for someone at the end of life can be physically and emotionally demanding. Carers are often ambivalent about their own needs and are reluctant to self-identify as a caregiver in need of support.
Aims: To explore the barriers to, and strategies for, identifying carers of people at the end of life in primary care, and to understand why carers do not self-identify. Methods Literature review, synthesis of data from previous research, and focus groups with carers and health professionals.
Results:
1.Transition into the caring role was a gradual process and carers did not necessarily identify with being a ‘carer’, meaning support was often initiated in response to a crisis.
2.As the patient deteriorated, caring was all-encompassing meaning that carers were managing competing demands and prioritised the needs of the patient, often at the expense of their own.
3. GPs were perceived to lack knowledge about available services and their reactive approach meant carers were less likely to see their needs as legitimate and ask for help.
Conclusions: Strategies to identify and support carers need to be commenced early in the illness trajectory to prevent crises. Primary care teams need to work together to ensure that carer’s needs are legitimised so that they are empowered to self-identify.
Poster abstracts of the month: July
- Preferred place of death – what are we documenting?
- Provision of lymphoedema risk reduction information
- Reflections on treatment decisions re lymphoedema
- Role of the nurse in palliative care
- Supporting people with learning disabilities through the palliative care journey
- Tailored care for end of life patients and their carers in Fife
- The experiences of caregivers of patients with delirium, and their role in its management in a palliative care setting
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.
Poster Abstracts of the Month: May
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:
- Making today matter everyday
- Managing not mending
- Palliative care training for social work home carers in Renfrewshire
- Panning for gold
- Partnership working to improve the quality of end of life care in care homes and at home
Making today matter everyday
‘Making today matter’ is our everyday business. We not only look after people’s physical needs, but also their needs as individuals and important members of their own families/social networks. Patients wish to mark a special occasion – bringing Christmas forward or supporting a couple to get married - during their time with us, and it is our aim to support them wherever we can. Special events and celebrations are held to create memories for the future. We also look at the nutritional aspect of all catering which is provided to patients and where they are assessed to be requiring additional nutritional support this is undertaken by the hospice team. A nutritional chart/ tool has been developed to identify which patients could be at risk. The care we provide goes above and beyond treating physical symptoms. It is difficult to measure the impact of the ‘extra’ effort that staff put into looking after people’s needs in any tangible way, but the gratitude people feel is clear to see; ‘Thank you….…for our beautiful wedding – balloons, food, service, flowers, location, driver who took me to get wedding rings, cake, bubbly. You made our day so very special.’
Managing not mending
Author(s) of poster: Jan Stanier Lead Speech & Language Therapist, Clyde Acute NHS Greater Glasgow & Clyde/Queen Margaret University Edinburgh; Dr Janet Beck, Head of Speech & Hearing Sciences, Queen Margaret University Edinburgh and Dr Mairghread Ellis, Programme Lead Podiatry, Queen Margaret, University Edinburgh
This poster depicts the preliminary findings of an exploration into the experiences of Speech and Language Therapists in providing end of life dysphagia (swallowing) care to people with Head and Neck Cancer. Whilst previous researchers have explored what the role entails (Pollens 2012; 2004, Newman 2009, Roe 2007), to date the reported experiences of those providing this care has not been fully examined. The study adopts a qualitative, phenomenological approach and has a multi-centre design.
The research question asks ‘What is the experience of Speech & Language Therapist in providing end of life care to people with head and neck cancer’.
Preliminary findings indicate that SLTs described a lack of preparation and guidance, differing experiences across settings, successes and challenges with multi-disciplinary team working, a view that swallowing management is different with this caseload, some lack of awareness and clarity around the SLT role, a considerable emotional impact and a concern with effective risk management and patient led decision making.
Palliative care training for social work home carers in Renfrewshire
Author(s) of poster: Susan Jackson
There is increasing recognition that the population in Scotland like other areas in the UK is ageing. Many people are living with the effects of one or more chronic illnesses (Audit Scotland 2008) with much of their care being delivered in the home or care home setting. Palliative care is a core component of the care package for this population and as such should be routine practice for health care professionals. However social care home carers are now facing clients with palliative care needs on a daily basis and are often unprepared for the situations they encounter. To address this within Renfrewshire, Accord Hospice designed and delivered several education sessions specifically tailored for this group and found it to be a worthwhile exercise with participants expressing increased confidence in their knowledge of palliative care. As a result discussions took place with Renfrewshire Community Health Partnership (CHP) and Renfrewshire Council to consider a collaborative approach to delivering a palliative care education and training programme for the home care service. An application was made to the Queen's Nursing Institute Scotland (QNIS) for a Partnership in Practice award which supported the delivery of a series of training days to 200 social home care staff in a period of 12 months.
Panning for gold: Ensuring an evidence base for End-of-Life decision making
Author(s) of poster: Margaret Colquhoun and Joyce Templeton
The End-of-Life Care (EOLC) Group is part of Clinical Governance at the Hospice with responsibility for quality EOLC. Good outcomes depend on staff having timely access to evidence for decision-making and understanding individual patient/family choices(1). Information literacy – i.e. access to electronic databases and search skills – are central to achieving this(2) in the context of an expanding literature. Membership of the EOLC Group is varied in terms of discipline and academic background. Using the metaphor of panning for gold, the Librarian and the Senior Nurse Lecturer, supported members to access the NHS Knowledge Network and set up electronic database search alerts. Members - individually or in pairs - selected an aspect of EOLC e.g. documentation or care after death, set up an alert and they bring relevant articles – ‘nuggets’ - to the meeting. Although not without its challenges, this approach has promoted staff engagement and integration of evidence with practice.
References:
1.Rutledge, D.N., Kuebler, K.K. 2005. Applying evidence to palliative care. Seminars in Oncology Nursing, 21 (1) pp.36-43.
2.Callinan, J. et al 2010. Analysis of library-associated information needs of staff in a specialist palliative and gerontological care centre in Mid-West Ireland. Health Information and Libraries Journal, 27, pp.286-294.
Partnership working to improve the quality of end of life care in care homes and at home
Author(s) of poster: Jan Dobie (Lead facilitator) Marlis Plumb (Facilitator) Sarah Shepherd (Facilitator) Louise Wood (Administrator)
Poster describes a 2-year fixed-term project which aims to improve the quality of end of life care for residents in care homes and for people dying at home. A pre education review of deceased residents’ records is carried out to establish baseline practice, highlight good practice and inform development of educational content. ‘End of Life’ study days are then delivered to care home staff. 8 comparable study days have been delivered as a pilot for home care staff. Resource packs and literature are supplied to each care home/ home care participant. Study days have been highly evaluated by participants. To date, over 600 staff have attended. There is also a reflective evaluation after 3 months. This unique project has allowed interprofessional collaboration and communication between professional groups and organizations: managers, educators, clinicians, pharmacy, specialist palliative care, Care Inspectorate, Scottish Care, local authorities and key stakeholders.
Poster abstracts of the month: April
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:
- Improving the experience for bereaved families by developing a process for issuing death certificates
- Integrated and coordinated discharge planning for palliative patients
- Its time to talk about death and dying
- Location, location, location
- Macmillan rural palliative care pharmacist practitioner project
Improving the experience for bereaved families by developing a process for issuing death certificates
I have undertaken an education programme delivering practical palliative care through a distance learning module and placement shadowing members of the various specialist palliative care teams in hospital, community and at the Ayrshire Hospice. The education was provided by the University of the West of Scotland and the overall project was funded by Macmillan Cancer Support. This programme provided me with the knowledge, skills and competence in delivering general palliative care to patients who were admitted to Ward 4C where I work. I was concerned that the process for issuing the death certificate for the deceased sometimes caused unnecessary additional distress for families. Without a death certificate it is difficult for families to finalise funeral arrangements or to begin to inform other agencies that the person’s death has occurred. I felt there were a number of simple changes that could be made. I based my approach on the premise that families’ preferences should determine the way in which they obtained the death certificate. This small change has now become standard practice and has helped to minimise distress for families by creating a simple, clear and compassionate approach for handing over a death certificate to a family member.
Integrated and coordinated discharge planning for palliative patients
Author(s) of poster: Katharine Thompson, Marnie Ferguson, Donna Doogan, Audrey McHugh
Palliative patients are a unique group whose needs change with the advancement of disease. According to National and Local Strategy, patient care should be delivered at home for as long as possible, including care at the End of Life if that is the patient’s wish.
Due to the nature of progressive disease, the window of opportunity for discharge home narrow. Therefore timely, effective discharge planning is essential to ensure that palliative patients achieve discharge home within a suitable timeframe, with the support of a coordinated, individualised care package and with the necessary equipment in place.
Our aim was to develop and deliver an efficient, effective discharge planning process to ensure patients are well supported to remain at home for as long as they wish. We focussed on the following key areas:
•Weekly multidisciplinary team discharge planning meeting
•Development of multidisciplinary discharge preparation checklist
•Dedicated Community Care Team
Funded to provide home care if prognosis is less than 42 days
Team developing skills in care of palliative patients
Individualised, flexible and timely care.
Initial patient and staff feedback regarding the impact of this initiative has been very positive – audit data to evidence this is currently awaited.
Its time to talk about death and dying
Author(s) of poster: Shirley Fife
This poster was designed initially for NHS Lothian Delivering Better Care Conference to support a Before I Die Wall. It helped to set the context as to why we felt it is important for people (public and staff) in Lothian (Scotland) to be more open about talking about death and dying. The poster highlight the reality, evidence and key messages from the Good Life Good Death Good Grief website, as this is a resource we promote within NHS Lothian.
Location, location, location: The Complexity of Preferred Place of Death [PPOD]Author(s) of poster: End of Life Care Group, St Columba's Hospice
Enabling a person to die in the place of their choice is viewed as a ‘critical contributor’ to the quality of death for the patient/ family(1). The Lothian Managed Clinical Network requires specialist palliative care to audit recording and achievement of PPOD. The End of Life Care (EOLC) Group – a small interdisciplinary team forming part of the Hospice clinical governance structure – has worked together to:
•review the relevant literature
•undertake data collection and analysis of PPOD at regular intervals for all deaths across the hospice in-patient, day-patient and community services over a 12 month period; • support practice development.
Although the documentation and review of PPOD has improved, the achievement of PPOD remains relatively unchanged - with patient preference often unknown. The literature review, audit findings and associated practice development initiatives all highlight the complexity of PPOD choices. Achieving PPOD may be influenced by a range of factors(2). There has been significant learning for the EOLC Group members and a number of future challenges have been identified.
References:
1.Health Improvement Scotland. 2013. Health Improvement Scotland. 2013. Palliative and End of Life Care Indicators.
2.Fields, A. et al. 2013. Discussing preferred place of death with patients. International Journal of Palliative Nursing, 19 (11) pp.558-565
Macmillan rural palliative care pharmacist practitioner project – Mapping of the Current service & Quality Improvement Plan
Author(s) of poster: Prof Marion Bennie, Alison MacRobbie, Dr Gazala Akram, Emma Dunlop Corcoran, Rosemary Newham, Gillian Harrington
The NHS Highland project pilots over a 3-year period (February 2013 – February 2016) the role of one full-time Macmillan palliative care rural practitioner pharmacist to be located within a community pharmacy in the Skye, Kyle & Lochalsh project area, testing the ability of a community based pharmacist to:
•develop community pharmacy capacity to effectively, efficiently and safely support the needs of those in this rural community with palliative care needs regardless of care setting
•improve service provision/co-ordination ensuring opportunities are developed for training and peer support
• provide quality information to support practice.
Year 1 enabled a baseline evaluation of service provision, establishing the role and highlighting service gaps to develop the evidence base for clinical practice within this area with focus on developing rural pharmaceutical care capacity. A single case study methodology, involving multiple healthcare settings within the project area was applied. Three methods were used to maximise data collection and incorporated semi- structured interviews with participant observation (when appropriate), completion of activity logs, service audits and questionnaires.
Core community pharmacy staff are engaging in multi-professional activity in an area where some relationships had previously been strained, supporting co-ordination of patient care and continuity of medicines provision. Recognition of the skills of community pharmacists has increased pharmaceutical care input to patient care, ensuring appropriate product choice, continuity of care provision and for patients and carers a recognition and increasing use of accessibility of pharmaceutical advice. An action plan to provide quality improvement has been developed.
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