Sharing Current Scottish Practice

Poster abstracts of the month - February

The SPPC Annual Conference in 2013 featured 36 poster displays, sharing work and research underway across Scotland. Each month, this blog will focus on the content of four of these posters.

This month, we focus on:

Poster abstracts of the month - January

The SPPC Annual Conference in 2013 featured 36 poster displays, sharing work and research underway across Scotland. Each month, this blog will focus on the content of four of these posters. This month, we focus on:

• A limited systematic review of the efficacy of the management of paraneoplastic sweating in palliative care populations
• Audit of oxygen therapy in a specialist palliative medicine unit
• Audit of the efficacy of Snoezelen Therapy in a specialist palliative care unit
• Better palliative care for heart failure patients, the Caring Together Programme

A limited systematic review of the efficacy of the management of paraneoplastic sweating in palliative care populations

Author(s):Mullin J (Cicely Saunders Institute; NHS Lothian)

Background: Paraneoplastic sweating is a distressing symptom to both patients and carers, interrupting sleep and causing daytime hyper-somnolence, fatigue and mood disturbance. Various therapeutic approaches have been trialled but there are no published clinical guidelines in place.

Aims: To present and critically appraise the published literature regarding pharmacological and non-pharmacological treatments for paraneoplastic sweating.

Method: A literature search was performed on Health Management Information Consortium, International Pharmaceutical Abstracts, OvidMEDLINE®, Embase, EmbaseClassic and OvidNursing. Further papers were identified from the reference lists.

Results: Reports of reduced sweating were identified for 5 pharmacological and 2 non-pharmacological treatments:

1. Cannabinoids: 1 case series

2. Thioridazine: 2 un-controlled trials

3. Somatostatin anologues: One case report

4. Thalidomide: 3 case reports & a crossover study of 6 patients

5. Etanercept: Incidental finding in open-label pilot study

6. Gabapentin: One case series

7. YuPing FenSan: One prospective trial.

Conclusions: The evidence for each treatment largely relies upon case reports and under-powered, uncontrolled, unblinded trials. As such, the evidence is currently of insufficient quality to create guidelines for clinical practice. Moreover, the success of some individual drugs has been handicapped by the palatability of treatment, side-effects and financial constraints.

Audit of oxygen therapy in a specialist palliative medicine unit

Author(s):Simmons C; Welsh J (St Margaret of Scotland Hospice, Clydebank)

Introduction: We audited the use of normobaric hyperoxia against guidelines issues by the British Thoracic Society (BTS). These state that oxygen should be prescribed to achieve target oxygen saturation of 94-98% for most acutely ill patients or 88-92% for those at risk of hypercapnic respiratory failure. Moreover, the target saturation should be documented on the drug prescription chart.

Methods: Retrospective analysis of the drug charts for all in-patients throughout January 2013 (cycle1) and April 2013 (cycle 2) was performed by 2 clinicians in St Margaret of Scotland Hospice.

Results: Cycle 1: Four of twenty one patients (19%) required supplemental oxygen. All patients had oxygen prescribed (100%) but only 1 (25%) had oxygen prescribed with the correct target saturation documented.

Results were presented orally to medical staff and via posters, and formal presentation of standards issued. Anticipatory care prescription sheets were modified to include oxygen for all in-patients for administration at time of need.

Cycle 2: Three of twenty patients (14%) required supplemental oxygen and all of these (100%) had oxygen prescribed regularly and all (100%) with correct target saturation documented which represented an improvement.

Conclusion: After intervention there was improvement to 100% adherence to the standard required for oxygen prescription.

Audit of the efficacy of Snoezelen Therapy in a specialist palliative care unit

Author(s):McMillan J (St Margaret of Scotland Hospice, Clydebank)

Introduction: Snoezelen is a therapy developed in the seventies in an establishment caring for disabled people. It is a multisensory environment. The evidence suggests it is beneficial for use within a Specialist Palliative Care unit for promotion of relaxation and some anxiety and pain management within a supportive setting.

Aim: To explore the effectiveness of Snoezelen Therapy for patients with specialist palliative care needs.

Methodology: Retrospective analysis of participants. Evaluation was performed on 11 random participants after 1 or more session(s) in the Snoezelen with a set questionnaire focussing on the benefits and experience participants felt through the use of the Snoezelen room.

This Specialist Palliative Care unit has a dedicated Snoezelen room with state of the art equipment. Results were disseminated and presented to a Multi-professional Meeting.

Result:

Ÿ number of participants who enjoyed the session – 9

Ÿ number of participants who would like to experience further sessions – 11

Ÿ number of participants who experienced relaxation – 9.

Snoezelen Therapy for patients who have Specialist Palliative Care needs can be beneficial to patient care and quality of life through providing relaxation, enjoyment and a peaceful environment.

Better palliative care for heart failure patients, the Caring Together Programme

Author(s):Armstrong I; Millerick Y (British Heart Foundation; Marie Curie Cancer Care; NHS Greater Glasgow and Clyde)

Heart failure is a life-limiting condition affecting up to 100,000 people in Scotland. Compared with many cancer patients, heart failure patients have a worse prognosis , poorer quality of life, and limited access to social services and palliative care.

In the first two years of the programme (June 2011 and June 2013), over 230 heart failure patients with palliative care needs have been referred to the Caring Together. These patients have benefited from a holistic assessment, anticipatory care planning, identification of a care manager and appropriate onward referral to other services such as day therapies and benefits assessment.

Caring Together designed and developed six core components with the support of key stakeholders including patients and carers. These core components were implemented as part of integrated models in three pilot sites across NHS Greater Glasgow and Clyde to meet local patient needs and within existing healthcare resources and structures. These models of care and core components were refined over two action research cycles to ensure that the models meet patient, care and clinician needs.

A key outcome is that Caring Together patients are less likely to die in hospital and more likely to be cared for and die in their preferred place of care, home.

Macmillan Pharmacy Service

In 2009, Macmillan Cancer Support funded a project within NHS Greater Glasgow & Clyde (GG&C), which piloted the establishment of four Macmillan Pharmacist Facilitators, the first of their kind in Britain.

With the aim of improving pharmaceutical palliative care services from the community, the facilitators spearheaded a quality improvement programme which engaged community pharmacies and the wider multi-disciplinary primary care team (MDT).

Four GG&C Community Health & Care Partnerships (CH(C)Ps) participated in the project and key outcomes included:

• Compilation and delivery of a palliative care resource folder to all community pharmacies across GG&C
• Delivery of palliative care training sessions for pharmacy support staff
• Improved networking amongst community pharmacies
• Improved communication between community pharmacy and the wider multi-disciplinary team
• Design and distribution of patient information leaflets
• Design and distribution of prescribing tools for GPs

The University of Strathclyde evaluated the project and conceptualized an evidence-based service delivery and capacity planning model. The model is aligned with Scotland’s palliative care national action plan Living and Dying Well and has, in part, been embedded within GG&C’s community pharmacy palliative care network service level agreement.

Following its success, Macmillan and GG&C have agreed to jointly fund the transition of the Macmillan Pharmacy Service from project phase to board-wide roll out. An exciting new development sees the establishment of five pharmacy technician facilitator posts. It is anticipated that the skill mix of pharmacists and technicians will maximize the capacity of the service to improve pharmaceutical palliative care to those with life-limiting conditions

Key Service Objectives:

• Increase awareness of palliative care service provided by network pharmacies and facilitate timely access out of hours to palliative care medication
• Improve provision/co-ordination of palliative care services through improved support of both network and non-network pharmacies
• Deliver support staff palliative care training to all community pharmacies within GG&C
• Extend training programme to GP practice managers and receptionists
• Promote cost-effective/appropriate prescribing and dispensing of palliative medicines
• Incorporate palliative care needs assessments and anticipatory care planning into the chronic medication service
• Develop information resources to enable patients and carers to access their medication, and palliative care advice, from their community pharmacy
• Strengthen communication strategies within pharmacy and across sectors; investigate the feasibility of sharing information on GP palliative care register

Facilitators are locally based within CH(C)Ps therefore are in a unique position within the primary care team to inform and support the delivery of palliative care services. This “on the ground” approach is designed to facilitate the sharing of good practice between community pharmacies and the wider MDT and aid the identification and resolution of problems.

For more information about the service or to talk to a local facilitator please contact:

Service Lead: Kate McCusker

Administrator: Charanpreet Sran

Telephone: 01505 706542 (Mon-Friday, 8am-4pm)

Widening Access at the Prince & Princess of Wales Hospice

The Culturally Sensitive Project was established at the Prince & Princess of Wales Hospice to address the discrepancy between the numbers of people from ethnic minorities requesting help from the hospice compared to numbers of people in the hospice's catchment area from an ethnic minority.

The Culturally Sensitive Project aimed to change this by engaging more with ethnic minority communities to raise awareness of the services the Hospice can offer. The project has three main strands of work: raising awareness, education initiatives and improvements to existing services.

Raising awareness has included:

• monthly drop-in clinics at a range of religious venues and key GP surgeries
• a health fayre at Glasgow Central Mosque, attended by over 200 people
• presentations to community groups and in local Mosques and Gudwaras

These activities have helped to break down barriers to accessing hospice care and to inform people about the services and help the Hospice can offer. Training has also been provided for hospice staff and volunteers, local hospitals and other external organisations.

Changes were also made to services within the Hospice, for example the Hospice now has facilities for Ablution and prayer, culturally sensitive advice is available for staff, and all patient leaflets are available in Urdu, Punjabi and Hindi.

The Culturally Sensitive Project takes into account the needs of specific communities whilst raising awareness of the Hospice’s services. Most information and events have focused on the South Asian community to date but more recently work has begun to find ways to get information and assistance out to asylum seeker and refugee communities.

The project team has helped to significantly increase the number of referrals where a patient’s recorded ethnicity came under the wider South Asian category. This has enabled the Hospice to help and support individual families many of whom first learned about the services available at one of the drop-in clinics in the community. Without the clinics these families would not have received any support.

Finally, due to the Culturally Sensitive Project’s work the Hospice has seen an increase in the number of volunteers from different ethnic groups and this is helping to foster even stronger relationships with all the communities of South Glasgow.

Barbara Love and Majabeen Ali are key to the success of the project, with organisations now spontaneously requesting for Barbara and Majabeen to attend their events.

Barbara Love, Culturally Sensitive Project Lead and Clinical Nurse Specialist at The Prince & Princess of Wales Hospice has led the project from its inception. Her determination to make sure that everyone in Glasgow will have the same opportunity to get help from the Hospice means that she has become a very well-respected figure among local Asian communities.

Majabeen’s Ali, Cultural Liaison officer, has advised and guided the project on South Asian cultural issues and norms. A fluid Urdu and Punjabi speaker, Majabeen has been integral to the hospice's liaison with Glasgow’s South Asian Communities, and to the success of the Hospice’s awareness raising presentations and events. A well known figure in the South Asian community, Majabeen has helped to break down cultural barriers.

For more information about the Prince & Princess of Wales Hospice's Culturally Sensitive Project please contact Barbara Love or Majabeen Ali.