Sharing Current Scottish Practice

Author(s): Mackay C; Wright J; Wylie F (NHS Greater Glasgow and Clyde)

Research has shown that the majority of individuals wish to die in their own home (Ryder, 2013), however within NHS Greater Glasgow and Clyde 52% of deaths are within the acute care setting (ISD, 2011). Despite discharging many patients home to die there are still patients that do not die in their preferred place of care. Anecdotal evidence suggests this may be due to deficits in knowledge, confidence and facilitation skills in staff coordinating the discharge.

To address this NHS Greater Glasgow and Clyde set up a multi-disciplinary short life working group whose aim was to develop a pathway that would form the basis of teaching for selected pilot areas.

The aim of the pilot was to promote:

• seamless discharge from hospital to home within normal working hours

• prevent re-admission where possible

• facilitate a peaceful death in the patients preferred place of care

The group also developed questionnaire's to enable feedback on the discharge from hospital, community and carers. Twelve pilot areas have been identified and have received teaching on the components of the pathway. Feedback has highlighted areas of good practice as well as areas for improvement specifically around DNACPR, medications and significant conversations.

Further feedback is essential to influence the information included in the pathway and to promote patient centred care.

Life story work within a hospice

Author(s): Jackson S; Murdoch I (ACCORD Hospice, Paisley)

Life story work, in a variety of health and social care settings has been used successfully as an intervention for people living with illness and disability and is invaluable in the pursuit of person centred care (DoH 2009). Life story work has become an emerging area of psychosocial intervention within Accord Hospice focussing on life story groups, individual life stories and community visits. Life story groups within the Day Therapy Unit consist of weekly discussions on the stories that make up the lives people have lived within the rich local heritage of family, industry,

community and culture. Reminiscence, sharing, creating stories, and uncovering skills and talents help patients and families face their present journey through illness.

Individual work consists of gathering patient’s stories within the day or bedded unit as a positive process for the person and a legacy for family when they die. The therapeutic acts of listening, remembering and recounting helps to affirm positive aspects of individual lives, no matter how ordinary the person perceives

them to be. Reflecting on a life lived can help in the process of both living and dying.

To date collections of stories from some of the group and individual work at Accord has been gathered into a booklet called ‘According to us’.

Loss, Grief and Bereavement ‘Toolkit’

Author(s): Lindsay J; Miller J; Kelly J; Guthrie M; Doyle J (St Margaret of Scotland Hospice,Clydebank)

Whole School Approach 'Toolkit’

Many children and young people will experience grief throughout their lifetime. These experiences will relate to the loss of a parent, sibling, family member or pet. Children will also experience grief when parents separate or are imprisoned, friendships are disrupted or when the nurturing process is interrupted. Grief is synonymous with life. ‘Grief’ is an emotional reaction to loss and when loss is specific to death, the reaction will be representative of the significance of the loss experienced,

and whilst it’s a natural process the effects can be overwhelming.

During bereavement, children and young people may experience a number of emotions, including 12 Poster and display list 2013 sadness, anger, anxiety, guilt, fear, denial, disbelief and confusion. With the right guidance and support, most children and young people will not require professional help and will become resilient individuals. According to the Child Bereavement Charity, what’s needed is continuity, honest answers to difficult questions and the familiarity of trusted adults. Schools are well placed to provide such support.

A working group has been established with representation from GCC Education Services, Educational Psychology, NHS GG&C Health Improvement Seniors – Schools Based, Education and Psychosocial staff from St Margaret of Scotland Hospice Clydebank, Marie Curie Hospice Glasgow and the Prince and Princess of Wales Hospice.

The purpose of the group is to:

• promote a planned, responsive and progressive approach to classroom teachers across Glasgow

• provide evidence based training specific to supporting children and young people as underpinned by GIRFEC (Getting It Right for Every Child), Curriculum for Excellence and Good Life Good Death Good Grief

• develop an online resource to be reviewed and updated as evidence base changes or new information becomes available.

Three study events have been facilitated with 30 delegates from a range of early years, primary, secondary and special needs schools. The events have achieved excellent evaluation. The on-line resource is complete and launch dates are planned from October 2013.

Macmillan Cancer Support at Argyll and Bute Libraries

Author(s): Daniel P; McCann P; Millar K; Tyrell P (NHS Highland)

Feedback from scoping studies on the information and support services of people affected by cancer was the recognition of the need to improve access to information and support especially to more rural communities (2008, 2007).

This service development represents a partnership approach between Macmillan Cancer Support, NHS Highland (Argyll and Bute CHP) and Argyll and Bute Council.

The Macmillan Cancer Support at Argyll and Bute libraries aims to improve the quality of life of individuals affected by cancer, by developing a collaborative approach to establish library based cancer information services within Argyll and Bute via a drop in facility in the libraries. Individuals, carers and families regardless of where they are on their cancer journey will have access to person specific information, practical, emotional and financial support. The service will build on and augment existing services. Through assessment of need individuals are signposted to all other services available, using a systematic and patient centred approach. The service will enable and empower individuals to make informed decisions about their care and treatment and will also promote self management.

The service will be staffed by a service manager and volunteer coordinator who will train volunteers and the librarians to ensure the sustainability of the service.

North Glasgow palliative care fast-track discharge service

Authors: Bunch H; Hekerem D; Layden J; McGlynn G (Marie Curie Cancer Care)

The fast-track discharge project is an innovative model of care for palliative and end of life care patients. A partnership between NHS Greater Glasgow and Clyde and Marie Curie, with the assistance of others, the service supports hospital and hospice discharge for people over 65 years, to receive care, and ultimately die, within the home environment, where this is their choice. The service is managed by two senior nurses and a team of senior health & social care assistants to deliver a coordinated care package that meets the needs of the individual patient. In the most recent financial year (2012-13) 121 patients were supported to die at home and almost 1000 hours of care were provided by the health care assistants.

The service has further contributed by preventing the unnecessary admission to hospital or hospice of 29 patients. This successful project is now being expanded to cover both NE and NW Glasgow.

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