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Sharing Current Scottish Practice

Poster Abstracts of the month: November

The SPPC Annual Conference in 2016 featured 36 poster displays, sharing work and research underway across Scotland. Each month, this blog focuses on the content of a few of these posters. This month, we focus on:

01. A quality improvement approach to cognitive assessment on hospice admission: could we use the 4AT or short CAM?


Baird L and Spiller J

Prevalence studies show that 15-42% of patients admitted to specialist palliative care inpatient units have delirium. Symptoms of delirium are often subtle and easily missed, or misdiagnosed as fatigue or even depression, and so the use of a screening tool could improve early identification and management of delirium and lead to improved outcomes. Patients admitted to the hospice are often frail and tired; therefore a quick and easy to use method of cognitive assessment is essential. A quality improvement approach was used to improve screening for delirium on admission to a hospice unit. The first cycle determined staff preference between the short CAM and the 4AT. Two further PDSA cycles embedded the 4AT (our preferred tool) into the admission process, establishing it as a usable tool in the hospice setting for up to 92% of admissions. A subsequent cycle showed poor sustainability prompting improvements to staff education and changes to admission documentation. The QI approach highlighted the need to link staff awareness of their use of the screening tool with perceived improvements in treatment of delirium which prompted the creation and implementation of a delirium checklist in the unit, which details the management of delirium, common causes and suggested investigations.

02. Addressing the Great Taboo


Alexander H and Beuken G

This short session was designed to address the taboo of talking about death, dying and bereavement. Although it had not been tried before and there were concerns that some participants may be distressed by the content, the observation results show that this was not a big problem. Participant responses during the session show that the audience knew quite a lot about the topic. This is helpful for peer learning but also because the session was designed as a structured conversation to encourage people to discuss the subject more openly, some mentioned that they planned some actions as a result of attending e.g. making a will or discussing their own funeral wishes with their family. Feedback from the end of the session showed that most people found the session very interesting, although others had mixed reactions, saying it was also challenging. In total 81% of those present requested more training, which indicates a strong desire for more. Some degree of discomfort was expected, however, the session appears to have been very positively received by most participants. There was a small level of not unexpected upset, and a strong desire to learn more.

03. Aiming to achieve realistic bereavement care throughout Greater Glasgow and Clyde


Dolan J, McNeill K, McVey H, Miller J and Neeson E

Introduction: ‘How people die remains in the memory of those who live on’. Facilitating a good death can impact positively on grief and bereavement.

57% of deaths in Greater Glasgow and Clyde occur in acute hospitals, as health care professionals we are in a privileged position to strive for good deaths. Enabling practitioners to be open and equipped to talk about death, dying and bereavement reduces negative experiences.

Aim: To increase practitioners’ confidence and competence when dealing with death, dying and bereavement.

To raise awareness of resources and processes to improve the experience of those affected by death, dying and bereavement in all care settings

Methods: Following a theoretical palliative care module practitioners returned to improve practice through various projects (in ITU, paediatrics, acute surgical receiving , orthopaedics, ENT, tissue viability, respiratory and general medicine), aiming to improve the patients and relatives experience of death, dying and bereavement out with specialist palliative care environment

Projects included:

ž memory making in the form of hand prints, hair and jewellery in organza bags

ž brightest star bereavement boxes

ž death certification checklist

ž raising awareness of resources and processes

ž care after death boxes.

Next steps: Secure funding to embed projects in daily practice, continuing partnership working

04. Approaches to delivering palliative care in nursing care homes in the UK: a systematic scoping review


Finucane A, Hockley J and Kohli-Lynch N

The UK population is ageing with more elderly people living and dying in nursing care homes, making these important settings for palliative care interventions. Multimorbidity and dementia are common and many residents will have high symptom burden and complex care needs. A scoping review was undertaken to map palliative care interventions in nursing homes in the UK. This involved systematically searching six databases from January 2000 to February 2016. 17 articles were identified. These consisted of 7 evaluations studies, 7 descriptive or observational studies and 3 implementation studies. The studies focused on palliative care pathways, advance care planning, staffing issues and healthcare links across settings. The majority of studies were focused on staff views with few focussing on residents’ experiences. However overall there was a paucity of research on palliative care interventions in UK nursing homes. An increased emphasis on developing and evaluating palliative care interventions that are informed by the needs and preferences of resident’s and family’s experiences is recommended.

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