Sharing Current Scottish Practice

CREOL - A realistic medicine approach to supporting compassionate care of the dying in any setting

Author(s)

Geraldine Finnan, Michelle Scott, Julia Hume

The Chief Medical Officer for Scotland presented an invitation for all health and social care professionals to make a shift in the way they support patients and carers. Realistic medicine is an approach and attitude where shared decision-making happens through respect for the individual’s values, with a focus on what matters to them.

For Palliative Care specialists it represents the “mainstreaming” of all the core aims and values of what palliative care has at its heart – recognition that this is every care professional’s job. This approach enables the benefit/burden balance of realistic treatment choices to be truly shared and understood and honest and open communication can empower patients and families.

The CREOL is a document that was developed to support delivery of compassionate person-centred high quality end of life care (EOLC) in all settings. A truly realistic medicine approach was integral to the design. It has been designed to be intuitive and flexible, allowing episodes of care and assessment to be documented in a clear and concise manner, which allows trends and patterns to be identified quickly.

The aim is to support and improve EOLC provision, promote discussion around dying, and ensure that clinicians value what matters most to the dying patient in any setting.

Developing an Adult Palliative and End of Life Care Plan for Angus Health & Social Care Partnership

Author(s)

Elaine Colville, Sally Wilson, Marion Gaffney, Dr Deans Buchanan

Angus Health and Social Care Partnership have co-produced a collaborative and integrated plan for Adults with palliative and end of life care (PEOLC) needs. This has been produced following consultation and engagement from a wide range of stakeholders including health, social services, voluntary and independent services, carers and the public. The plan is shaped around people’s current experiences, understanding and hopes regarding PEOLC in Angus. We are proud to be the first Health and Social Care Partnership in Scotland to develop a dedicated plan for PEOLC and this strengthens our commitment to achieve the best Palliative and End of Life Care that we can.

What did we do?

Review of literature and strategic guidance

PEOLC Steering Group convened

Engaged widely with carers, public and workforce

Themed feedback which identified our strengths and gaps.

We asked:

What do you think good palliative and end of life care look like?

What do you think we could do differently?

Is there something else you want to tell us about palliative and end of life care?

The plan outlines 6 outcomes:

Compassionate and person centred care

Care as close to home

Compassionate communication and conversations

Getting it right for the family

Education and development for the workforce

Public health approaches to palliative and end of life care.

Next steps involved the development of an Action Plan and Implementation.

Dying well night and day: A mixed-methods evaluation of out-of-hours services in Scotland for people with palliative care needs

Author(s)

Bruce L. Mason, Scott A. Murray, Marilyn Kendall, Nicole Brun, Anne Finucane, Emma Carduff, Andrew Stoddart, Lewis Ritchie, Jeremy Keen, Marie Fallon, Sian Tucker, Erna Haraldsdottir, Lorna Moussa, Stella Macpherson, Joannes Kerssens, Sheonad Laidlaw, Kirsty Boyd,

Background: Scotland’s national datasets provide insights into use of out-of-hours (OOH) services in the last year of life.

Methods: Patient data from the national register of deaths (2016) linked to five urgent/ unscheduled care datasets within a Data Safe Haven was analysed for every episode of OOH care in the 12 months before death. Three qualitative case studies in diverse regions of Scotland involving patients, carers, and healthcare professionals explored decision-making.

Results: Of 56,407 people who died in Scotland in 2016, 98% had a long-term illness (cancer 28%, organ failure 38% and frailty dementia 25%). Overall, 95% (53,852) used an OOH service; 50% of this in the last 2 months of life when calls to NHS 24 and primary care OOH increased proportionately but cost a fraction of hospital care. People with organ failure, especially from lower income quintiles, tended to call 999 and attend A&E. Those with cancer had more bed days and were the highest users of primary care OOH. Perceived legitimacy, prior experience and enhanced access to services influenced people’s decisions about seeking help.

Conclusions: Users find OOH services difficult to navigate but need to contact them more as death approaches. Patterns of use were impacted by diagnosis, deprivation and proactive planning.

Hospice Incident Reporting: Our Transition from Paper to the Web

Author(s)

David Manion

Clinical governance has long been recognised as the system with which health organisations are accountable for continuously improving the quality of their care and the way that service is delivered. Incident reporting is a significant part of this process, in it provides an indication as to the level of reporting culture in place within an organisation with the added benefit of ‘soft intelligence’ included in the incident’s descriptive narratives. This investigation and review process can provide the basis of continued work into improving working practices and quality of care.

During March 2019 St Columba’s new web based incident reporting system went online and staff went from a traditional paper form based reporting process to a data management system. The system would not only provide Incident Reporting but also Facilities Management, Complaints, and an electronic Risk Register for the hospice.

We have taken this point in time (6 months) as a good opportunity to document the benefits and difficulties experienced during this period of innovation and hope the example provided might help other organisations when considering a similar reporting solution.