Sharing Current Scottish Practice

Author(s) of poster: Norma Langford, Deputy Charge Nurse, University Hospital Cross house; Josaleen Connolly, Macmillan Project Lead, NHS Ayrshire and Arran

I have undertaken an education programme delivering practical palliative care through a distance learning module and placement shadowing members of the various specialist palliative care teams in hospital, community and at the Ayrshire Hospice. The education was provided by the University of the West of Scotland and the overall project was funded by Macmillan Cancer Support. This programme provided me with the knowledge, skills and competence in delivering general palliative care to patients who were admitted to Ward 4C where I work. I was concerned that the process for issuing the death certificate for the deceased sometimes caused unnecessary additional distress for families. Without a death certificate it is difficult for families to finalise funeral arrangements or to begin to inform other agencies that the person’s death has occurred. I felt there were a number of simple changes that could be made. I based my approach on the premise that families’ preferences should determine the way in which they obtained the death certificate. This small change has now become standard practice and has helped to minimise distress for families by creating a simple, clear and compassionate approach for handing over a death certificate to a family member.

Integrated and coordinated discharge planning for palliative patients

Author(s) of poster: Katharine Thompson, Marnie Ferguson, Donna Doogan, Audrey McHugh

Palliative patients are a unique group whose needs change with the advancement of disease. According to National and Local Strategy, patient care should be delivered at home for as long as possible, including care at the End of Life if that is the patient’s wish.

Due to the nature of progressive disease, the window of opportunity for discharge home narrow. Therefore timely, effective discharge planning is essential to ensure that palliative patients achieve discharge home within a suitable timeframe, with the support of a coordinated, individualised care package and with the necessary equipment in place.

Our aim was to develop and deliver an efficient, effective discharge planning process to ensure patients are well supported to remain at home for as long as they wish. We focussed on the following key areas:

•Weekly multidisciplinary team discharge planning meeting

•Development of multidisciplinary discharge preparation checklist

•Dedicated Community Care Team

Funded to provide home care if prognosis is less than 42 days

Team developing skills in care of palliative patients

Individualised, flexible and timely care.

Initial patient and staff feedback regarding the impact of this initiative has been very positive – audit data to evidence this is currently awaited.

Its time to talk about death and dying

Author(s) of poster: Shirley Fife

This poster was designed initially for NHS Lothian Delivering Better Care Conference to support a Before I Die Wall. It helped to set the context as to why we felt it is important for people (public and staff) in Lothian (Scotland) to be more open about talking about death and dying. The poster highlight the reality, evidence and key messages from the Good Life Good Death Good Grief website, as this is a resource we promote within NHS Lothian.

Location, location, location: The Complexity of Preferred Place of Death [PPOD]

Author(s) of poster: End of Life Care Group, St Columba's Hospice

Enabling a person to die in the place of their choice is viewed as a ‘critical contributor’ to the quality of death for the patient/ family(1). The Lothian Managed Clinical Network requires specialist palliative care to audit recording and achievement of PPOD. The End of Life Care (EOLC) Group – a small interdisciplinary team forming part of the Hospice clinical governance structure – has worked together to:

•review the relevant literature

•undertake data collection and analysis of PPOD at regular intervals for all deaths across the hospice in-patient, day-patient and community services over a 12 month period; • support practice development.

Although the documentation and review of PPOD has improved, the achievement of PPOD remains relatively unchanged - with patient preference often unknown. The literature review, audit findings and associated practice development initiatives all highlight the complexity of PPOD choices. Achieving PPOD may be influenced by a range of factors(2). There has been significant learning for the EOLC Group members and a number of future challenges have been identified.

References:

1.Health Improvement Scotland. 2013. Health Improvement Scotland. 2013. Palliative and End of Life Care Indicators.

2.Fields, A. et al. 2013. Discussing preferred place of death with patients. International Journal of Palliative Nursing, 19 (11) pp.558-565

Macmillan rural palliative care pharmacist practitioner project – Mapping of the Current service & Quality Improvement Plan

Author(s) of poster: Prof Marion Bennie, Alison MacRobbie, Dr Gazala Akram, Emma Dunlop Corcoran, Rosemary Newham, Gillian Harrington

The NHS Highland project pilots over a 3-year period (February 2013 – February 2016) the role of one full-time Macmillan palliative care rural practitioner pharmacist to be located within a community pharmacy in the Skye, Kyle & Lochalsh project area, testing the ability of a community based pharmacist to:

•develop community pharmacy capacity to effectively, efficiently and safely support the needs of those in this rural community with palliative care needs regardless of care setting

•improve service provision/co-ordination ensuring opportunities are developed for training and peer support

• provide quality information to support practice.

Year 1 enabled a baseline evaluation of service provision, establishing the role and highlighting service gaps to develop the evidence base for clinical practice within this area with focus on developing rural pharmaceutical care capacity. A single case study methodology, involving multiple healthcare settings within the project area was applied. Three methods were used to maximise data collection and incorporated semi- structured interviews with participant observation (when appropriate), completion of activity logs, service audits and questionnaires.

Core community pharmacy staff are engaging in multi-professional activity in an area where some relationships had previously been strained, supporting co-ordination of patient care and continuity of medicines provision. Recognition of the skills of community pharmacists has increased pharmaceutical care input to patient care, ensuring appropriate product choice, continuity of care provision and for patients and carers a recognition and increasing use of accessibility of pharmaceutical advice. An action plan to provide quality improvement has been developed.

173

b