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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: January

The SPPC Annual Conference in 2016 featured 36 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:

Bereavement Support in a Hospice Setting

Elliott J, Jackson S and Taylor M

Bereavement can be a difficult process for people however evidence suggests that sharing experiences and feelings can help to lessen the effects on individuals. It is also known that people can struggle to access the right support at the right time following bereavement. Hospices are at the sharp end of caring for people who are dying and offering support to their families is a fundamental part of specialist palliative care. The patient and family support team at Accord Hospice consists of trained counsellors and volunteer bereavement support workers who proactively offer bereavement support and try to do so in innovative ways to meet the varying degrees of need of bereaved families within the local community. These services are offered both within Accord and off site at our outreach facility.

User experience feedback has been collected over the past 12 months. Collated results would appear to show there is definitive value to offering timely, appropriate and varied bereavement services from a skilled hospice based team. Many of the comments received from people would reinforce the evidence that suggests that support can lessen the effects of bereavement.

Children's Palliative Care in Scotland: the role of the Diana Children's Nurses

Harley D, Porter C, Reid F and Rodger E

Children's Hospice Association Scotland has employed three Diana Children's Nurses (DCNs) since 2014. They are financed through the treasury from funds set up by the government to commemorate the life and work of Diana Princess of Wales. The overarching aims of the roles are given in generic terms, encompassing strategic service development, direct and indirect clinical care, and staff training / support. The three individual roles, DCN West, East and North, focus on the specific remits of oncology and paediatric intensive care, neonates, and the community. They work within, and alongside, the NHS and other statutory and voluntary sectors to support babies, children, and young people (BCYP) with palliative care needs and their families across Scotland. This may be from the point of diagnosis or recognition, at any point through the journey, to end of life and bereavement. Their roles exemplify a holistic approach that recognises all the environments in which BCYP live their lives. More realistic choices for families can be better enabled through exploring changes to practice, whilst developing systems, skills and resources.

CNS model for identifying level of support/intervention needed for care homes

Barker L, Gardner H, Milton L and Stevenson B

Background: Continued support from palliative care specialists is recognised as a way to assist the sustained adoption of new systems and palliative care principles in care homes. (2, 3) Hospice community teams are well placed to support care homes to improve planning and delivery of palliative care. The community palliative nurse specialist team support 28 care homes by providing support to develop processes for identifying deterioration or dying, regular review of palliative care needs, education and specialist advice for individual residents.

Aim: This intervention builds on two previous projects aimed at increasing care home staff knowledge of palliative care practice and procedures, and how they can link together with other palliative care providers’.

Description: The challenges encountered especially with care home staff engagement influenced the importance of shaping any interventions to suit the needs of the individual care home.

An individual Care Home Profile and Algorithm (flowchart) was developed to assist the CNS to determine and agree, with the manager, a Level of CNS Intervention most appropriate and achievable for the individual care home.

Effects of Intervention: Issues such as staff turnover, engagement, and lack of GP resources are an on-going challenge when trying to change palliative care practice and procedures in care homes. Utilising the Care Home Profile and identifying a Level of Intervention has helped the CNS and manager to focus on the priorities for education and change in practice for each care home. Using this model has helped CNS to set achievable goals of intervention and therefore ensure their skills and times are being used appropriately.

Complex Communication Needs: Nursing the patient with Motor Neurone Disease

Alexander J and Kerr F

Case study of a hospice patient combined with a literature review to:

  • establish what communication difficulties can be experienced by nursing staff caring for a patient with MND
  • identify ways in which nurses can improve their knowledge of Augmentative and Alternative Communication (AAC) to better care for this patient group
  • identify assessment tools which can assisted with achieving the most appropriate AAC. 

Poster Abstracts of the Month: June

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:

 

Macmillan Rural Palliative Care Pharmacist Practitioner Project (MRPP): Phase

 

Author(s) NHS Highland/Macmillan Team: Alison MacRobbie; Gill Harrington

University of Strathclyde Team: Professor Marion Bennie; Dr Gazala Akram; Emma Dunlop; Dr Rosemary Newham

In 2012, NHS Highland aimed to explore a new service model piloting the development of a full-time Macmillan Rural Palliative Care Pharmacist Practitioner (MRPP). The aims were to develop community pharmacy to support the needs of palliative patients, improve service provision, develop training and peer support opportunities and provide quality information to support practice. Phase 1 explored service gaps and key issues and has previously been published.

Phase 2 aimed to investigate new areas of service, develop evidence-based resources for healthcare professionals and patients, and provide a set of recommendations upon which the service could be developed further. A mixed case study approach was used for evaluation and results were summarised under two key areas; ‘Education, Training and Awareness’ and ‘Integration of the MRPP in the Multi-Professional Team’. Within these areas were included development of a series of training resources, ‘Sunny Sessions’ for Care Home Staff, and mouse mats and mugs containing palliative care prescribing information for healthcare professionals. There was enhanced pharmaceutical presence at multidisciplinary meetings and access to patient medicine information.

For NHS Scotland the evidence from this project presents a clinical practice model for community pharmacy palliative care services in rural areas in line with existing key health policy.

'No decision about me without me’

Author(s): A Todd; A Pringle; S Keir

Introduction: Ensuring patients have as much input as they wish into their care is a fundamental aspect of good medical practice and as such the Department of Health advocates shared-decision making (ISBN: 13:9780101788120). Recent legal rulings highlight the willingness of the public to hold health services to account should they fail in this regard ([2014] EWCA Civ 822).

Aims: To evaluate the introduction of an anticipatory care plan (ACP) form on both the degree of shared decision-making with multi-morbid patients and their families, and the speed at which on-call teams could access this information for timely treatment decisions.

Methods: Via small tests of change, an ACP form was designed that documented four key decisions concerning response to deterioration (figure 1). Central to the form was a box recording date of discussion with the patient or next-of-kin. We measured the frequency of shared decision-making before and after the introduction of the ACP form.

Results: Shared decision-making increased. The time to find all key information significantly reduced informing appropriate response to deterioration.

Conclusion: The introduction of an ACP form encouraged shared decision making and facilitated out-of-hour assessments. The presence of the form provided a forcing function that triggered more discussions.

‘No specialist and no out of hours service!’ – Audit and experience of end of life care in a rural Australian hospital

Author(s): Natasha Freeman

Palliative care provision in Kempsey Hospital consists of a specialist nurse consultancy service, no inpatient or community beds, no afterhours or weekend support and no specialist physician cover. Local GP’s estimate 40% of palliative care patients require end of life care in hospital. We audited end of life care standards for inpatients and surveyed staff opinions on current end of life care practice.

Our patients ranged from 35 – 85 years, and 8% were Indigenous Australians. We showed that less than half of patients had a complete physical assessment of symptoms, had anticipatory medications prescribed and had spiritual needs addressed. Nearly 70% of nurses believed a new end of life care pathway was required and 85% requested more education and support in palliative care practice.

A redesigned end of life care pathway is being introduced to improve standards not currently being met. Our findings highlight the need for developing innovative educational programmes on end of life care for rural nurses, and video conferencing is being explored as a means of delivery. In response to the current lack of specialist service in Kempsey, locally designed and tailored educational programmes are being developed aimed at strengthening current hospital and community expertise.

Patient and family experiences of DNACPR discussions: an integrative review of the literature

Author(s): Dr CC Hall; Dr E Carduff; J Lugton; Dr J Spiller

The aim of this review is to identify patient and family views on the communication of DNACPR decisions based on their experiences of DNACPR discussions. A literature search of multiple databases was performed for (adult) patients, from all countries over the last 10 years. 559 abstracts were identified. After coding and exclusions were applied, 46 relevant full texts were included (9 UK, 37 rest of world). Cultural variations were considered and recurring themes were tabulated.

Themes revealed the importance of DNACPR discussions being held by someone trusted and the importance of family/ carer involvement, as well as perceived concerns about burdening family members. Timing of discussions revealed the difficulty of finding the ‘right time’ to discuss DNACPR. For certain patients earlier is preferable (e.g. in elderly patients while cognition is good) where as cancer patients prefer not to discuss DNACPR close to diagnosis or starting treatment.

Discussions held at home or at the GP surgery were preferable to discussions held during acute admissions to hospital. Content of discussion highlighted the importance of discussing prognosis and quality of life with patients. Also that patients find discussing DNACPR in the context of a wider discussion around treatment escalation options acceptable.

Person Centred Care at the End of Life: Developing a care plan for End of Life Care in a hospice setting

Author(s): Kim Donaldson; Vicky Hill; Duncan Brown

Recognising dying, and caring for people at end of life, is often challenging, uncertain and emotive for all involved1. Striving to ‘get it right’ when you only have one chance is a fundamental attribute of professionals.

Having successfully used the Liverpool Care Pathway (LCP) to guide the care offered to dying people and their families, St Columba’s Hospice (SCH) appreciated the importance of taking a considered approach in moving forward after the LCP planned phase out in 2014.

A working group critically reviewed the literature and undertook a rigorous consultation with clinical staff, non-clinical staff, volunteers, patients and families to elicit views on what mattered most at the end of life. An openness from colleagues across Lothian to share their work and review the work of SCH was invaluable.

This poster illustrates the development, implementation and initial evaluation of the SCH Person Centred Care at the End of Life document.

Poster abstracts of the month: February

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:

Improving Discussion and Documentation of CPR and Escalation Status in the ECC

Authors: Moray Kyle ; Jenny Smith ; Amy Armstrong ; Louise Ratcliffe ; Jenna Schafers

Background: Escalation planning and CPR decisions not always considered early enough in patient journey, potentially leading to suboptimal care.

Aim:To assess the standard of documentation in inpatient notes across the ECC wards relating to the discussion of resuscitation and escalation status.

Results: 46 patients’ notes reviewed. 9/46 had DNACPR form of which 6/9 had documented discussion with family. 4/46 patient's had documentation of escalation status. 7/9 forms countersigned by consultant & 3/9 had review date completed.

Summary: If decision for DNACPR has been made then in general all completed and discussed correctly. Poor documentation of any advance planning or DNACPR discussions.

Future - Introduce a Treatment Escalation Plan proforma to the ECC to prompt and aid discussions about escalation and CPR. This work is ongoing.

Key Information Summary Access and Anticipatory Care Planning in Secondary Care: A Quality Improvement Project

Authors: Dr Charlie Hall; Dr Juliet Spiller

The electronic Key Information Summary (KIS) is a vital way of conveying Anticipatory Care Information from Primary to Secondary care. For patients with Anticipatory Care plans, Special Notes and electronic Palliative Care Summaries are now available to hospital teams readily via the KIS.

Using the PDSA approach we undertook audits and interviews to assess: KIS prevalence among patients admitted to a Medical Admissions Unit (MAU) and content of the KIS. We assessed levels of clinician access to the KIS, their opinions of the usefulness and also barriers to accessing the KIS. Evidence of Goals of Care (GOC) discussions with patients at risk of deterioration or dying were also assessed.

The majority of hospital clinicians thought the KIS was useful but many did not know how to access it. Interventions were subsequently trialled including: Education and awareness, trial of an 'Anticipatory Care Planning tab' and introduction of the SPICTTM tool to MAU admissions booklets.

Re-audit showed a significant increase in access to the KIS on admission, but mixed results regarding the use of the new admission documentation and GOC discussions. Further PDSA cycles to test sustainable interventions throughout NHS Lothian are discussed and recommendations made.

Poster abstracts of the month: July

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

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

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

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

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

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

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

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

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

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

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

Author(s) of poster: Allan Thomson

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

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

Author(s) of poster: Margaret Anne Garner

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

Role of the nursing in palliative care within A&E

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

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

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

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

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

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

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

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

Key outcomes the service aims to deliver include:

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

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

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

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

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

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

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

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

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

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

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

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

Author(s) of poster: Susan Campbell, Fiona Cruikshank, Miriam Tadjali, Stephen Tinney, Kirsty Cornwall

‘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.

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