Sharing Current Scottish Practice

Introduction of a 7-day Clinical Nurse Specialist service, a partnership approach

Author(s)

Libby Milton; Dot Partington; Liz Barker; Niall Kieran

Background: A joint hospice approach to expand the Clinical Nurse Specialist Service, enabling access to nurse specialist palliative support 7 days per week. This supports existing NHS services at weekends, providing additional palliative care expertise to patients, families and professionals and integrating with the Marie Curie Nursing Service. Existing funding was re-allocated to test this model prior to embedding into business as usual.

Aim: The service targeted inequity of provision of specialist palliative care out of hours and reduce avoidable admissions at weekends.

Methods: The CNS service was delivered over 7 days, offering telephone advice and support +/- a home visit. A mixed-methods methodology was used to analyse service use and outcomes of the pilot. Stakeholder, healthcare professional and service user surveys were carried out to review service acceptability and quality. Analysis of activity levels was used to assess the impact on the service. Economic analysis was undertaken to estimate potential savings from implementation of the model.

Results: The evaluation evidenced improved quality outcomes for patients and a change in hospice inpatient usage. Significant reduction in admissions to hospital or hospice with a positive return on investment. Patients and carers had a service satisfaction rating of 94%.

Conclusion: The integrated service model demonstrates that investment in coordinated specialist palliative care services across seven days, delivered in partnership, results in positive outcomes in quality of care and health economics.

Is palliative care appropriate for people with major stroke?

Author(s)

M Kendall; E Cowey; GE Mead; M Barber; S Borthwick; K Boyd; C McAlpine; DJ Stott; SA Murray

Background: Case fatality after total anterior circulation stroke (TACS) is high. Our objective was to describe the experiences and needs of patients and carers, and to explore whether, and how, palliative care should be integrated into stroke care.

Methods: Mixed-methods. We recruited a purposive sample of people with TACS from three Scottish stroke services, and conducted serial, qualitative interviews with them and their informal and professional carers at six weeks, six months and one year. Interviews were transcribed for thematic and narrative analysis. A data linkage study of all TACS patients admitted to these services over six months recorded case fatality, place of death and readmissions.

Findings: Data linkage (n=219) showed that 57% of TACS patients died within six months. We conducted 99 interviews with 34 patients and their informal and professional carers. Patients and carers faced death or a life not worth living. Those who survived felt grief for a former life. Professionals focussed on physical rehabilitation rather than preparation for death or limited recovery. Future planning was challenging. ‘Palliative care’ had connotations of treatment withdrawal and imminent death.

Interpretation: Major stroke brings likelihood of death but little preparation. Realistic planning with patients and informal carers should be offered, raising the possibility of death or survival with disability. Practising the principles of palliative care is needed, but the term “palliative care” is unhelpful.

Is Scotland ready to create its own day of the dead?

Author(s)

Rebecca M Patterson; Mark A Hazelwood

Aims and background: This work aimed to test whether, in Scotland, a national community-based festival of storytelling and remembrance is a culturally acceptable way of building individual and community resilience in dealing with loss.

Social and personal support mechanisms are important in helping people to cope with bereavement, yet religious and/or community-based support networks are non-existent for many. People want to support others through bereavement, but often struggle to know how. Rituals of remembrance can build solidarity, yet many traditions relating to the expression of loss have faded. Improving experiences of bereavement is part of a public health approach to palliative care.

Design, methods and approach taken: A clear approach to developing the festival was established, drawing on authors’ previous work, relevant literature, and experiences of bereaved people and bereavement specialists. To Absent Friends (TAF), a people’s festival of storytelling and remembrance was planned for 1-7 November 2014 and 2015. Carefully designed resources including website, film, leaflet and participation ideas were produced to encourage participation. These were promoted via the professional and personal networks of the authors and media. Quantitative and qualitative data for evaluation of TAF 2015 was gathered via online survey of participants; structured questionnaire to event organisers; web and social media metrics; direct observation.

Results: In 2015 over 5000 people participated, from a broad variety of organisations and demographics. 1.75 million were exposed to the festival via the media. 98% of survey respondents reported taking part was a positive experience. Qualitative responses indicate that participation was of deep significance for many.

Conclusion/Lessons learned: The festival is an acceptable approach and enthusiasm exists in Scotland to create a time of year when remembering dead loved ones is socially accepted and supported within mainstream culture.

"Living Right up to the End" What people with long term conditions want to support them to plan ahead

Author(s)

Susan High; Dr Sally Boa; Marjory Mackay

National policy encourages people with Long Term Conditions (LTCs) to plan for end of life. People seem reluctant to do this. The “Living right up to the end” project aimed to find out what was important to people in the last year of life in relation to planning ahead, and what would support them to do this.

We held 18 engagement events in local venues. People with LTCs and their carers were asked

- What matters to you when you are living with declining health?

- What prevents you making plans for the future?

Direct quotes were analysed using framework analysis. The findings were verified at two further engagement events

We found maintaining control, having a plan, important conversations and access to appropriate information were what mattered to people

Barriers to planning ahead included cost, lack of information, lack of social support and uncertainty.

We worked with groups of people with LTCs to co-produce an information pop up stand with resources to help with planning ahead and having difficult conversations. The stands have been tested in local venues and manned by volunteers from the local community with personal experience of LTCs.

We are working with people with LTCs to evaluate this intervention.

More Care Less Pathway approach to end of life care

Author(s)

Gerry Finnan

Following the publication of the More Care Less Pathway report The Liverpool Care Pathway (LCP) was withdrawn from use within Scotland by the Scottish Government (SG) in 2014. Later in 2014 the SG published guidance on end of life care Caring for people in the last hours and days of life but no care plan to replace the LCP was introduced. Following consultation with major palliative care groups across Scotland a Strategic Framework for Action on Palliative and End of Life Care was published by the SG early 2016 which stated their commitment to work with partners to ensure that high quality palliative and end of life care is available to all who can benefit from it.

The Care Record for End of Life (CREOL) was developed by the palliative care team within the Margaret Kerr Unit to help achieve high quality accessible end of life care across NHS Borders. The CREOL is a record of care delivered to patients at end of life and is not a tick box exercise or rigid process or procedure to be followed. It can be used to promote discussion of diagnosis of dying between clinicians and the wider multidisciplinary team and promotes clear concise communication between clinicians, patient and family or carers. This poster presents the new document which has been trialled for 12 months in the palliative care unit within Borders General Hospital.

Moving towards a vision of Person Centred Culture (PCC) across the hospice: do all eyes see the same truth?

Author(s)

Tracy Smith (Practice Development Facilitator); Tracy Paton (Charge Nurse); Brigid Lydon (Secretary); Hilary Ford (Hospice Manager)

Background: Over a 2 year period from-2015-2017, Queen Margaret University (QMU) facilitated a programme of practice development with a key group of multi-professional clinical and non-clinical staff. The Person-centred Practice Framework developed and updated by McCormack and McCance in 2016, continues to guide this on-going programme of work.

Aims: The overall aim was to move towards a shared vision of person-centred culture that focused strongly on people’s individual beliefs and values, processes and the care environment.

Methods: Transformational methods demonstrating the principles of practice development (McCormack et al 2013) were used to create and define the person-centred vision and to explore and evaluate person-centred culture. Evaluation methods included staff and patient stories and observations of care and environment. Facilitated events also took place to explore workplace culture, relationships and practices within designated teams.

Results: Measuring culture change is challenging and is on-going. Baseline and repeated evaluation however shows demonstrable change in relation to the physical environment, improved team-working and workplace culture and staff wellbeing.

Conclusion: The person-centred processes that have been used in all aspects of the work have proven to be effective will continue through active facilitation and integration within all areas of the hospice in the future.