This article presents a framework for the practical implementation of a 24-hour specialist palliative care advice line, illustrated by two case examples from the authors' experience. In the UK, National Institute for Health and Clinical Excellence guidance requires provision of 24-hour access to specialist palliative care advice for healthcare professionals and carers regardless of a patient's location. Effective implementation of a telephone advice line for specialist advice is one approach to addressing the current variability in palliative care service provision, both in the UK and elsewhere. The authors were unable to identify a model with documentation for ensuring adequate clinical governance of an advice line in the literature and so present their own. The accompanying case examples demonstrate the difference between 'evolution of services by demand' and taking a systemic approach to service design. Key recommendations for practice are outlined for an effective advice line service which incorporates training and education into the clinical governance structures of the host organization.
Programme implementation phases. IPU managers undertook programme. Self-selecting Band 5 RNs undertook programme. Joint working with another local hospice which has offered a peer review and ensured sustainability of the education programme. Evaluation phase. Claims, concerns and issues (Guba & Lincoln, 1989) exercise around prescribed medication with all RNs.. Patient and family experience with pain and symptom medication sought through direct engagement and review of general hospice feedback. Focus groups with RNs. Review of CD administrations procedure pre-and postimplementation. Mapping against the Person-centred Practice Framework (McCance & McCormack, 2017). Results RNs described moving through a period of anxiety to feeling overall confidence, autonomy, safety, trust and eventual sense of liberation and empowerment through the process. They reported reduced waiting and quicker response times for patients requiring controlled drugs since the commencement of the SNCDA programme. In a 24 hour period 14 hours of nursing time was released for other activities. Conclusion SNCDA has a positive impact for patients and RNs in supporting pain and symptom management. A PD approach supported staff to embrace SNCDA and enhanced person-centred practice.
Results Forty-eight participants completed the course in November 2015, with 43.8% (n=21) completing both phases of assessments across 3 European sites. Average knowledge scores improved significantly from 47.7% to 66.1% (p=0.0005). Self-efficacy (p=0.00005) and overall confidence (p=0.0005) also improved. Twelve HCPs participated in two focus groups across two sites, which identified the overarching theme-the ECHDC enhanced participants practice. Conclusion This study demonstrated that a multidisciplinary distance learning course significantly improved the knowledge and self-efficacy of HCPs in delivering end of life care to patients with dementia and their families. The course was felt by participants to improve the care they provided for patients. The aim of the project is to enable more people who are triaged as appropriate for admission by the Multi-Disciplinary Team, to be admitted and receive timely specialist in-patient palliative care. Background The rationale behind the project was that: P-74. Data indicated an increasing demand on specialist palliative care beds. . There was evidence of the impact of delayed discharges on achieving timely access. . There is need to educate society about the changing role of specialist palliative care.Aim The aim is to increase the number of appropriate admissions from 70% to 75%. Method The project uses Quality Improvement methodology as the mechanism for improving practice. The driver diagram below demonstrates how we structured our project. Small change ideas are being used to slowly make improvements that are effective and sustainable. An example of one change was to review the referral form and admission documentation to ensure from the point of referral that patients understand the reason for their in-patient hospice care and the potential for discharge.The project is based on the Model for Improvement tool. Results We are using a measurement strategy to map and evaluate our progress. We are making significant progress as for the last eight months we have surpassed our original target and reached 79%. There are further change ideas that we intend to explore to help with sustainability and spread. One of these is holding a round table discussion with external partners to look at ways they can support the discharge process. Opportunities We are intending that this project will enable us to maximise available resources whilst at the same time improve access to specialist palliative care to more people in a more timely way. Background Despite high antibiotic prescribing rates for urinary tract infection (UTI) at the end of life, the evidence suggests little or no symptomatic benefit in >50% of patients. This leads to concerns around the rigour underpinning UTI diagnosis in hospice inpatient settings and the lack of an applicable evidence base, with clear but conflicting antimicrobial guidelines in other populations. Methodology Two matched retrospective audits of hospice inpatients over six-month periods in 2014 and 2016. Notes were analysed for symptoms consistent w...
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