AimOur multidisciplinary team quality improvement project aimed to ensure that all dying patients who experience TA have an effective individualised plan of care on an acute stroke ward (L21) within a tertiary centre.BackgroundLeeds Teaching Hospitals was selected to be one of 10 hospitals to be part of the national 'Building on the Best Programme' in conjunction with Hospice UK, Macmillan, NHSE and NHSI. This was to build on what was already being achieved by hospitals to improve the quality of end of life care (EOLC). Often improvement work focuses on the management of pain and we wanted to focus on improving the care of patients with TA, a symptom found in up to 90% of dying patients, but not always focused on.MethodsThis work was led by the Palliative Care team in conjunction with the frontline team on L21. A driver diagram was produced to identify key areas of focus (FIG 1). Interventions included ward-based role modelling of expert care of the dying; (this included the recognition, assessment, care planning and evaluation of interventions for patients experiencing TA), ward-based teaching, display and presentation of improvement data and discussion of dying patients in safety huddles. Run charts were created for these initiatives, with baseline data pre-intervention and on-going data collection during the testing, implementation and sustainability phases. All interventions were developed following identification of gaps in care delivery/evaluation.ResultsRun charts (FIG 2–4) demonstrated statistically significant improvements in the rate of assessment, reassessment and evaluation of terminal agitation (p<0.05). Routine review and dissemination of data with the frontline teams in these initiatives enhanced collaborative engagement, motivation and success.ConclusionThrough collaborative working and ward-based role modelling we have demonstrated it is possible to improve the overall management of this challenging symptom in terminal care.
AimTo explore who responded to the Leeds Teaching Hospitals Trust (LTHT) bereaved family survey.BackgroundThe LTHT Specialist Palliative Care Team (SPCT) locally adapted a bereavement survey for families (Worcestershire Acute Hospital NHS Trust, 2012). This was developed to give bereaved relatives the opportunity to provide feedback on their experience of the care their relative received at the end of life in the acute setting. The LTHT SPCT Bereaved Carers Service User (BCSU) group contributed to the design of the survey at the outset.MethodOver a 10 week period, March to May 2013, the survey was given to bereaved relatives of adult patients when they collected medical cause of death certificates from the bereavement office. Patients who died in A&E were excluded.ResultsThere were 146 respondents (response rate 23%).Trends identified from the demographics were that respondents tended to be from children of the deceased (son 23%, daughter 40%) and most responses came from older peoples' services (27%). The most prevalent age of death was 86–90. There was a low response rate from oncology wards (1%). Results were presented to the BCSU group.ConclusionThe highest response was from daughters of older adults. Further exploration is needed into the low response rate from oncology, and spouses of the deceased. The timing of the survey may have influenced the group of respondents. It may have been too early on in their bereavement. Delaying the time that the survey is sent to bereaved relatives/carers may help increase the response rate. Opinions from the BCSU group and experience from other hospital trusts will be considered to inform changes to the next survey to gain feedback from a more representative population and improve the care patients receive at the end of life.
Aim To give relatives the opportunity to provide feedback on their experience of their relatives care received in the last days/ hours of their lives in an acute hospital. Background Results from the National Views of Informal
accepted it (74.6% of those offered). 238 patients accepted a research pack, with 105 returning questionnaire 1 (44.1% response rate), and 26 returning questionnaire 2 (24.8% of initial respondents). Questionnaire 1 (patients)-40% found it difficult or burdensome repeating information to HCPs, and almost 70% were interested in a PHR to reduce repeating information. Questionnaire 2 (patients)-74% found it the passport easy to use, but only a few actually used it regularly. Some felt the passport helped conversations with family and HCPs about day-today and future care. Over 60% stated the PHR was 'very' or 'quite' useful', and would recommend it to others. Questionnaire and focus group with HCPs indicated it was mainly patients and relatives who used the passport, not non-palliative HCPs. Half felt the passport was initially well received, but only 4 (22%) felt it was used regularly by patients or their families. More found it useful to talk about facilitation discussion about future care compared with day-today care. Conclusions While initial uptake of the passport was high, use appeared low. This evaluation does not support widespread use of a PHR in palliative care, but it may be helpful to individuals, especially earlier in their disease trajectory.
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