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Sharing Current Scottish Practice

Poster abstracts of the month

The SPPC Annual Conference in 2017 featured 46 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 six of these:



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


Dr Lucy Baird; Dr Juliet Spiller

Prevalence studies show that 13-42% 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 depression, and so the use of a screening tool could improve early identification and management of delirium and lead to improved outcomes. A quality improvement (QI) approach was used to improve screening for delirium on admission to a hospice unit. A baseline measure was taken of the rate of performance of cognitive assessment on admission. Five PDSA cycles were then undertaken. The first cycle determined staff preference between two cognitive assessment methods: the Short CAM and the 4AT. Two further PDSA cycles embedded the 4AT (the 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 showing poor sustainability prompted staff education and changes to admission documentation, resulting in an increase in cognitive assessment being performed, from 50% to 76%. The QI approach highlighted the need to link staff awareness of their use of the screening tool with perceived improvements in the treatment of delirium, which prompted the creation and implementation of a ‘Delirium Checklist’.

02. A very expensive sticking plaster?


Dr Sheonad Laidlaw; Dr Maire O’Riordan; Carolyn Mackay

From September 2015 – September 2016 the use of Lidocaine 5% plasters totalled 14% of Marie Curie Glasgow drug expenditure despite limited evidence on benefit in palliative care patients.

A retrospective analysis of in-patient case notes for October 2016 was undertaken. The primary aims of this analysis were: to better understand the number of patients using Lidocaine 5% plasters; to understand the rationale for prescribing this treatment and whether it is in line with current evidence and recommendations; and to reduce our total spend on a treatment of doubtful benefit.

50% patients admitted on this treatment were prescribed them appropriately as guided by Scottish Palliative Care Guidelines. 4 x patients had their treatment initiated by us inappropriately for musculoskeletal pain. 83% of patients were using 1 plaster daily, 17% using 2 daily (totally 98 plasters a week at a cost of £235.50).

We are currently assessing patient benefit at 48-hours and 1 week post admission/ initiation, and trialling a 24-hr patch free period if the pain is shown to respond to the plaster; by doing so we aim to ensure that Lidocaine plasters are only prescribed if of proven benefit and that expenditure is reduced where there is no patient benefit.

03. Accessing Advanced Care Plans: what's in a Key Information Summary (KIS)?


Dr Lucy Baird; Dr Jennifer A. Harrison

78% of people are admitted to hospital in their last year of life and 89% of those who die in hospital are admitted as an emergency. They often have an Anticipatory Care Plan, documented by GPs in the Key Information Summary (KIS). This can include invaluable information, but utilisation remains poor in the acute hospital setting. We aimed to find out more about the information contained in KISs and improve use of the KIS in the Acute Receiving Unit (ARU) at the Western General Hospital in Edinburgh using Quality Improvement methodology. We collected data from 20 patients/month (August ‘16 to July ‘17) admitted through ARU who had a KIS. We documented what information each KIS contained, whether we judged it to be useful and if there was any record of it being utilised in the first 24 hours following admission. A staff survey was performed which looked at KIS awareness. Following departmental teaching and poster display, data collection continued to track any improvement. KIS utilisation improved marginally, from 8% to 13%, with our interventions, but overall remained poor. Information most and least likely to be included in KISs was information related to chronic diseases and patient decisions respectively.

04. Adult and Children's Palliative Care Services Working Together to Transform Transitions through Trust and Innovation


Liz Smith; Fiona Wylie; Jayne Grant

There is growing evidence of the increased number of young adults (YA) living with life limiting conditions in Scotland. In response to this the Prince and Princess of Wales Hospice (PPWH) recognised they have a role to play in supporting YA and their family transition from paediatric to adult hospice services.

To support the above there was a need to ensure that the staff had the appropriate knowledge, skills and competence to support YA and their families.

Recognising a gap in these areas the hospice sought potential support and collaboration with Children’s Hospice Across Scotland (CHAS).The developed project aimed to support PPWH staff deliver a high standard of care to YA by addressing their learning needs through joint workshops and staff secondments to CHAS. This work supported building trust and establishing relationships between the children and adult hospice. Pre and post secondment evaluation, feedback and reflection is a key aspect of this work informing and developing the YA hospice service model.

To date this collaboration has been shown to be an effective way of influencing and managing change, building staff skills and confidence positively impacting on the patient and family experience

05. An Evaluation of the Lothian Palliative Care Redesign Programme


Niall Kieran; Helen Highley

Background: An independent evaluation of a collaborative programme initiative to review the local delivery of palliative care and delivery of a whole systems improvement.

Aim: The programme aimed to identify local palliative care need, working with local stakeholders to invest in identified improvement areas.

Methods: Qualitative interviews with stakeholders, individual project reports and quantitative data relating to hospital usage allowed for significant sources of evaluative data. In combining sources of data, the evaluation sought to measure both the practical impact, and the Strategic Added Value of strong partnership working

Results: A total of 8 projects were funded through the programme, with results from each project including:

ž an increase in potential number of patients identified as palliative

ž in excess of 500 social care workers receiving palliative care training

ž new model of working in Marie Curie Hospice Edinburgh

ž increased awareness raising for palliative care

ž improved experiences for employed carers

ž increase in the amount of time patients spent in their own homes and a reduction in deaths in hospital

ž befriending service launched for patients and families.

Conclusion: The investment in the programme allowed a culture of change to develop in local palliative care. In doing so, staff have benefited from increased palliative care knowledge, whilst ultimately patients now have improved outcomes and experiences.

06. An Innovative Approach To Community Nursing


Margaret O'Donnell

Introduction: Community palliative CNS, Margaret O’Donnell, identified many patients who were referred were in crisis with little understanding of their condition/ medications / and how to manage symptoms. To meet the needs of these patients an early intervention pilot was established

Aim: The overall aim of this pilot was to offer early intervention in symptom management and psychological support, for patients diagnosed with life limiting conditions by providing early access to specialist palliative care. The hope was that this would reduce the episodes of crisis noted by GPs and district nurses, and help to support patients and their families

Method: A seven month pilot was initiated, GP’s were asked to refer patients with life limiting illness to an outreach clinic held in the local health centre. Qualitative and quantitative audit was undertaken post pilot period. Activity at the clinic was monitored – patient referrals and outcomes, feedback regarding the care experience was sought from patients who attended the outreach clinic, healthcare professionals were asked for feedback regarding their experience of this service.

Results: Total referrals received/reason for referral/duration of care/patient outcome continuing care of patients from the pilot/other hospice services utilised

Feedback from patients and healthcare professions on their experience.

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