Sharing Current Scottish Practice

Phase 2 randomised controlled trial of future care planning in patients with advanced heart disease

Author(s)

Kirsty Boyd; Shirley Robertson; Sarah Cudmore; Gill Highet; Lisa Donald; Kristen Haga; Christopher Weir; Scott Murray; Martin Denvir

Integrating cardiology care and palliative care can benefit many patients with advanced heart disease at increased risk of death or hospitalisation. Future care planning provides a framework for discussing a range of palliative care problems with patients and their families. This approach can be introduced at any time during the patient's journey of care and ideally well in advance of end of life care. Future care planning is applicable to a wide range of patients with advanced heart disease and could be delivered systematically by cardiology teams at the time of an unplanned hospital admission, akin to cardiac rehabilitation for myocardial infarction. We have tested this in a successful pilot, controlled trial of an early future care planning intervention consisting of an initial review meeting with the patient plus a family carer by the cardiologist and specialist nurse who offered community follow-up. Liaison with the primary care team promoted early community support and KIS completion. Impact on quality of life was measured using questionnaires and interviews.

Preparing for 'real life' - Reducing Death Anxiety in 3rd year nursing students

Author(s)

Lynn Griffin

Communication around death and dying is challenging. Students are often protected and excluded from these conversations during clinical placement. This reduces the opportunity to learn from other clinicians. Students often report anxiety in how they will have these difficult conversations with patients and their families, once registered. The common theme is one of getting it 'right' and not causing further distress.

The University of Dundee School of Nursing and Health Science has been using a variety of ways to encourage students to talk more openly about death and dying. Innovations showcased by Good Life, Good Death, Good Grief, such as, Before I die Walls, Death Cafes as well as, end of life Clinical Simulations, (underpinned by theoretical modular content) have been used as frameworks/platforms to support and encourage students engagement and learning experience.

Quality Improvement with Nursing Handovers

Author(s)

Laura Johnston; Lesley Ferguson; Elaine McManus

Improving Nursing Handovers in a Hospice In-Patient Unit

Nursing handovers aim to communicate essential patient information between shifts. They have been identified as a communication ‘hotspot’ where inaccurate, missing or untimely information can lead to compromised quality or safety in care.

Handovers in the In-patient unit were long (resource intense), lacked focus, did not closely reflect the patient journey/agenda and produced multiple ‘nurses’ pocket notes’ which had an unknown destination. A Plan, Do, Study, Act (PDSA) methodology was used to improve the handover process.

A handover template was developed to address the problems and then piloted. Clear instructions for how to generate, use and destroy the handover sheet were disseminated to staff prior to implementation.

The template was well received by nurses and encouraged them to be more outcomes-focused and person-centred. The sheet, with its handwritten additions, was physically passed on to the next shift to avoid duplication or inaccurate information and shredded after 24 hours.

Questionnaires were used to gain feedback from nursing staff. Outcomes included: nursing handovers were structured, outcome focused and gave specific attention to patient wishes and goals; reduction of handover time by 50%; patient data in nurses’ pocket notes had been eradicated.

Supporting people with learning disabilities through the palliative care journey- NHS Greater Glasgow and Clyde Learning Disabilities and Palliative Care Pathway

People with Learning Disabilities (PWLD) frequently experience various barriers in accessing effective and appropriate health care, and are often marginalised from regular health services. These barriers, linked with lack of understanding about the palliative care role, add to difficulties accessing palliative care services.

PWLD who have life limiting illness require skilled support from their core team with access to specialist palliative care services being available when needed to support early intervention.

Following a scoping exercise carried out by The Prince and Princess of Wales Hospice in 2011 the award winning project ‘Learning Disabilities and Palliative Care-Building Bridges: Supporting Care’ was established.

As part of the project aim the following objective was set – ‘to develop a care pathway to deliver appropriate and high quality palliative care for PWLD, including guidance referral to specialist palliative care, then to pilot, evaluate and roll out the pathway nationally by 2015’.

The Care Pathway has been developed with multi-professional commitment from both specialist services ensuring holistic care needs of individuals with LD are considered. It is underpinned by evidence based practice and fundamental in promoting the delivery of high quality palliative care for PWLD. The pathway aims to support practitioners across all health and social care settings.

Supportive and Palliative Care Indicators Tool (SPICT): Enabling identification of patients at risk of deteriorating and dying worldwide

Author(s)

Dr Kirsty Boyd

Better care of people dying with one or more advanced conditions depends on primary care teams, hospital specialists and a range of other health and social care professionals making earlier identification part of their routine clinical practice. SPICT highlights readily identifiable general indicators and clinical signs of deteriorating health that mean patients are at risk of deteriorating and dying. Clinicians are prompted to consider assessment of unmet holistic care needs and offer people opportunities to talk about their health problems, the things that matter most to them and their families, and future care planning. SPICT seeks to improve ‘prognostic awareness’ while addressing the ‘prognostic paralysis’ that sometimes means palliative care is only offered when there are few or no other treatment options and the patient is close to dying. Initial and ongoing development is supported by the designated SPICT website and involves a growing network of Scottish, UK and international SPICT collaborators. The EAPC Primary Palliative Care Taskforce recommends SPICT for use across Europe. SPICT is clear, credible and useful in all care settings to promote integrated palliative care.

Talking the Untalkable in Fife

Author(s)

Dr Gordon McLaren; Edward Small; Sheila Matthew; Tracey Blyth; Sarah Nealon  

Aim: A multiagency group was set up in 2011 to encourage a more open approach to death, dying and bereavement in Fife, through raising awareness and encouraging people across society to consider how they can further this agenda themselves.

Method: The group has organised two well attended Fife wide conferences, with participants from different organisations and the public, an all-day drop-in shopping centre event, and a cafe event. Group members produced brief practical information about Wills, Powers of Attorney, Advance Directives, Funeral Planning and death registration. Both conferences drew on the knowledge and skills of participants as members of society encouraging them to have confidence to take forward the agenda themselves.

Results: The most recent conference in November 2014 was very well received. Many attendees indicated they would take forward some actions themselves either at home, in their workplace or in their communities.

Conclusion: The group’s work complements Good Life Good Death Good Grief nationally, providing a local focus to enable wider conversations about openness about death, dying and bereavement in Fife and greater knowledge of practical information. The most recent conference indicated that people felt more able to take forward their own actions in their own communities.

The challenges for volunteering in hospice and palliative care in Europe

Author(s)

Dr Ros Scott

Introduction: Volunteers offer the gift of presence, different skills, experience and time. In some European countries they are and will continue to be essential to providing hospice and palliative care (HPC) services as an integral part of a comprehensive highly professional HPC settings. However, hospice and palliative care faces many challenges and alongside this a new generation of volunteers have different expectations of volunteering and some want to use their skills in different and more meaningful ways.

Based on the work of the EAPC Task Force on Volunteering in HPC, this poster explores some of the challenges for the development volunteering and volunteers in hospice and palliative care in Europe including:

ž The values and principles of HPC and volunteering

ž The influence of culture on volunteering

ž Understanding and recognising the place of volunteers within the multi-professional team

ž Balancing the changing expectations of organisations with those of volunteers

Conclusion: If volunteering is to be developed successfully in the future we must be able to match the changing needs of our patients, their families and our organisations with the changing expectations of the volunteers of tomorrow.

The new West Lothian Community Palliative Care Service: reflections from the first year

Author(s)

Gail Allan; Kate Henriksen; Janice Strachan; Lorna Mackay; Linda Weir; Susan Lawson; Sharron McKay

This poster will describe the first year of the new West Lothian Community Palliative Care Service which was re-launched in Spring 2014. The service is a unique partnership between Marie Curie, Macmillan and NHS Lothian, based in the Macmillan Centre in St John’s Hospital. It will detail the setup of the community service, the current service delivery model, the team who deliver the service, key achievements, challenges and future plans. We will provide feedback from the patients, families, carers and stakeholders. We will also discuss the teams own personal reflections on their first year in post, with a key theme that change has been a positive experience.