Sharing Current Scottish Practice

Author(s): Dr Erna Haraldsdottir; Lesley Christie

Background: Art Strategy was developed in a hospice, in collaboration with an artist organisation and with funding from Creative Scotland.

The process of writing the strategy:

• Five months consultation period with the hospice staff, volunteers and patients, artists, cultural organisation and potential funders.
• A number of workshops and consultation approaches with staff patients and volunteers.
• Short art based workshops for patients.
• Implementation of the Art Strategy:

• The strategy proposes a programme of activities that will offer appropriate therapeutic engagement for patients, families and staff as well as bringing in the wider community into the hospice building and grounds.
• Eleven proposed projects have been identified within the themes of:
• oSensitive spaces, exhibition spaces, partnership residence projects, the social programme, staff project, research project and emergent artist mentoring scheme.

What we will achieve with the strategy:

• Permanent public art elements for sensitive spaces enhancing a therapeutic environment
• Space within the hospice exhibiting patients’ and artists’ work
• Event programme attracting the public into the hospice.
• Therapeutic art as part of hospice activities for staff, patients and families.
• Long term partnership with arts organisations and link with the local professional creative community.

Avoiding Harm at the End of Life: How good are we?

Author(s): P Brooks Young; S Keir et al

Aim: When someone is dying, there is no room for less than perfect care for the person involved and their family. It is critical that staff have the knowledge-base and skills to reliably deliver high-standard person-centred care. Within a larger piece of work supporting the delivery of key aspects of palliative care, we wanted create a system that would enable us to know how well we were achieving this.

Methodology: A tool was developed across 11 in-patient areas to define four key process indicators of high quality end of life care: communication, symptom management, essential care and review. This was implemented across the Medicine of the Elderly department. Five sets of case notes are randomly selected and reviewed each month.

Results: Case note review took less than 10 minutes each. This was aided by the introduction of a new care-rounding document that incorporated key aspects of essential care. Review data was used at the well attended multi-professional morbidity & Mortality (M&M) meeting to remind all members of the team of key aspects of care and to support continuous quality improvement.

Conclusion: This tool provides a route to assure our delivery of palliative and end of life care It also provides a way of monitoring the impact of other quality improvement measures being tested including patient / family experience.

Beer Mat Chat – Love, Loss and Lager

Author(s): Mark A Hazelwood; Rebecca M Patterson

Background: Storytelling/remembrance can the reduce isolation of recently (and less recently) bereaved people, and strengthen community resilience [1]. Traditional rituals and approaches which supported storytelling/remembrance are declining in Scotland. Pubs are hubs of social interaction and storytelling, especially for men.

Aim: To explore the acceptability of beer mats in pubs as a prompt to storytelling and remembrance of people who have died, and to promote To Absent Friends, a peoples’ festival of storytelling and remembrance.

Method: Five mats were designed – each had a carefully selected quotation or piece of trivia relating to loss or remembrance, plus a weblink to www.toabsentfriends.org.uk 20,000 mats were made available to order.

Feedback regarding acceptability was elicited through conversation with bar tenders, direct observation and a questionnaire dispatched with some orders. A press release was issued.

Results: The mats were generally viewed as being acceptable. A local brewer distributed c 15,000 mats to pubs across Edinburgh. The main Edinburgh newspaper ran a prominent article about the mats, the To Absent Friends Festival and the value of greater openness about death and dying.

Conclusion: Beer mats appear to be an acceptable way of introducing reflection on loss, grief and mortality into pubs. More research is needed to establish the effectiveness of the mats in prompting storytelling and remembrance.

Community Referrals : ensuring an appropriate and timely response through the use of a telephone triage tool

Author(s): Milton L; Barker L

Background: The Marie Curie community palliative care teams in Edinburgh and West Lothian receive over 800 new referrals per year. Crucial for any service is the process around the screening of referrals; important both in clinical terms and to ensure efficiency of the service.

Method: The teams in Edinburgh and West Lothian developed a new approach to respond to referrals, with a triage telephone call being made to the patient by an experienced clinical nurse specialist to assess:

• the appropriateness of the referral,
• the urgency and complexity of the patient’s situation,
• which location would be appropriate for the first assessment.

Results: Referrals to the service over a six month period were analysed (n=406). 7% of referrals were assessed as not being appropriate (n=28). The triage process identified the complexity, urgency and condition of the remaining 378 patients; 55% of patients were seen within 5 days. 10% of patients were seen as an out-patient in the hospice; 90% were seen at home.

Conclusions: Telephone triage is an effective method of determining the appropriateness of referral and location for the first assessment, allowing care to be prioritised. It also demonstrated the team offer a responsive service to complex and urgent patients.

Don't forget about me: Developing a person centred approach to caring for people with dementia with a hospice setting

Author(s): Kim Donaldson; Fiona Cruickshank

The number and care of people living with dementia is of growing global concern. Predications suggest that in Scotland the numbers will have doubled by 2031. As palliative care strives to care for all, regardless of diagnosis, culture or background there is a need for hospices to meet the challenge of caring for those living with and dying from dementia.

St Columba’s Hospice set up a working group with the aim to develop a person centred care plan for patients with dementia and/or other cognitive impairment. The care plan guides professionals to consider how to best communicate with the person, the impact the environment has upon them, meaningful activities, tools to support symptom management and liaising with external professions. The use of the care plan in practice has been supported by additional information resources and education. An initial informal evaluation has taken place and adaptations made.

This poster aims to illustrate the development of a care plan to support professionals to make all interactions with people living with dementia meaningful.

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