Sharing Current Scottish Practice

Author(s)

S Botros; Dr D Buchanan; Sir A Cuschieri; Dr R Flint; J Forbes; Professor J George; Dr S Jamieson

Introduction and Aims:

The study evaluated The Safer Prescription of Opioids Tool (SPOT), an app-based equianalgesic opioid conversion tool as a clinician decision support (CDS) platform in opioid dose conversion using clinical data across primary, secondary and tertiary care in a palliative care setting at a Scottish Health Board.

Methods:

This prospective clinical utility single-centre pilot study followed a mixed methods design. Prescribers were asked to complete an initial survey to explore their current opioid prescribing practice in palliative and end-of-life care. Thereafter, prescribers were asked to use SPOT for opioid dosage conversions in parallel to usual clinical practice. Lastly, prescribers were asked to evaluate SPOT through a survey and follow up focus group.

Results:

62% of conversions were for cancer pain and 72% for 24 hour-daily dose conversions. SPOT correctly matched the Gold Standard result in 258 of 268 (96.3%) calculations performed during the study period. Users had a statistically significant increase in confidence in prescribing opioids after using the tool.

Conclusions:

The data from the study highlights the role of CDS when users prescribe high risk medicines. Almost all of those participating in the study would double-check their equianalgesic opioid conversion calculations if there was a simple, quick and safe option to do so, reflecting a pressing clinical need in a high-risk prescribing environment.

Foundations in Palliative Care: A Programme of Facilitated Learning for Care Home Staff and Home Carers

Author(s)

Ali Humphries; Suzanne Nimmo; Shannon Rendall; Karen Stewart

High quality palliative and end of life care delivery across Scotland should be the gold standard, but to achieve this there must be robust education and training in place to support all health and social care staff to achieve this goal.

The Strategic Framework for Action on Palliative and End of Life Care (2015) highlights that everyone should have access to palliative and end of life care but acknowledges that there are challenges for staff to be released for training. Similarly, Macmillan Cancer Support in Scotland have also outlined in their priorities that people with palliative and end of life care requirements should have their experience improved, but to do this, we must develop and integrate the wider cancer workforce.

In order to improve the palliative and end of life care experience of people throughout Scotland, Macmillan Cancer Support commenced an educational programme in November 2017. The Macmillan Foundations in Palliative Care resource pack (FIPC) underpins the delivery of this training to Care Home and Care at Home staff.

To date we have provided 15 courses throughout Scotland and have trained 209 people.

This poster outlines the rationale for the above project and provides evidence of the preliminary qualitative and quantitative results.

Hospital Doctor's Experience of Caring for Dying Patients: Report of themes from free text responses

Author(s)

D Gray; G Haworth; H Hood; G Linklater; C Smyth

The aim of this study was to examine, by means of a postal questionnaire, the experience of all grades of doctors caring for patients dying in an acute hospital in Scotland. There was an overall 42% response rate (127/306). Of responding doctors 55% had cared for 10 or more patients in the previous year. A quarter of respondents had personal experience of bereavement out with clinical practice within the previous year. 65% of responding doctors agreed that their most memorable patient death had had a strong emotional impact upon them. Responding doctors reported benefit from peer support. There was no association between length of time as a doctor and difficulty rating for talking to patients about death (p-value 0.203). There was no association between difficulty rating and length of time working as a doctor when talking to relatives about death and dying (p value 0.205). The questionnaire enabled respondents to provide further information in relation to their own experience and the response have been grouped into themes and reported in this poster.

Impact of population ageing on end-of-life care in Scotland: Population based projections of place of death and recommendations for future service provision

Author(s)

Anna Bone; Catherine Evans; Anne Finucane; Barbara Gomes; Irene Higginson; Richard Meade; Scott Murray; Tim Warren

Background:

Due to global population ageing, we are expecting a rise in the number of deaths, with implications for service provision in care settings.

Aims:

To project where people will die from 2017 to 2040 across all care settings in Scotland, and identify expert recommendations in response to projected trends.

Methods:

Population-based trend analysis of place of death and a consensus group meeting.

Results:

Annual deaths in Scotland are projected to increase by 15.9% from 2016 to 2040. Between 2004 and 2016, proportions of home and care home deaths increased, while the proportion of hospital deaths declined. If current trends continue, the numbers of deaths at home and in care homes will increase and two-thirds of patients will die outside of hospital by 2040. To sustain current trends, recommendations included: 1) increase, equip and sustain the health and social care workforce 2) to build community capacity and resilience and 3) to hold a realistic national debate on funding of palliative care.

Conclusion:

End-of-life care provision in community settings needs to increase by over 60% by 2040, otherwise hospital deaths will increase. Investing in a community-based health and social care workforce; and identifying and supporting informal carers are crucial.

Improving identification of people who could benefit from a palliative care approach

Author(s)

Paul Baughan; Michelle Church; Laura Dobie

The current situation is that many people across Scotland are not being identified and not receiving palliative care. There are lots of different tools that support earlier identification. So, one of the things that we have done in Healthcare Improvement Scotland is to try and make sense of which tool to use in which situation. We've produced the Palliative Care Identification tools comparator, which explains what tools are available, how they work and provides a decision tree that can help services decide what tool would best suit their aims.

Improving Palliative Care for People who are Homeless in Scotland - Possible Solutions

Author(s)

Joy Rafferty

There is need to consider how palliative care services can be more accessible and responsive to the needs of people who are homeless in Scotland. Review of published and grey literature, online searches and networking identified ongoing projects/services providing palliative care for homeless people in developed countries worldwide. These were examined, looking for examples of good practice and consideration made of transferability to the Scottish context. Eleven types of projects were identified aiming to improve palliative care for people who are homeless. One solution is unlikely to meet all the needs of this complex varied group with combinations of different services ideal. There is scope in Scotland to engage with specialist GP practices for people who are homeless and provision of support and education to staff working with this group. Consideration should be given to developing respite/intermediate care beds in culturally appropriate settings (e.g. homeless hostels), which can be utilised for those with palliative care needs. With many homeless people affected by profound and complex loss, specialist bereavement support can be helpful. Homeless people are unlikely to proactively access services so effective outreach involving relationship building and partnership working with other services is vital.