BackgroundIn January 2013, the support of children aged 18 years and younger with a parent admitted to the hospice was audited. This showed variations in the assessment of children's needs and subsequent discussions within the multidisciplinary team, leading to the formation of a multidisciplinary Task and Finish group to review how this aspect of holistic care can be improved.MethodsA multidisciplinary group met regularly over a 6 month period. Terms of reference were agreed with the aim of reviewing identification of children's support needs, and seeking ways to improve this. Audit standards for adoption by the hospice were agreed to facilitate ongoing service evaluation.ResultsThe group identified a need for the following:Improved documentation: Weekly MDT meetings are a suitable forum for identifying and discussing concerns. A trial of specific prompts for record of discussions increased the documentation of children's knowledge of their parent's illness and the impact of the illness on children and their family to 100% (previously 28.6% and 71.4% respectively).Accessible resources for patients and staff: Approval was gained from the Patient Information Group for age-appropriate leaflets to be freely accessible in the hospice, with additional child bereavement resources available if requested. Cushions showing emotions were purchased for the children's play area to improve communication with younger children.Ongoing review of practice: A steering group was established to continue work focusing on meeting children's bereavement needs.ConclusionsIntroduction of specific prompts to aid documentation of MDT discussions appear to be effective at highlighting the need for additional support for children, whilst still enabling an holistic, individualised approach to patient care. It is recommended that a specific MDT template be developed which incorporates these. The introduction of additional resources and ongoing review by a steering group will facilitate ongoing service development.
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BackgroundPatients being cared for palliatively are at increased risk of developing pressure ulcers due to multiple intrinsic and extrinsic risk factors, therefore a robust process for preventing pressure ulcers is a crucial aspect of providing safe patient care to this patient group.AimTo work collaboratively with local partners in health and social care and commissioners to increase the profile of pressure ulcer prevention to health and social care staff, patients, carers and the general public.MethodA strategic group including Clinical Leaders and Tissue Viability Nurses from each sector met monthly to discuss how to empower health and social care staff, patients, carers and the general public to reduce the risk of pressure ulcer development. This resulted in the development and implementation of the following;The development of a standardised education package regarding identifying, preventing and treating pressure ulcers which was delivered to social and healthcare staff throughout Leicestershire. This package was supplied to all local nursing agencies and delivered face to face to the agency used by the Unit.Monthly figures for each organisation were shared at each meeting and geographical areas of concern noted, with action plans made to address these.A leaflet was developed to alert patients and carers to early signs of pressure damage to encourage them to seek help. This was used to educate patients and carers throughout the organisations.ResultsPositive working relationships have been developed between the sectors. This has enhanced care for patients as they now receive more consistent care between the settings as the staff are receiving the same training and share appropriate information. For LOROS the incidence of hospice acquired pressure ulcers has reduced by 19% in comparison with the last financial year and sharing good practice has facilitated the development of robust assessment, implementation and documentation of pressure ulcer prevention, identification and treatment strategies.
BackgroundIn 2012 a study to explore hospice nursing and medical staff knowledge of, and attitudes towards, organ and tissue donation was undertaken. The study identified that the barriers to discussing tissue and organ donation were multiple and the results highlighted several recommendations:▸Increase staff awareness and knowledge▸Introduce guidelines onwhocan donatewhatandhow▸Increase patient awareness of the option of tissue donation▸Explorewhenis the right time to ask a patient about their wishes relating to organ and tissue donationPutting research findings into practiceTo address these, key links have been established with the National and local acute Trust Organ and Tissue Donation Teams. This has enabled the facilitation of a teaching and awareness session for clinical staff to enhance their knowledge about who can donate, which tissues can be donated, the process of donation, and what to do if a patient expresses a wish to be a donor.Exploring when to ask a patient about their wishes was also discussed at the Patient and Carer Participation Group. The general consensus was that it is acceptable to ask patients, but the timing of this needs to be sensitively considered. Ideally, the outpatient setting was seen as the most favourable environment as part of the patient's holistic assessment acknowledging that it is also acceptable to ask patients in discussions about dying.A simple question “Do you carry a donor card?”may provide a good opening to discussion.The next stepsThe implementation of change is ongoing. Currently we are considering written information for patients and carers, reviewing the most appropriate place to record the patient's wishes within the patient's electronic record and formulating clear guidelines for clinical staff to refer to.
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