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 2015 featured 38 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:
- Phase 2 randomised controlled trial of future care planning in patients with advanced heart disease
- Preparing for 'real life' - Reducing Death Anxiety in 3rd year nursing students
- Quality Improvement with Nursing Handovers
- Supporting people with learning disabilities through the palliative care journey- NHS Greater Glasgow and Clyde Learning Disabilities and Palliative Care Pathway
- Supportive and Palliative Care Indicators Tool (SPICT): Enabling identification of patients at risk of deteriorating and dying worldwide
- Talking the Untalkable in Fife
- The challenges for volunteering in hospice and palliative care in Europe
- The new West Lothian Community Palliative Care Service: reflections from the first year
Phase 2 randomised controlled trial of future care planning in patients with advanced heart disease
Author(s)
Kirsty Boyd; Shirley Robertson; Sarah Cudmore; Gill Highet; Lisa Donald; Kristen Haga; Christopher Weir; Scott Murray; Martin Denvir
Integrating cardiology care and palliative care can benefit many patients with advanced heart disease at increased risk of death or hospitalisation. Future care planning provides a framework for discussing a range of palliative care problems with patients and their families. This approach can be introduced at any time during the patient's journey of care and ideally well in advance of end of life care. Future care planning is applicable to a wide range of patients with advanced heart disease and could be delivered systematically by cardiology teams at the time of an unplanned hospital admission, akin to cardiac rehabilitation for myocardial infarction. We have tested this in a successful pilot, controlled trial of an early future care planning intervention consisting of an initial review meeting with the patient plus a family carer by the cardiologist and specialist nurse who offered community follow-up. Liaison with the primary care team promoted early community support and KIS completion. Impact on quality of life was measured using questionnaires and interviews.
Preparing for 'real life' - Reducing Death Anxiety in 3rd year nursing students
Author(s)
Lynn Griffin
Communication around death and dying is challenging. Students are often protected and excluded from these conversations during clinical placement. This reduces the opportunity to learn from other clinicians. Students often report anxiety in how they will have these difficult conversations with patients and their families, once registered. The common theme is one of getting it 'right' and not causing further distress.
The University of Dundee School of Nursing and Health Science has been using a variety of ways to encourage students to talk more openly about death and dying. Innovations showcased by Good Life, Good Death, Good Grief, such as, Before I die Walls, Death Cafes as well as, end of life Clinical Simulations, (underpinned by theoretical modular content) have been used as frameworks/platforms to support and encourage students engagement and learning experience.
Quality Improvement with Nursing Handovers
Author(s)
Laura Johnston; Lesley Ferguson; Elaine McManus
Improving Nursing Handovers in a Hospice In-Patient Unit
Nursing handovers aim to communicate essential patient information between shifts. They have been identified as a communication ‘hotspot’ where inaccurate, missing or untimely information can lead to compromised quality or safety in care.
Handovers in the In-patient unit were long (resource intense), lacked focus, did not closely reflect the patient journey/agenda and produced multiple ‘nurses’ pocket notes’ which had an unknown destination. A Plan, Do, Study, Act (PDSA) methodology was used to improve the handover process.
A handover template was developed to address the problems and then piloted. Clear instructions for how to generate, use and destroy the handover sheet were disseminated to staff prior to implementation.
The template was well received by nurses and encouraged them to be more outcomes-focused and person-centred. The sheet, with its handwritten additions, was physically passed on to the next shift to avoid duplication or inaccurate information and shredded after 24 hours.
Questionnaires were used to gain feedback from nursing staff. Outcomes included: nursing handovers were structured, outcome focused and gave specific attention to patient wishes and goals; reduction of handover time by 50%; patient data in nurses’ pocket notes had been eradicated.
Supporting people with learning disabilities through the palliative care journey- NHS Greater Glasgow and Clyde Learning Disabilities and Palliative Care Pathway
People with Learning Disabilities (PWLD) frequently experience various barriers in accessing effective and appropriate health care, and are often marginalised from regular health services. These barriers, linked with lack of understanding about the palliative care role, add to difficulties accessing palliative care services.
PWLD who have life limiting illness require skilled support from their core team with access to specialist palliative care services being available when needed to support early intervention.
Following a scoping exercise carried out by The Prince and Princess of Wales Hospice in 2011 the award winning project ‘Learning Disabilities and Palliative Care-Building Bridges: Supporting Care’ was established.
As part of the project aim the following objective was set – ‘to develop a care pathway to deliver appropriate and high quality palliative care for PWLD, including guidance referral to specialist palliative care, then to pilot, evaluate and roll out the pathway nationally by 2015’.
The Care Pathway has been developed with multi-professional commitment from both specialist services ensuring holistic care needs of individuals with LD are considered. It is underpinned by evidence based practice and fundamental in promoting the delivery of high quality palliative care for PWLD. The pathway aims to support practitioners across all health and social care settings.
Supportive and Palliative Care Indicators Tool (SPICT): Enabling identification of patients at risk of deteriorating and dying worldwide
Author(s)
Dr Kirsty Boyd
Better care of people dying with one or more advanced conditions depends on primary care teams, hospital specialists and a range of other health and social care professionals making earlier identification part of their routine clinical practice. SPICT highlights readily identifiable general indicators and clinical signs of deteriorating health that mean patients are at risk of deteriorating and dying. Clinicians are prompted to consider assessment of unmet holistic care needs and offer people opportunities to talk about their health problems, the things that matter most to them and their families, and future care planning. SPICT seeks to improve ‘prognostic awareness’ while addressing the ‘prognostic paralysis’ that sometimes means palliative care is only offered when there are few or no other treatment options and the patient is close to dying. Initial and ongoing development is supported by the designated SPICT website and involves a growing network of Scottish, UK and international SPICT collaborators. The EAPC Primary Palliative Care Taskforce recommends SPICT for use across Europe. SPICT is clear, credible and useful in all care settings to promote integrated palliative care.
Talking the Untalkable in Fife
Author(s)
Dr Gordon McLaren; Edward Small; Sheila Matthew; Tracey Blyth; Sarah Nealon
Aim: A multiagency group was set up in 2011 to encourage a more open approach to death, dying and bereavement in Fife, through raising awareness and encouraging people across society to consider how they can further this agenda themselves.
Method: The group has organised two well attended Fife wide conferences, with participants from different organisations and the public, an all-day drop-in shopping centre event, and a cafe event. Group members produced brief practical information about Wills, Powers of Attorney, Advance Directives, Funeral Planning and death registration. Both conferences drew on the knowledge and skills of participants as members of society encouraging them to have confidence to take forward the agenda themselves.
Results: The most recent conference in November 2014 was very well received. Many attendees indicated they would take forward some actions themselves either at home, in their workplace or in their communities.
Conclusion: The group’s work complements Good Life Good Death Good Grief nationally, providing a local focus to enable wider conversations about openness about death, dying and bereavement in Fife and greater knowledge of practical information. The most recent conference indicated that people felt more able to take forward their own actions in their own communities.
The challenges for volunteering in hospice and palliative care in Europe
Author(s)
Dr Ros Scott
Introduction: Volunteers offer the gift of presence, different skills, experience and time. In some European countries they are and will continue to be essential to providing hospice and palliative care (HPC) services as an integral part of a comprehensive highly professional HPC settings. However, hospice and palliative care faces many challenges and alongside this a new generation of volunteers have different expectations of volunteering and some want to use their skills in different and more meaningful ways.
Based on the work of the EAPC Task Force on Volunteering in HPC, this poster explores some of the challenges for the development volunteering and volunteers in hospice and palliative care in Europe including:
ž The values and principles of HPC and volunteering
ž The influence of culture on volunteering
ž Understanding and recognising the place of volunteers within the multi-professional team
ž Balancing the changing expectations of organisations with those of volunteers
Conclusion: If volunteering is to be developed successfully in the future we must be able to match the changing needs of our patients, their families and our organisations with the changing expectations of the volunteers of tomorrow.
The new West Lothian Community Palliative Care Service: reflections from the first year
Author(s)
Gail Allan; Kate Henriksen; Janice Strachan; Lorna Mackay; Linda Weir; Susan Lawson; Sharron McKay
This poster will describe the first year of the new West Lothian Community Palliative Care Service which was re-launched in Spring 2014. The service is a unique partnership between Marie Curie, Macmillan and NHS Lothian, based in the Macmillan Centre in St John’s Hospital. It will detail the setup of the community service, the current service delivery model, the team who deliver the service, key achievements, challenges and future plans. We will provide feedback from the patients, families, carers and stakeholders. We will also discuss the teams own personal reflections on their first year in post, with a key theme that change has been a positive experience.
Exploring the importance of creative activity to palliative care
The successful creative arts service at The Prince & Princess of Wales Hospice is opening its doors to figures from the world of arts and heatlhcare.
To celebrate Creativity and Wellbeing Week, from June 13 to 19, the relevance of creative activity to palliative care will be explored by invited guests, from artists working within healthcare to palliative care professionals.
The idea is that the workshops, which offer guests the chance to explore different art materials and mark-making techniques, will open conversations between professionals with an interest in palliative care, arts and health.
John Jones, 54, from Govan, Glasgow, has been a day services patient at Glasgow’s Hospice since early 2015 and rediscovered a long-forgotten love for art.
“I always enjoyed art at school and my teachers wanted me to take it further but I left school and started work,” he said. “I went on to work at the Rogano restaurant, I started off as a page boy, and was then a waiter and went on to do bar work.”
He works with watercolour crayons to create bright, lively pieces of artwork, two of which hang on the walls of the hospice’s art room.
"I enjoy the peace and quiet to work in the art room, it takes your mind off other things that are going on in your life,” he added. “I look forward to going to the art room, it give you a different interest. You try not to think about what’s going on in your life and carry on as normal. The art room takes your mind off things.
“The artists are excellent, they give you help and advice. I’ve got a few pieces at home now and some on the walls of the art room.
“It is uplifting, I’d definitely recommend it. A lot of people come into the hospice and it’s not for them but many find they’re good at it and you’d think they had been drawing and painting all their lives. It just seems to come naturally.”
John Kelly, 77, from Govanhill, Glasgow enjoys painting landscapes.
“I’ve been coming to day services at the hospice every week for about six months. Staff asked me if I wanted to go to the art class and I thought I’d give it a try,” he said. “I like painting landscapes and architectural pieces. One of the first ones I did was of the monastery on the isle of Mull, it had a lot of intricate work.
“I enjoy the company in the class. I don’t get out much at home, there are things I used to do that I can’t now. The class is relaxing.”
Initially set up in 2003 to address the absence of art in palliative care in Scotland, the artists who staff the project worked from a table in the corner of day services. It has grown and thrived to become a fully integrated key service with its own art room.
The creative arts service includes visual art and creative writing workshops and is open to all patients, family members and carers registered at the hospice.
There are patient art workshops, in which individual projects are undertaken within a group, as well as private family art workshops for adults and children, a carer’s drop-in workshop, and individual patient creative writing workshops.
The service aims to give people the opportunity to develop their creativity, express themselves and try something new while engaging in a relaxing and meaningful activity during a difficult time in their life.
It gives people back some of the control they have lost through illness, disability and caring responsibilities. Unlike art therapy the intention is never to analyse or explore issues raised by the creative process.
Most people who access the creative arts service at the hospice have had no previous experience, or have been forced to give up creative pastimes through ill health. Their attendance might offer respite for the patient, family member of carer, a therapeutic activity or a focused activity with their peers.
All sessions are patient-led and supported by qualified practicing artists who have extensive experience in the arts and health, specifically in palliative care, and have ongoing art practices of their own.
“When we meet people they have often lost a lot of confidence and are going through a very difficult time. In the art room they are in charge of every mark they make. We are there to encourage and support participants to develop their own creative practice as artists in their own right, where ideas and skills can grow over time,” said artist Jeni Pearson.
“It can offer those involved an increased sense of wellbeing. Art has the ability to help us view the world through new eyes. I have heard so many of our participants say that they look at things differently now and for many it can be a life-enriching experience, and this has to be of great importance within the context of palliative care.”
The hospice is currently fundraising to build a new hospice in Glasgow’s Bellahouston Park that will offer the very latest techniques in palliative care. Art will be an integral part, with gallery space for patients’ work.
By: Angela McManus, Communications manager, Prince & Princess of Wales Hospice
Picture credit: Nick Ponty
Enhanced End of Life Care in Ayrshire Nursing Home
The Abbotsford Nursing Home in Ardrossan has been providing meaningful and sensitive care for its residents for almost 30 years in North Ayrshire.
Recently, we have developed a new service, Enhanced End of Life Care, for when a person is no longer able to be supported at home (for instance, due to carer fatigue), or the person has been admitted to hospital but would prefer his/her place of care to be closer to home, family and friends.
In a close working partnership with District Nursing, G.P.'s, NHS Specialist Palliative Nurses and The Ayrshire Hospice Specialist Palliative Care Community Nurses, we respond to provide a comprehensive form of palliative care in an informal, relaxed environment. Our holistic approach includes pain and symptom management and nursing care in a dedicated en-suite bedroom
facility, as well as accommodating the person's spiritual, emotional and/or social support needs.
Our Enhanced End of Life Care service has been developed with strong support from Specialist Palliative Nursing teams at The Ayrshire Hospice and the NHS, local District Nursing teams and Macmillan Cancer Support. This collaboration is providing support and assistance both operationally and with additional knowledge and skills development for our team in Abbotsford.
It is free to the service user and is funded through the Scottish Government's Integrated Care Fund. We were awarded this funding by the North Ayrshire Health & Social Care Partnership and it is currently for one dedicated en-suite room facility. This initiative will enable local people in the advanced stage of their illness to be cared for twenty four hours a day in closer proximity to their family, friends and within their community. The service can be offered to people who would
prefer this choice and where their life expectancy is limited. However, should the person's symptoms stabilise, it is anticipated that a return to home will be a positive outcome, allowing the service to become available for another individual and his/her circle of friends and family.
If you would like more information on this new, innovative service, please contact Louise Pettigrew, Registered Manager, or her Depute, Georgette Langan, on 01294 602915 or by email.
By Nigel Wanless, Abbotsford Nursing Home
Macmillan Pharmacy Service Annual report
The Macmillan Pharmacy Service has published its Annual Report for 2014-15.
The service has now been rolled out across all Health and Social Care Partnerships within Greater Glasgow and Clyde. The expansion began in August 2013, following successful evaluation of the Macmillan Pharmacy Facilitator pilot project (2009-2013), by the University of Strathclyde.
The overarching aim of the service is to support community pharmacy and the wider primary care health and social care team to advance person-centered, sustainable, high quality, safe and timely pharmaceutical palliative care (PC) services as close to home as possible for patients, carers and families.
The idea is to shift the balance of care away from the acute sector to a more financially sustainable community based services that will better serve the growing ageing population, reduce pressure on out-of-hours services and avoid emergency hospital admissions.
The annual report is available for download here: Macmillan Pharmacy Service Annual Report.
Poster abstracts of the month: January
The SPPC Annual Conference in 2015 featured 38 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:
- Establishing a Culture of Improvement in a Scottish Hospice
- Goals of Care within a Structured Response Tool
- How Palliative care nurses make meaning of loss and death when delivering end of life care to patients and their families
- Implementation of a Falls Prevention and Management programme in a Hospice In-Patient unit
- Implementing the adapted ‘6 steps’ approach – An end of life care project for local care homes
Sime C; Milligan S; Bett P; McConnell S; Pyper C; Mills A; Rooney K
The Scottish Government’s 2020 Vision for healthcare in Scotland is to provide safe, high quality care, whatever the setting. National quality improvement programmes have been developed to deliver these ambitions, resulting in an upwelling of improvement activity across NHS Scotland.
However, the spread of improvement methodologies through the Scottish hospice sector has been considerably less dramatic. Indeed, there appears to be relatively little uptake of improvement as a specific model for achieving quality and effectiveness, in spite of its adoption elsewhere.
Ardgowan Hospice has committed itself to utilising the model of improvement in order to continuously address the safety, effectiveness and person-centredness of its services. A Continuous Improvement Team was created to facilitate improvement projects, in conjunction with the creation of two new posts within the organisation to support data management and improvement activity. Key areas identified for improvement were referral pathways into the hospice, and referral-to-bed times. This is a joint project with the University of West of Scotland. Internal improvement projects are establishing and embedding the ‘what matters to you’ model; a quality of sleep study and the introduction of outcome measures, including the Integrated Palliative Outcome Scale (iPOS) and carers assessment tool.
Goals of Care within a Structured Response Tool
Sarah Gossner; Gordon Mills; Tracy Burton
A project has been undertaken to design and test a Structured Response Tool (SRT) to support the recognition and escalation of, and response to deteriorating patients in acute care in NHS Lothian. Its development was driven by a combination of the National Point of Care Priorities (Scottish Government 2013; HIS 2013) and local findings from the Deteriorating Patient Collaborative and the Advance Nurse Practitioner (ANP) scoping project.
Throughout the local Deteriorating Patient Collaborative there has been a focus on anticipatory care planning within Goals of Care.
In addition to this the Information Reconciliation project has informed the development of the SRT to support the clinical teams to ensure a bespoke Structured Response is achieved for all deteriorating patients.
There has been multi-disciplinary acknowledgement that a SRT can support the recognition and appropriate response to deterioration. This presentation will discuss the impact of the SRT on the consideration of Goals of Care and inclusion of previous ACP for patients who may be at risk of further deterioration and dying. Moving forward we will assess whether the SRT acts as a forcing function to improved engagement with patients and families.
Geraldine Finnan
If palliative and end of life care is to be delivered in an effective manner then understanding of patient’s needs, improved education and training for health care providers and more resources are required (NHSScotland 2014). The nurse as an individual with personal attitudes, beliefs and values must also be considered. According to Peters et al (2013) following their literature review of death anxiety faced by nurses, in the course of their care delivery many nurses face death and dying patients and their attitude to death is made up of a complex combination of past and present experiences, cultural, societal and philosophical views. A study conducted by Gerow et al ( 2010 ) found that nurses experience grief for their patients in a very different manner to that experienced by family members .The need to remain strong and offer support on one hand whilst managing their own emotions following the death of a patient with whom they may have formed a connection can be very difficult and Remen (2006) states that
‘The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet’.
Implementation of a Falls Prevention and Management programme in a Hospice In-Patient unit
Jean Gow (Specialist Physiotherapist in Palliative care); Elaine McManus (Practice Educator)
Evidencing Best Practice and Documentation
Falls prevention and management is a key aspect of patient safety and an important quality indicator. This can be challenging in a specialist palliative care setting where the pace of decline and fluctuating levels of independence is a common feature. The aim of care is to deliver safe professional practice whilst promoting patient choice, independence and dignity.
Aim: To evidence best practice
Method: Based on the latest guidance from National Institute of Excellence we developed 1) a falls risk-assessment tool; 2) a care plan for falls prevention and management and 3) ten quality standards.
A practice focused approach was used to engage staff in the importance of the guidance and the use of the tools pre and post implementation. The tools were integrated into the e-Health recording system (Crosscare) and compliance with the standards were audited one year after implementation (February 2015).
Results: The audit identified good compliance against the standards and also identified areas for improvement.
Next steps: Devolve ownership of programme to IPU nursing staff; explore best practice in managing specific risk factors ie delirium/cognitive deficits using a person-centred approach; link the process to outcomes.
Implementing the adapted ‘6 steps’ approach – An end of life care project for local care homes
Jackie Higgins; Margaret Ramsay
Background and Aims: This collaborative project was funded by Falkirk, Stirling and Clackmannanshire Change Fund ‘Reshaping Care For Older People’ The overall aim was to design, develop and deliver a palliative care/end of life care education package targeted at nursing and local authority care homes in Forth Valley. This project focused on supporting organisational change and the development of staff knowledge and skills related to EOL care.
Project Outline: This innovative project involved classroom teaching and ongoing support from the project’s Palliative Care Facilitator (PCF) within the participants care home setting. This approach supported transfer of learning from the classroom to the workplace. Participants were also encouraged to complete a project related to end of life care.
Evaluation: Participants completed pre and post participation questionnaires to demonstrate impact of learning and individual self-confidence ratings related to specific end of life domains.
Results: Participants demonstrated increased confidence related to communication about end of life issues with residents, families and other health care professionals. Participants also identified areas where they could implement change.
Discussion: This project enabled staff to increase their confidence in talking about and planning for end of life care within their care homes. The PCF supported participants to put their learning into practice and undertake changes in practice within their own settings.
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