- 12 new projects to improve palliative care in acute hospitals
- Winner of the Derek Doyle Poster Prize announced
- Scotland's Palliative Care Poster Parade
- Shaping the future of palliative and end of life care
- Grants available for Quality Improvement Projects in Acute Hospitals
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 2019 featured 32 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:
- Service Evaluation of Key Information Summary (KIS) Completeness and Changes over time for Patients Referred to Community Specialist Palliative Care Services
- Song writing for grief and loss: An intergenerational project between hospice patients and primary school children
- SPARC – Supportive and Palliative Action Register in the Community
- SPOT - The Safer Prescription of Opioids Tool Deployment in Clinical Practice
- The Truacanta Project – Helping Each Other with Death, Dying, Loss and Care
- Tracing Autonomy: a reflective approach in support of autonomy in life
- Welcoming the public to St. Columba’s Hospice on Edinburgh Doors Open Day
Author(s) Libby Sampey, Dr Juliet Spiller, Dr Anne Finucane
Background: KIS, an electronic palliative care coordination system, enables unscheduledhealthcare providers access to key clinical information to guide care out of hours. This project aims to determine whether KIS is complete for appropriate patients and how it alters over time.
Methods: This was a service evaluation reviewing patient case notes, including KIS documentation at referral and one-month post-referral. Additionally, semi-structured interviews with Palliative Community Nurse Specialists (CNSs) explored KIS usefulness.
Results: 77% of patients had a KIS at referral. One-month post-referral, all had a KIS and 59% contained updates. At referral, 53% of KISs stated there was an anticipatory care plan (ACP) in place, 50% specified a DNACPR decision and 24% noted preferred place of care or death. Carer details were available in 29% of KISs. CNSs find ACP the most useful aspect of KIS and proposed more ACP detail in updates. One recommendation suggested to improve this was allowing CNS access to update KIS.
Conclusion: The majority of new referrals to palliative services had a KIS at referral and all rereviewed had one at one-month post-referral. Areas of potential development include improving KIS accessibility for CNSs and putting in place future systems allowing CNSs to edit KIS.
Author(s) Giorgos Tsiris, Donna Hastings, Becky Chaddock, Stephen Fischbacher, Margaret McLarty
In 2019, as part of its expanding community engagement and health promotion work, the Arts and the Family Support services of St Columba’s Hospice implemented an innovative project raising death and dying awareness.
This project, which was co-led by St Columba’s Hospice and Fischy Music, took the form of an intergenerational song writing project. Hospice patients and children from Victoria Primary School were brought together to explore, express and share through music their experiences of grief, change and loss in life. Their collaborative work was subsequently shared with the public through recordings of the songs and live performances which attracted public and media attention. The project also included training for all school staff and school-wide workshops raising awareness and equipping people with the resources to cope creatively with loss change and grief in life. In this poster we outline some key processes and outcomes of the project alongside illustrative materials such as photos and direct quotes by the participants. Looking ahead, we also consider the implications of the project and discuss future developments. This includes the role of hospices as a resource hub for the local community fostering partnerships and opportunities for open dialogue and creative action around death, dying, change and loss.
SPARC – Supportive and Palliative Action Register in the Community
Author(s) Dr Melanie Sloan, Susanne Gray, Vicki Cloney, Dr Katie Clark
A previous partnership with Macmillan Cancer Support aimed to redesign community based palliative care in Renfrewshire. This led to the testing of SPARC - Supportive and Palliative Action Register in the Community. Key outputs included developing:
- weekly MDT meetings (WISeR)
- a social prescribing model for individuals with a palliative condition whose support needs are stable.
This led to a year-long partnership with Healthcare Improvement Scotland to test ways to more effectively identify people who would feed into these services.
A key shift in thinking was to establish a way to identify people who would benefit from the social prescribing arm of the SPARC approach. This led to the development of a ‘new’ GP question to identify people much earlier. The old ‘surprise question’ is still helpful for identifying people approaching the end of their life; however, our aim is to facilitate early palliative care.
Through our work with GP practices it was apparent that there are a wide variety of approaches to managing palliative care registers and meetings. Therefore, we have developed a new ‘SPARC’ register format that supports both identification and discussion of these individuals. The register can be shared with other practices should they wish to use it.
SPOT - The Safer Prescription of Opioids Tool Deployment in Clinical Practice
Author(s) Roger Flint, Geraldine Finnan, Annabel Howell
The Chief Medical Officer for Scotland invited all clinicians to innovate and disseminate innovation throughout the NHS.
The Safer Prescription of Opioids Tool, SPOT, is a novel software medical device designed to improve the safety of opioid conversion in Palliative and End-of-life care in all settings and for all prescribers.
It was developed over the course of five years with a multi-professional and interdisciplinary team. SPOT’s initial release version is complete and it is undergoing adoption and roll-out Board-wide in NHS Borders.
This poster outlines the key steps and activities required to disseminate and foster adoption of an innovative software medical device throughout an NHS Health Board in Scotland. It identifies the key barriers to adoption and the methods and mechanisms to overcome these blocks. This process includes stakeholder engagement, project planning and initiation and a communications and dissemination plan to spread SPOT throughout the NHS Board, leading to the adoption of the innovation in the Health Board.
This spread and sustainability framework was used to inform the process and learning from this pilot and could be used to encourage and spread the dissemination of other innovative tools in NHS Health Boards (Healthcare Improvement Scotland 2013).
The Truacanta Project – Helping Each Other with Death, Dying, Loss and Care
Author(s) Caroline Gibb, Mark Hazelwood, Rebecca Patterson
The Truacanta Project will support local communities across Scotland who are interested in taking community action to improve people’s experiences of death, dying, loss and care. It is a three year initiative being run by Scottish Partnership for Palliative Care and funded by Macmillan Cancer Support.
Communities have an important role to play in supporting people through the difficult times associated with ill health, dying, loss and care, but in many ways, have become ill-equipped to provide this supportive role. The international compassionate communities movement shows an appetite for change; in Scotland there are many individuals and groups keen to find ways to enhance compassion in their own communities, who bring with them skills or experiences that have the potential to be hugely beneficial.
Using a community development approach, The Truacanta Project aims to mobilise these assets - the strengths, knowledge, experience, skills and resources that already exist - to nurture compassionate communities in Scotland.
This poster will help delegates understand the background to and aims of The Truacanta Project, what we mean by a community development approach, and the vision for how the project and participating communities will develop.
Tracing Autonomy: a reflective approach in support of autonomy in life
Author(s) Dr Ben Colburn, Jeni Pearson, Kirsty Stansfield
Tracing Autonomy is a collaboration between the Art Team at PPWH and Philosopher Dr Ben Colburn, University of Glasgow & End of Life Studies Research Group. Tracing Autonomy offers a systematic way of reflecting on practice that is appropriate, efficient and focussed.
It offers a 4-step process that can be tailored and adapted to practice and in relation to the patient. It is not a form to fill in but instead offers a reflective framework for thinking about how to support a patient’s autonomy in life and to identify what might undermine the autonomy of a patient.
This poster will describe the framework, including its use of an expanded holistic terrain. The terrain takes into account the physical, psychological, social and spiritual aspects of a person’s life. It also considers the environment, quality of dialogue and sensory experiences that a person may have. We will present the four characteristics of autonomy (choice, value, relationships and authorship) that can be used to identify and understand what has undermined or supported a person’s autonomy. This reflective process allows the practitioner to engage in meaningful and purposeful dialogue with the individual and begin working towards alternatives and in some cases the ideal.
Welcoming the public to St. Columba’s Hospice on Edinburgh Doors Open Day
Author(s) Danuta Orlowska, Karen Filsell, Giorgos Tsiris, Suzie Stark, Maggie Young
Doors Open Day is one of Edinburgh’s popular free days out when members of the public can explore some of the city’s fascinating buildings. Though our doors are open throughout the year, taking part in Doors Open Day is an opportunity to locate our community engagement work within a city-wide event. Participation enables us to share our vision and values in a relaxed and informal way. As well as seeing our buildings and interior design, visitors can talk to staff and volunteers and find out about what we offer: services for patients (inpatient, day therapies and community), opportunities for supporting the hospice (working and volunteering in a variety of ways) and the education and research in which we are involved.
The poster presents information about our participation in Edinburgh Doors Open Day
- planning behind the scenes
- selected highlights of our participation
- some of the feedback we have received.
Participation in Edinburgh Doors Open Day is now an established part of our calendar and we look forward to welcoming visitors on Saturday 28 September 2019 (11.00 – 15.00).
Poster abstracts of the month: August
The SPPC Annual Conference in 2019 featured 32 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:
- NHS Forth Valley Macmillan Healthcare Support Worker Project
- Oral care at end of life
- Paediatric End of Life Care - A National Managed Clinical Network Approach to Improving Care
- Palliative Care: Succession planning for rare beasties
- Palliative care volunteers in Europe: qualitative analysis of volunteer activities and experiences
- Palliative News: Back to the Future
- Project ECHO: Supporting children transitioning to adult palliative care services
NHS Forth Valley Macmillan Healthcare Support Worker Project
Oral care at end of life
Paediatric End of Life Care - A National Managed Clinical Network Approach to Improving Care
Palliative Care: Succession planning for rare beasties
Palliative care volunteers in Europe: qualitative analysis of volunteer activities and experiences
- the experiences of volunteers in HPC
- why they work in HPC
- what HPC volunteering means to them
- In total, 37 stories of 400-500 words were received from eight countries.
- Almost all (n=34) volunteers offered practical, emotional, social and spiritual support to adult patients and families.
- 32 were involved in diverse adult HPC settings including patient’s homes, hospices, hospitals and care homes and two in community children’s palliative care
- All found significant meaning in HPC volunteering, described as an important part of their life and values.
- Volunteers described the privilege of being with people at end of life and how much they learn from encounters with death and dying.
- Others describe the challenges of HPC volunteering and how their lives are enhanced by their experience.
Palliative News: Back to the Future
Project ECHO: Supporting children transitioning to adult palliative care services
Poster Abstracts of the Month: February
The SPPC Annual Conference in 2019 featured 32 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:
- How can we ensure a realistic approach to dietetic care in acute medical inpatients? A retrospective cohort study of survival-related outcomes in patients referred to dietetics in NHS Fife
- Introducing the Macmillan Support Worker : Innovative Practice within a Community Palliative Care Service
- ‘Making Memories’ – An Exhibition of artwork by patients of Victoria Hospice
- Music to my ears: Implementing personalised music playlists in a Hospice Inpatient Unit (IPU)
How can we ensure a realistic approach to dietetic care in acute medical inpatients? A retrospective cohort study of survival-related outcomes in patients referred to dietetics in NHS Fife
Author(s)
Jamie Kok, Angela Southam, Scot Bullivant, Huai Ling Tan, Joanna Bowden
Introduction: In NHS Fife, acute hospital admissions who are identified as being at risk of malnutrition are referred to dietetics. Our objective was to characterise the acute medical population referred to dietetics over a one month period and to examine their survival-related outcomes.
Methodology: A retrospective cohort study of 206 referrals to the dietetics department of Victoria Hospital, Kirkcaldy in September 2017 was undertaken. Descriptive statistics were produced to characterise the population and their outcomes. Binomial logistic regression and Kaplan Meier survival analyses were also used.
Results: 36% of patients referred to dietetics had died within 3 months of referral. By 18 months, only 40% of patients were still alive. Older age and low albumin levels were associated with shorter survival (p<0.0001). People with cancer had lower one year survival rates than those without cancer.
Conclusion: A significant proportion of acute medical patients referred to dietetics are in their last phase of life. If patients with a poor prognosis are not identified, they are at risk of receiving dietetic interventions that do not add value. Conversely, patients with a good prognosis can also benefit from being identified. This should enable dietitians to tailor their interventions individually, so as to provide the best care possible.
Introducing the Macmillan Support Worker : Innovative Practice within a Community Palliative Care Service
Author(s)
Jan Dobie, Jade Cantwell, Leslie Chapman, Sheila Shaw
The Community Palliative Care Team (CPCT) in East Lothian comprises 3 full time Clinical Nurse Specialists (CNS).
As an organisation, Macmillan has recognised that care coordination is not one person’s role, job or responsibility. It is the joining up of services, coordination, information and communication between care givers, treatment providers and those living with life limiting conditions and their families. To that effect, Macmillan has developed a model and potential workforce solution; a Band 4 Role called a Macmillan Support Worker (MSW).
In discussions with Senior Management within East Lothian Health and Social Care Partnership and Macmillan, the CPCT recognised that a MSW would be of benefit in helping patients to achieve positive outcomes and would also support the team by sharing and coordinating care in a more efficient way. This was a new initiative which had never been tried in Scotland.
Funding was secured from Macmillan Cancer Support for a 2 year pilot project to introduce a Band 4 Support Worker.
This poster will share experiences and data from September 2018 to the current date.
Examples will be provided of what the MSW has been able to achieve and how this has influenced practice and patient and family care.
‘Making Memories’ – An Exhibition of artwork by patients of Victoria Hospice
Author(s)
Amy McNeil
Stigma surrounding hospice care can become a barrier to accessing specialist services. Often misconceptions mean patients who would benefit most from Day Hospice are reluctant to consider attending. Whilst society accepts the need for palliative care, alternative approaches can be made to highlight the Specialist Palliative Care service and engage local communities, helping to change perceptions of the service and patients.
Art sessions are an integral part of Hospice Day Care, providing significant benefits to patients’ health and wellbeing, resulting in a variety of meaningful artwork. Over 3 months in 2018, day patients’ artwork was exhibited in a public art gallery with the intention of engaging the public through art instead of information.
As the exhibition was unmanned the number of visitors and the effect of the exhibition will remain unknown. The majority of feedback came from those already aware of services offered, in particular friends and family of deceased patients, all of who commented on the significance of a having local, non-clinical venue in which to reflect. The exhibition as a whole provided them comfort and a connection to their loved ones.
Overall the exhibition showed the potential for using art to create connections and conversations surrounding specialist palliative.
Music to my ears: Implementing personalised music playlists in a Hospice Inpatient Unit (IPU)
Author(s)
Kim Donaldson, Jen McLean, Liz Collins, Fiona Cruickshank, Erna Haraldsdottir
Background:
Creating individualised playlists for people living with a dementia has positive benefits including the reduction of behavioural and psychological symptoms1. As hospices across the UK have been urged to build skills needed to support people with dementia2 we decided to implement Playlist for Life3 within our IPU as a creative way of offering support to patients and their families. Although our initial aim was to work with people with a dementia, we have also used Playlist for Life3 for people with other cognitive impairments or none at all.
Using Playlist for Life3 has:
Enabled life story telling and reminiscing
Supported the management of breathlessness and anxiety
Increased sense of wellbeing
Supported Advanced Care Planning
Been a legacy for family members.
Our next steps are to:
Continue to establish an evidence base in a hospice setting through further evaluation
Establish referral criteria.
Outcome:
Individualised music playlists can be an effective therapeutic tool in a hospice setting.
1Bowell, S. and Bamford, S.M. 2018. What would life be – without a song or a dance, what are we? ILC –UK: London.
2Hospice UK. 2015. Hospice enabled dementia care: The first steps. Hospice UK: London.
3Playlist for Life. 2019. https://www.playlistforlife.org.uk/
Poster Abstracts of the Month: January
The SPPC Annual Conference in 2019 featured 32 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:
- CREOL - A realistic medicine approach to supporting compassionate care of the dying in any setting
- Developing an Adult Palliative and End of Life Care Plan for Angus Health & Social Care Partnership
- Dying well night and day: A mixed-methods evaluation of out-of-hours services in Scotland for people with palliative care needs
- Hospice Incident Reporting: Our Transition from Paper to the Web
CREOL - A realistic medicine approach to supporting compassionate care of the dying in any setting
Author(s)
Geraldine Finnan, Michelle Scott, Julia Hume
The Chief Medical Officer for Scotland presented an invitation for all health and social care professionals to make a shift in the way they support patients and carers. Realistic medicine is an approach and attitude where shared decision-making happens through respect for the individual’s values, with a focus on what matters to them.
For Palliative Care specialists it represents the “mainstreaming” of all the core aims and values of what palliative care has at its heart – recognition that this is every care professional’s job. This approach enables the benefit/burden balance of realistic treatment choices to be truly shared and understood and honest and open communication can empower patients and families.
The CREOL is a document that was developed to support delivery of compassionate person-centred high quality end of life care (EOLC) in all settings. A truly realistic medicine approach was integral to the design. It has been designed to be intuitive and flexible, allowing episodes of care and assessment to be documented in a clear and concise manner, which allows trends and patterns to be identified quickly.
The aim is to support and improve EOLC provision, promote discussion around dying, and ensure that clinicians value what matters most to the dying patient in any setting.
Developing an Adult Palliative and End of Life Care Plan for Angus Health & Social Care Partnership
Author(s)
Elaine Colville, Sally Wilson, Marion Gaffney, Dr Deans Buchanan
Angus Health and Social Care Partnership have co-produced a collaborative and integrated plan for Adults with palliative and end of life care (PEOLC) needs. This has been produced following consultation and engagement from a wide range of stakeholders including health, social services, voluntary and independent services, carers and the public. The plan is shaped around people’s current experiences, understanding and hopes regarding PEOLC in Angus. We are proud to be the first Health and Social Care Partnership in Scotland to develop a dedicated plan for PEOLC and this strengthens our commitment to achieve the best Palliative and End of Life Care that we can.
What did we do?
Review of literature and strategic guidance
PEOLC Steering Group convened
Engaged widely with carers, public and workforce
Themed feedback which identified our strengths and gaps.
We asked:
What do you think good palliative and end of life care look like?
What do you think we could do differently?
Is there something else you want to tell us about palliative and end of life care?
The plan outlines 6 outcomes:
Compassionate and person centred care
Care as close to home
Compassionate communication and conversations
Getting it right for the family
Education and development for the workforce
Public health approaches to palliative and end of life care.
Next steps involved the development of an Action Plan and Implementation.
Dying well night and day: A mixed-methods evaluation of out-of-hours services in Scotland for people with palliative care needs
Author(s)
Bruce L. Mason, Scott A. Murray, Marilyn Kendall, Nicole Brun, Anne Finucane, Emma Carduff, Andrew Stoddart, Lewis Ritchie, Jeremy Keen, Marie Fallon, Sian Tucker, Erna Haraldsdottir, Lorna Moussa, Stella Macpherson, Joannes Kerssens, Sheonad Laidlaw, Kirsty Boyd,
Background: Scotland’s national datasets provide insights into use of out-of-hours (OOH) services in the last year of life.
Methods: Patient data from the national register of deaths (2016) linked to five urgent/ unscheduled care datasets within a Data Safe Haven was analysed for every episode of OOH care in the 12 months before death. Three qualitative case studies in diverse regions of Scotland involving patients, carers, and healthcare professionals explored decision-making.
Results: Of 56,407 people who died in Scotland in 2016, 98% had a long-term illness (cancer 28%, organ failure 38% and frailty dementia 25%). Overall, 95% (53,852) used an OOH service; 50% of this in the last 2 months of life when calls to NHS 24 and primary care OOH increased proportionately but cost a fraction of hospital care. People with organ failure, especially from lower income quintiles, tended to call 999 and attend A&E. Those with cancer had more bed days and were the highest users of primary care OOH. Perceived legitimacy, prior experience and enhanced access to services influenced people’s decisions about seeking help.
Conclusions: Users find OOH services difficult to navigate but need to contact them more as death approaches. Patterns of use were impacted by diagnosis, deprivation and proactive planning.
Hospice Incident Reporting: Our Transition from Paper to the Web
Author(s)
David Manion
Clinical governance has long been recognised as the system with which health organisations are accountable for continuously improving the quality of their care and the way that service is delivered. Incident reporting is a significant part of this process, in it provides an indication as to the level of reporting culture in place within an organisation with the added benefit of ‘soft intelligence’ included in the incident’s descriptive narratives. This investigation and review process can provide the basis of continued work into improving working practices and quality of care.
During March 2019 St Columba’s new web based incident reporting system went online and staff went from a traditional paper form based reporting process to a data management system. The system would not only provide Incident Reporting but also Facilities Management, Complaints, and an electronic Risk Register for the hospice.
We have taken this point in time (6 months) as a good opportunity to document the benefits and difficulties experienced during this period of innovation and hope the example provided might help other organisations when considering a similar reporting solution.
Poster Abstracts of the Month: October
The SPPC Annual Conference in 2018 featured 48 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:
- Tackling Fatigue; Take charge! Recharge!
- The Coracle Project - Art and Bereavement Support
- The FLTTN (Forward Looking To The New) Project
- Timely identification and support for carers of people at the end of life through the Adult Carer Support Plan
- Triggers for the Pharmacological Management of Delirium in Palliative Care
- Use of Propofol in a Specialist Palliative Care Unit
- Views of Care - Delivering End of Life Care Now and Improving for the Future
- What Matters at end of Life - Using Principles of End of Life Care in Clinical Practice
- What matters to you?’ Staff perspectives on the identification and documentation of ‘What matters’ and the role of values-clarification in palliative care settings
- Working Together Learning Together, Collaborative Working: Single Nurse Controlled Drug Administration
Tackling Fatigue; Take charge! Recharge!
Author(s)
Donna Bruce
St Andrew’s Hospice Occupational Therapist has provided fatigue management as part our services for a number of years. However, following repeated requests from healthcare professionals in the community we agreed to develop and pilot an education session for patients on self-management techniques for fatigue. The aim of the pilot was to provide patients with adequate knowledge, empowering them to manage their own symptoms thus allowing them ‘to longer healthier lives at home or in a homely setting’ (Scottish Government 20/20 vision, 2011)
The Session was developed and ran by our specialist Occupational Therapist and consists of a one-hour session which teaches the concept of energy conservation in managing fatigue and introduces self-management tools such as the energy battery and activity diaries.
35 patients completed evaluation forms and the results show that 100% of attendees reported that they had learned techniques which could help them manage their fatigue.
Comments included:
‘To prioritise, to stop and think, to realise certain tasks can wait.’
‘Session was excellent and at right pace. Provided a much better understanding of fatigue’
Following the pilot, the education sessions currently run once per month and are led by a Rehabilitation Support Worker.
The Coracle Project - Art and Bereavement Support
Author(s)
Suzie Stark
Art and Conversation - Painting a Grief Journey
People who had completed 1:1 bereavement support sessions at a hospice were invited to take part in an art-based group project. The Coracle Project consisted of six sessions facilitated by the chaplain. The group explored words and images that encapsulated aspects of a grief journey with which all participants identified.
The analogy of being at sea in a small craft was used by the chaplain in 1:1 bereavement support sessions and was familiar to most of the group. The artwork depicts three different stages of a grief journey, noting that progress is not linear and stages might be experienced many times. Words, colours and images were used to create ‘mood boards’ and from these three paintings were produced - the turmoil of raw grief, the sense of being lost in fog and the longed for, but often elusive, calmer waters.
The paintings have been exhibited and used as conversation starters to help others discuss their feelings of loss and bereavement, demonstrating how conversation and art in a safe group environment can be beneficial for those taking part as creators and leave a legacy for others struggling with their own losses.
The FLTTN (Forward Looking To The New) Project
Author(s)
Claire Coleman-Smith; Niki Ferguson; Janette McGarvey
Story of the FLTTN Project:
At the Prince and Princess of Wales hospice we have an inclusive approach to caring for everybody affected through life-limiting illness and we deliver our holistic compassionate care, for people at the most difficult times of their lives; for patients, family members, carers and friends. Our specialist (bereavement) Butterfly Service, funded by the Big Lottery, specifically looks after children, young people and their families.
As part of the development of the butterfly service and inspired by the upcoming move to our new home at Bellahouston park we have invited a working group of young people with connections to the Butterfly service to co-produce a transitional creative project (THE FLTTN PROJECT- Forward Looking to The New). The project aim is to provide a platform for children and young people (CYP) to voice their collective experiences and thoughts on the transition from the historic Georgian building on Carlton Place to the modern 21st century new build in Bellahouston Park. This will involve CYP exploring all areas of the arts (Visual art, Music, Digital (film, photography and animation) Creative writing and Performance) to produce content for an exhibition to be held in 2018 (Year of the Young person) in the new hospice.
The emphasis is not necessarily on each CYP telling their own personal story about their connection to the hospice but rather to explore broadly the theme of transition and change; individually and/ or as part of a small group. The CYP will consider marking endings and establishing new beginnings, linking the past to the future, and how the spirit of a place can transition and evolve into a new environment to form new memories.)
Timely identification and support for carers of people at the end of life through the Adult Carer Support Plan
Author(s)
Emma Carduff; Richard Meade; Susan Swan
Introduction:
The Carers (Scotland) Act (2016) places a duty on local authorities to prepare an Adult Carer Support Plan (ACSP) for any carer who requests one or is identified as such. From 2020, this will be assisted by a fast track process for carers of people in their last six months of life.
Aim:
To provide evidence on the supportive needs of carers to inform recommendations regarding the timescale for the creation of fast tracked ACSPs under the Carers (Scotland) Act (2016).
Methods:
The study triangulated data from a literature review, qualitative secondary analysis (n=19 interviews; 3 focus groups) and two primary focus groups with bereaved carers (n=11).
Results:
Themes included; barriers to and triggers for identification and needs including physical support, psychological support, respite, information, communication, co-ordination and competing demands. Additional themes were speed of decline and end of life care.
Conclusion:
Health and social care professionals need to take a radical, reactive move to presume that every patient has a carer and ensure they understand their entitlements. Carer identification is everyone’s responsibility and it should be the ambition of the Carer (Scotland) Act (2016) that this happens early in the illness trajectory. In so doing, rapid assessment and support can be initiated to help carers navigate and cope with an uncertain, often rapidly deteriorating illness trajectory.
Triggers for the Pharmacological Management of Delirium in Palliative Care
Author(s)
Catherine Fairfield; Anne Finucane; Juliet Spiller
Introduction:
Delirium is a serious neurocognitive disorder with a high prevalence in palliative care. There is a lack of evidence of benefit for pharmacological interventions such as antipsychotics.
Aims:
1) To determine the prevalence of delirium in a palliative care inpatient setting and how it is documented/described by staff. 2) To determine the extent delirium screening tools are used in its identification and how they are viewed by staff. 3) To determine the triggers for pharmacological intervention in managing delirium in palliative care.
Methods:
A case-note review of admissions to Marie Curie Hospice Edinburgh from 1st-17th August 2017 was performed as were small group interviews with hospice doctors and nurses.
Results:
21 patients were reviewed. 76% had documented symptoms of delirium and 62% were screened on admission. Its documentation/description was variable and the term itself was used infrequently. Midazolam was the most commonly used medication. Triggers for pharmacological intervention included failure of non-pharmacological measures, distress, agitation and risk of patient harm.
Conclusions:
The infrequent use of the term delirium suggests it may be under-recognised.
Triggers for pharmacological intervention are in-keeping with guidelines, however the level of understanding of delirium’s presentation varied between participants.
Use of Propofol in a Specialist Palliative Care Unit
Author(s)
H Crockett; C Ross
Purpose of audit:
Propofol is a fast-acting general anaesthetic agent. However, beneficial use of propofol in palliative care has also been reported, in refractory agitation. This has informed the practice of our specialist palliative care unit. The purpose of the audit was to monitor adherence to the unit’s propofol protocol.
Methodology:
A protocol for propofol use in refractory agitation was developed in 2011 in our specialist palliative unit. A proforma was used to document use over the next six years.
Results:
There were nine episodes (seven patients) of propofol use. The indications for use included refractory agitation, status epilepticus, and sedation for NIV removal. In non-seizure related episodes, a benzodiazepine and antipsychotic had been used prior to propofol, as a minimum. The propofol infusion was stopped when the patient died in seven episodes, and when symptoms had resolved in two episodes.
Conclusion:
Propofol use is well documented and has a valuable role in palliative care. A new proforma has been written to allow for more robust auditing of the use of propofol. Propofol has been used very infrequently, but the impression of the specialist staff is that is an invaluable tool for very difficult and refractory cases.
Views of Care - Delivering End of Life Care Now and Improving for the Future
Author(s)
Bridget Johnston; Elaine O’Donnell; Patricia O’Gorman; Claire O’Neill; Jackie Wright
Obtaining feedback on End of Life Care from dying people and their relatives is difficult. This pilot project tested the use of questionnaires to gather views on end of life care from relatives /friends in the acute setting.
Aim:
• Test the feasibility of collecting feedback using questionnaires
• Capture qualitative Views of Care
• Identify areas of good practice and areas for improvement
A sensitive questionnaire was issued to relatives in pilot sites when collecting the medical certificate of death. After 6- and 12-months questionnaires were issued to gather staff opinions of the project.
The feedback revealed that high quality End of Life Care is being delivered and that this is important to both relatives and staff. 32 questionnaires were received from bereaved families. Themes emerging included communication, compassion and emotional support. Areas for improvement were also identified.
Staff questionnaires captured valuable feedback both benefits and concerns were identified.
This project has been effective in obtaining valuable feedback from bereaved relatives. The results identify good practice and highlight areas for improvement.
More research is required to identify the optimal timing and method, such as using technology, for obtaining views of care at end of life from bereaved relatives.
What Matters at end of Life - Using Principles of End of Life Care in Clinical Practice
Author(s)
Morven Kellett; Lesley Murciano; Evelyn Paterson; Helen Upfold
This poster has translated the 4 principles of end of life care (ref: Caring for People in the last Hours and Days of Life, Scottish Government National Statement 2013) into more memorable language; Communicate, Collaborate and Co-ordinate, Care and Comfort, Compassion. It has been used to raise awareness of the principles of end of life care and as an educational tool - asking multidisciplinary staff to reflect on how their care delivery aligns with these principles and to identify areas where improvements could be made.
What matters to you?’ Staff perspectives on the identification and documentation of ‘What matters’ and the role of values-clarification in palliative care settings
Author(s)
Anne Finucane; Jack Irvine; Juliet Spiller
Introduction:
Values-clarification has an important role in palliative care for clinical staff and their patients. The question ‘What matters to me?’ forms part of the daily assessment of each patient at the Marie Curie Hospice Edinburgh.
Aims:
Explore staff perspectives on the role of understanding patient values and their interaction with clinical practice.
Methods:
A service evaluation investigating the practical application of ‘What matters to me?’ as a proxy question for values identification, using a retrospective case notes review and focus group discussion. Data was qualitatively analysed.
Results:
Doctors recorded ‘What matters to me?’ information most frequently (52%). Focus group results indicated widespread understanding of the importance of values to staff personally but revealed varying approaches to electronic documentation. Multidisciplinary team meeting electronic records were found to be less useful than intended. Quality of evidence of community documentation of ‘What matters’ being transitioned to the inpatient setting was, overall, positive. Core themes included family, being at home and general health.
Discussion:
Extensive agreement regarding the positive impact of using the ‘What matters to me?’ question to elicit patient values. Implications for hospice practice include clarifying electronic documentation practices, increased healthcare assistant access to electronic records and regularly updating nursing handover sheets.
Working Together Learning Together, Collaborative Working: Single Nurse Controlled Drug Administration
Author(s)
Irene Barclay; Kim Donaldson; Helen Keefe; Dorothy McArthur; Libby Milton; Dot Partington
Single Nurse-Controlled Drug Administration (SNCDA) was developed in response to registered nurse (RN) concerns that patient waiting times for controlled drugs (CDs) were excessive and the two-staff resource impacted other responsibilities.
SNCDA is used in various healthcare settings and although RNs may have initial anxieties there is no evidence to suggest it has any adverse effect on safety. Many feel it is safer.(1)
A practice development approach was used to elicit the values and beliefs of IPU (Inpatient Unit) RNs surrounding SNCDA which informed policy, procedure, risk assessment and the programme of education. Roll out was gradual allowing confidence building in the process. Following the second successful cohort the clinical pharmacist, working across two hospices, recognised the potential in the second hospice and presented a proposal for collaborative working. Following scrutiny via the second hospice’s clinical governance structure, the two hospices entered into a joint working agreement.
Working in partnership has offered an opportunity to strengthen relationships and ensure quality and equity across both sites. Staff report feelings of autonomy, empowerment and of being more responsive to patient need.
(1) Taylor, V. Middleton-Green, L., Carding S. and Perkins P. 2016. Hospice nurse’s views on single nurse administration of controlled drugs.
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