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: May
The SPPC Autumn Season 2020 featured an online poster exhibition of 64 posters, sharing work and research underway across Scotland. Each month, our blog focuses on the content of a few of these posters. This month, we focus on:
- Managing home support volunteers during a pandemic
- NHSGGC inspiring leadership, leading self and leading with others in a palliative care setting
- Opioid prescribing in palliative head and neck cancer patients
- Palliative care education: Transformational change in response to COVID-19
- Parlez-vous prognostic indicators? How health and social care occupational therapists in Fife are driving integrated system-wide change in palliative care services
- Past, present and future: Caring for those approaching the end of life in Scottish hospitals
- Perspectives of palliative care clinical nurse specialists regarding the management of delirium in terminally ill patients in the community
- Pilot of Macmillan Foundations in Palliative Care For Health Care Support Workers in Acute Hospitals across NHSGGC
Poster abstracts of the month: April
The SPPC Autumn Season 2020 featured an online poster exihibition of 64 posters, 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 well did we palliate breathlessness in those dying of COVID-19?
- Improving Anticipatory Care Planning on a general medical ward
- Improving venous thromboembolism and steroid prescribing at an inpatient hospice unit: A quality improvement project
- Indictors of quality at end of life: A regional project spanning hospice, hospital and community specialist palliative care services in Lanarkshire
- Keeping connected through creative arts
- Leading Anticipatory Care Planning that includes cardio-pulmonary resuscitation decisions and discussions with patients and families: An advanced practice role for nurses and physiotherapists
- Living and dying - Class in a bag
- Making waves to keep patients at home: Establishment of a domiciliary ultrasound service for palliative care patients
Poster abstracts of the month: October
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:
Young People’s Rollercoaster of Bereavement
Glasgow City’s Riverside Care Home
An Alternative place for Palliative Care
Improving Anticipatory Care Planning (ACP) in Palliative care
Identifying people living with COPD who would benefit from Palliative care in East Ayrshire
MAGICE model – getting palliative care right every time
Poster Abstracts of the Month: September
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 six of these:
- Pressure Ulcer Prevention in Palliative care
- Raising Death Awareness in Thailand, the Case of Life Unlocking Card Game
- ReSPECT - Find out what it means to me
- Scotland’s first pilot of the ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) process
- Sharing the Learning at the Palliative Care in Prisons Conference
- Supportive and Palliative Care in HMP Glenochil
Pressure Ulcer Prevention in Palliative care
Author(s)
Katherine Hynd, Libby Milton
‘Pressure ulcers impose a significant financial burden on health care systems and negatively affect quality of life’ (Moore and Cowman 2013).
Marie Curie (MC) recognised that pressure ulcer (PU) prevention/ management was an area where practice could be improved.
Approaches:
Leadership
• Creation of link nurse role
• Commitment by MC to support the development of link nurse
• Participation in national MC TV working group
Clinical
• Review of risk assessment and implementation of updated assessment tool
• Low threshold to reporting all PUs acquired in our care regardless of grade
• Ensuring most appropriate equipment in place
• Review and development of documentation
Educational
• Developed teaching package for RNs and HCAs
• All staff included in roll out of teaching – face to face sessions to allow space for group
discussions and individualised learning
• Developed materials to display on the wards
• Link nurse role to offer support and guidance in practice
Cultural shift
• Every PU acquired in our care investigated and RCA completed, with feedback to the team
• Raised profile of patients who are at risk in patient safety briefs
Outcomes:
• Incidence of PUs acquired in our care demonstrates sustained improvements, with 9 sequential
months data below previous average.
Raising Death Awareness in Thailand, the Case of Life Unlocking Card Game
Author(s)
Tanida Apichanakulchai; Deans Buchanan; Linda McSwiggan; Tharin Phenwan; Ekkapop Sittiwantana; Judith Sixsmith
Introduction:
Advance Care Planning (ACP) is an agreement of preferred care between patients, family, and the health care team should the patient become incapacitated. However, ACP uptake and awareness is still low in Thailand. The Life Unlocking Card Game is an intervention that aimed to use gamified element to raise ACP awareness. This study assessed the effectiveness of the Life Unlocking Card Game as a tool to raise death and ACP awareness in Thailand.
Methods:
A retrospective feasibility study using a convenient sampling method with Thais participants who are older than 18 years old. 27 card game sessions were held during January 2014 and December 2016 with 342 participants. We used data from an anonymised pre-game and post-game survey for participants' demographical data and evaluation feedback. Data was analysed using thematic analysis with investigator triangulation.
Results:
Three themes emerged; 1) Closeness of death, 2) Co-construction of the meaning of death, 3) the obligation and importance of ACP.
Discussion and conclusion:
The Life Unlocking Card Game is a useful tool to raise death and ACP awareness amongst Thais. Further study is recommended with other groups such as the patients, carers, and healthcare professionals.
ReSPECT - Find out what it means to me
Author(s)
Dr Sean Duignan; Dr Lynsey Fielden; Dr Jennifer McNeill
‘ReSPECT’ (Recommended Summary Plan for Emergency Care and Treatment) is a process which facilitates emergency and anticipatory care planning. All new admissions to an acute ageing and health receiving ward were screened between 10/5/18 and 10/6/18 for ReSPECT ‘triggers’. If trigger positive, retrospective assessment of escalation planning was conducted by reviewing whether there was a pre-existing KIS (Key Information Summary), ReSPECT form or consultant escalation plan on admission. These triggering patients were highlighted to the medical team in the patients notes as a prompt to consider a ReSPECT discussion with patients and families.
Since ReSPECT screening has started and ReSPECT documents have been completed for patients, there has been an increase in the number of documented emergency/ anticipatory care plans in the form of: KIS; admission escalation plans and ReSPECT forms. This reached a total of 100% of patients screening ‘positive for ReSPECT’ in the final week.
Scotland’s first pilot of the ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) process
Author(s)
S Campbell; LA Fielden; D Lynch; K Petrie
Background:
Across Scotland, there is no universal process for recording emergency treatment discussions besides DNACPR decisions which have been associated with negative connotations. The ReSPECT process creates personalised recommendations for a person’s clinical care in a future emergency when they are unable to make/express choices. Resuscitation decisions are considered as part of an overall treatment plan. The aim of the pilot was to evaluate ReSPECT by obtaining feedback from patient, carers and staff.
Methodology:
A small pilot of ReSPECT was introduced in 4 key areas (acute care of the elderly ward, adult mental health, day hospice, 2 GP practices) from November 2017 to May 2018. We obtained feedback from patients/carers who had been through the process; public carers forum; staff who had utilised the ReSPECT process.
Results:
180 people experienced the ReSPECT process. Patient/ carer feedback was overwhelmingly positive with the vast majority describing the process as ‘excellent’ and the remaining ’good’. All felt that ‘what matters to you’ was considered and they were involved in the decision-making process. Similarly, the carers forum described the process as excellent or good. 94% of staff felt that ReSPECT involves the patient and/or family in decision making. 88% felt ReSPECT would help the individual/ team deliver the most appropriate care for patients. This feedback will be utilised to shape the roll out of ReSPECT across NHS Forth Valley to facilitate truly person-centred care in emergency/ anticipatory care planning.
Sharing the Learning at the Palliative Care in Prisons Conference
Author(s)
Gail Allan
Background:
The Scottish prison population is disproportionately drawn from the most deprived areas in Scotland and have an increasing ageing population. The nature of offending and longer prison sentences means there is an increasing number of prisoners who will be facing end of life in prison. In September 2018 the first Palliative Care in Scotland's Prisons Conference took place.
Aims:
The aims of the conference were to raise awareness about the need for a Supportive and Palliative Care approach in Prisons and share the current work that was taking place in Scotland's prisons.
Approach:
Invited speakers addressed the issues of why prisons should develop a supportive and palliative care approach. Both NHS and Prison Service staff shared the work they were undertaking in their prisons to address these issues.
Workshops allowed the audience to engage with the staff that works in prisons. They were asked to share what they have done to support palliative care in prisons and who they should connect with to support this work.
Results:
Ÿ Increased stakeholder engagement with project
Ÿ Development of Macmillan Palliative care in Prisons Community of Practice
Supportive and Palliative Care in HMP Glenochil
Author(s)
Gail Allan; Fiona Donnelly; Fiona McAinsh
Background:
The fastest growing population in Scotland’s prisons is males over 50. The prison health demographics sees the health age of most prisoners as being at least a decade older than the general public, with a shorter life expectancy. A recent report, Who cares? The Lived Experience of Older Prisoners in Scotland’s Prisons by HM Inspectorate of Prisons Scotland highlighted the case of ageing prisoners. It also discussed the challenges for the staff working in prisons in caring for this group.
Aims:
HMP Glenochil are taking a proactive approach in supporting the staff and people in their prison.
Methods:
Ÿ Education
Ÿ Use of Early identification tools
Ÿ Improving multidisciplinary working
Ÿ Improving communication systems.
Results:
Ÿ Delivered Education sessions including Macmillan Foundations in Palliative Care Programme
Ÿ Development of Palliative Care Champions
Ÿ Development of Supportive and Palliative Care Meeting and Register
Ÿ Development of Gold Standard Folder for Prison use.
Poster Abstracts of the Month: June
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 six of these:
- Inspiring Leadership leading self; leading with others in a palliative care setting
- Investigating the need for palliative care among people who are homeless in Scotland
- Lessons learned from integration of IPOS into the Community: Building relationships and sharing learning and understanding between Specialist and Generalist Palliative Care Services
- Kilbryde Hospice to Kirriemuir Nursery: See how our garden grows!
- Lifetime in Pebbles
- Making a Difference – The Provision of Palliative and End of Life Care within a Community Hospital
Inspiring Leadership leading self; leading with others in a palliative care setting
Author(s)
Claire O’Neill, Jane Miller, Susan Jackson, Fiona Wylie.
Aims:
Pilot and evaluate a leadership programme for band 6 Palliative Care Clinical Nurse Specialist’s working within NHSGGC acute and hospices. The programme focussed on the leadership behaviours set out in the NHS Scotland Leadership Qualities Framework.
Methodology:
The programme aims included to build participants personal effectiveness, resilience and create a network of support, develop leadership behaviours consistent with an enabling culture and deliver a quality improvement project demonstrating impact on patient and families’ care experience. Participants attended master classes on:
• Myers Briggs and Working with Differences
• Quality Improvement Methodology
• Influencing skills
• Strategic landscape for Palliative Care.
They undertook 360 review with feedback sessions linking with PDPs, Action Learning Sets, shadowing opportunities and completed a work-based QI project.
The programme was evaluated using a combination of quantitative and qualitative data collection methods.
Results:
The evaluation data indicates that this was a very effective programme. The line manager / key person qualitative data supported the views of the participants by giving tangible examples of the impact of the programme at individual, patient, team and organisational levels.
Recommendations:
The outstandingly positive evaluation of the programme supports the view there is a need for this programme to continue.
Investigating the need for palliative care among people who are homeless in Scotland
Author(s)
Joy Rafferty
A scoping exercise assessed
the need for palliative care among people who are homeless in Scotland. Published homelessness data estimated the
number of homeless people in Scotland.
Literature review examined morbidity and mortality, challenges of
providing palliative care to homeless people and their views on palliative care.
There were 34,100
homelessness applications in Scotland in 2016/17 though the true number of
homeless people is likely double this.
The literature shows complex palliative care needs with homeless
people having significantly worse symptoms at end of life than other
populations. Challenges to providing
palliative care described in the literature include uncertain
prognostication, complex trauma, chaotic lifestyles, service design and
delivery and few available options. In
published research homeless people expressed fears of dying anonymously,
alone, on the streets and not being found and of being forgotten after
death. Self-determination was vital,
with concerns admission would cause a loss of freedom and control. Psychosocial care, staff availability,
continuity and developing trusting relationships were essential. The importance of staff reaching out was
expressed.
We need to consider how
palliative care services can be more accessible and responsive to the needs
of people who are homeless in Scotland.
Kilbryde Hospice to Kirriemuir Nursery: See how our garden grows!
Author(s)
Karen Kilpatrick; Melissa Woodhouse
Background:
Kilbryde Hospice Day
Services, providing a rehabilitative model of care, was keen to introduce
therapeutic horticulture to promote independence and promote wellbeing.
Equally, a local nursery wished to establish a link to the hospice. A joint
project to promote an intergenerational partnership was established in April
2018 to establish and maintain the external gardens in the new hospice
grounds. Epstein & Boisvert (2006) reported the benefits of an
intergenerational space that is shared whilst Kaplan, (1995) acknowledges the
use of natural environments to be beneficial in promoting wellbeing. This
project endorses Scottish Government Health& Social Care Standards (2017)
to encourage hospice staff to provide activities that patients can
participate in either indoors or outdoors.
Aim:
To provide social and
therapeutic horticulture to Kilbryde Hospice Day Services patients improving
their wellbeing through active or passive gardening. Involving the nursery
children allows a working relationship to develop, expanding their knowledge
of plant life and develop their social skills within the hospice
environment.
Method:
Nursery:
• Weekly visits by nursery children to hospice for 30
minutes
• No more than 8 children in a group at the one time
• Children accompanied by 2 or 3 staff members
• Kirriemuir staff fully responsible for the children on
their visit
• Hi-visibility vests provided by nursery to be worn by
children
• Children and patients to
maintain 3 main garden areas; patio, front garden and rear garden.
Hospice:
• Therapeutic horticulture planned within Hospice Day
Services 13-week programme
• Provision of one clinical support worker and 2 volunteers
per session
• Patient choice to attend the session
• All levels of mobility catered for
• Fundraising Team at
Kilbryde arranged for donation of plants and soil.
Results:
6 patients with regular horticulture participation
• IPOS scores decreased in feelings of anxiety and worry in
3 patients
• IPOS scores improved in
feeling depressed in 3 patients
Children:
“I
like going to help everyone at the hospice” HL
“I loved all the plants because some were coloured” JD
Kilbryde
Patients:
“Kids
make us laugh with what they say and do” AMH
“Both patients and children enjoy mixing. Long may it
continue!” TH
Nursery
Staff:
“Promotes
the bond between adults and children working together” MW
“Children have developed a sense of responsibility” JA
Kilbryde
Volunteers:
“Loved
listening to kids asking patients about plants” ME
“Watching the children interested in the flowers and
sharing tasks, they brightened up the patient’s day.” MI
Conclusion:
• Improved outcomes on measuring feelings of anxiety,
worry, depression
• Apparent improvement in social isolation
• Introduction of therapeutic horticulture has now been
embedded into Day Services 13-week
programme.
• A planned seasonal project has extended to throughout the
year with periodic adjustments
• Exclusively positive feedback from all 4 sources
• Nursery visits have
increased to twice a week as a result.
References:
Epstein,A.S.
& Boisvert,C. (2006) Let's Do Something Together Journal of
Intergenerational Relationships. 4 3 87-109
Kaplan
S. (1995) The restorative benefits of nature: Toward an integrative
framework. Journal of Environmental Psychology. 15(3):169-182.
Scottish Government (2017) Health & Social care
Standards. My support, my life. Crown Copyright
Lessons learned from integration of IPOS into the Community: Building relationships and sharing learning and understanding between Specialist and Generalist Palliative Care Services
Author(s)
Neill Cree; Dr G Dunnet; Dr S McConnell; Dr J McKane; Janice Renfrew; Dr C Sime; Dr John Thompson; Dr Margaret Thompson
The aim of the project was
to embed the use of the Integrated Palliative Outcome Scale (IPOS) within the
Inverclyde Community Primary Care teams. IPOS is a validated and reliable
tool used to identify unmet needs for people living with a life limiting illness.
IPOS use within primary care is an innovative strategy. IPOS use in
Specialist Palliative Care Services is well established.
We identified key barriers
and challenges to collaborative inter-disciplinary working within Generalist
and Specialist services. We acknowledged the different priorities in managing
patients with life limiting illnesses and focused on innovative solutions to
translate and integrate the use of IPOS into the Community.
We had to establish project
momentum by supporting community staff. We developed case-based reflections,
education and mentorship programmes to enable practices to embed IPOS
development whilst supporting teams to develop clinical governance solutions
to allow maximal impact of IPOS. We trained IPOS champions in the community
to allow learning to be shared.
We identified key barriers
and developed multifaceted solutions for the interaction and communication
between Generalist and Specialist Palliative Care Services during integration
of a new tool in an environment where Generalists have competing demands,
specific to their specialty.
Lifetime in Pebbles
Author(s)
Shona Crain; Mairi-Ann Higgins; Ishbel Murdoch
The poster displays a creative project that tells the story of the growth of the Accord Hospice in Paisley where a large pebble mosaic has been hand painted by patients, families, volunteers, staff and local school children. The creation of the mosaic has involved the therapeutic benefits of art and is a reflection of the community the hospice is embedded in. It is installed in the gardens of the Accord Hospice.
Making a Difference – The Provision of Palliative and End of Life Care within a Community Hospital
Author(s)
Lynne Hoffin; Linda Kerr; James Mack; Dr Jillian Nicoll; Dr Kathleen Sherry; Morag Thomson; Karen Wilson
Patients in their last year of life use 30% of all acute hospital bed days. Evidence shows that over 50% of Scotland’s annual deaths take place in hospital. About 50% of NHS complaints relate to end of life care.
Community hospitals such as the Biggart Hospital play an important role in the provision of healthcare. They are at the forefront of shifting the balance of care from acute services into the community and they are ideally placed to develop a range of services focussing on the provision of palliative and end of life care.
MacMillan ward is a 23 bedded which specialises in palliative, end of life and Hospital Based Complex Continuing Care for patients with the need for frequent, sometimes not easily predictable, clinical interventions.
During a planned Leadership Walk round it was identified that there appeared to be issues with patients’ treatment being deemed unnecessarily escalated who were approaching the end of their life. Other factors identified during the transfer process were the lack of treatment plans, recognition or assessment of the palliative identity or needs of these individuals. These complexities and lack of recognition of palliative care needs were having an impact on establishing and implementing an individual’s wishes in regard to their plan of care.
This project focused on enhancing the experience for patients and their families with generalist palliative care, death, dying and bereavement needs, through the provision of specialist palliative care support/education for nursing and medical staff within MacMillan Ward.