Sharing Current Scottish Practice

Anticipatory Care Plans and preferred place of end of life care/death

Anticipatory prescribing at the end-of-life in Edinburgh care homes

Art in Reflective Practice: 16 weeks, Reflections of a trainee in Palliative Medicine

Clinical Psychologists in specialist palliative care: what do we actually do?

Day Therapies: Promoting Health and Well-being in Palliative Care

Introduction: As part of the Children’s Hospice Association Scotland (CHAS) quality programme, an audit was undertaken to assess how frequently the preferred place of care/death for children and young people (CYP) was achieved.

Aim: To establish which of the 54 CYP who died between 1 April 2013 and 31 March 2014 had an Advanced Care Plan (ACP) or Children and Young People’s Acute Deterioration Management Plan (CYPADM). To establish whether end of life care/death occurred in the stated preferred place when one or both were in place.

Findings:

· Five had both an ACP and a CYPADM

· Three had an ACP only

· 22 had a CYPADM only

· 24 had neither an ACP or CYPADM.

· 18 place of care was achieved

· 12 place of care not achieved

· 24 place of care note recorded.

All the CYP who had an ACP in place died in their stated preferred place.

Conclusion: The results show a strong association between having one or both forms completed, and CYP dying in their preferred place and will inform further analysis of why these forms are not in place. This will enable CHAS to make improvements to fulfil preferences at end of life for more families.

Background: Common symptoms at the end-of-life include pain, breathlessness, anxiety, respiratory secretions, and nausea. National end-of-life care strategies advocate anticipatory prescribing to manage these symptoms, enhance patient care and reduce unnecessary hospital admissions. Anticipatory prescriptions for four classes of ‘as required’ medicines are recommended for patients in the last days of life - analgesics, anxiolytics, and anti-secretory and anti-emetic medication.

Aims: This study explored the extent to which residents in eight South Edinburgh care homes had anticipatory medications prescribed prior to death. Results Data on 77 residents was collected, 71 of whom died in the care homes (6 died in hospital). Of the 71 who died in the care homes, 59% had some anticipatory planning medications in place: Morphine for analgesia (52%); Midazolam for anxiety and distress (38%); Hyoscine Butylbromide for respiratory secretions (21%); and Levomepromazine or Haloperidol for nausea (23%). Overall, 41% no anticipatory medications prescribed in the last days of life. Only 15% had prescriptions for all four medications.

Conclusions: Many care home residents do not have the recommended anticipatory medications in place in the last days of life and thus may experience inadequate symptom control. Interventions that build the skills and confidence of care home staff to diagnose dying and facilitate such prescribing are recommended

Professionals training in palliative medicine are regularly exposed to situations, emotions and concepts that are difficult to express in writing in reflective practice. There has been a move towards alternative methods for reflection that allow these less tangible aspects to be expressed. '16 weeks: Reflections of a trainee in palliative medicine' is a project that explored the use of art, specifically textile art, in the reflective practice of a Core Medical Trainee in a 16-week placement in a hospice. Each week one aspect of the work that struck the trainee was imagined in a piece of textile art, and the resulting pieces were formed into a patchwork quilt. The resulting artwork is explained in a series of notes for those viewing the quilt. In this poster the trainee gives a short description of how useful they have found the project as a form for reflection.

Promoting mental and emotional wellbeing is at the heart of the palliative care ethos. It is widely acknowledged that psychological distress contributes to the difficulty of managing physical symptoms such as pain, breathlessness, nausea etc and yet dealing with significant psychological distress is an area of practice that many specialist palliative care clinicians feel ill-equipped to address adequately. There is increasing recognition in policy and in professional organisations that clinical psychologists - whose training emphasises individual formulation of difficulties drawing on a range of theoretical models, and adapting evidence-based interventions to meet specific patients’ needs – have much to contribute in this setting. There is also an increasing research evidence base for psychological interventions. However, surveys of psychologists working in related areas suggest that a lack of clarity about the role and activities of clinical psychologists may present a barrier to optimum working relationships and to patient referrals. Despite this, little has been published describing the actual work of clinical psychologists in specialist palliative care in concrete and accessible terms. This poster attempts to address this gap by presenting a selection of case examples illustrating the diversity of patient difficulties encountered by a clinical psychologist working in and Edinburgh hospice, and describing the interventions in response.

Author(s) of poster: Jon Jordan, Eilidh Maitland 

1. Day Therapy - Patients attend once a week for a 6 hour day. The programme includes gentle exercises, discussion groups, creative activities, and the opportunity to have 1:1 input from OT's, Physio, Complementary Therapists, Chaplain and Nurse. By running this as a group session people are also benefitting from social interaction and peer support.

2. Specific group sessions (health and well-being, life story work, creative, IT skills) held weekly in the Netley Day Centre in Inverness. These run weekly, approx 2 hours each. For these, patients opt in to a 12 week programme.

3. Outreach sessions which run fortnightly in Skye, Fort William and Thurso. These sessions run for 3 hours per session and their programme is similar to that of the health and well-being group. The sessions focus on a specific topic eg anxiety management. The staff facilitate discussion and promote peer support.

 

164

b