Following identifi cation of the limitation of nurse intershift handover within a specialist palliative care unit, a review of the research literature is undertaken. The aim is to identify and appraise what is known about best practice within nurse intershift handover and evaluate the implications for practice within a specialist palliative care inpatient unit. The retrieval of literature identifi ed 19 pertinent research papers which were critically analyzed. Three main themes emerged within the literature: purpose; type; and content of handover. Only two studies had been carried out within a generalist palliative care context; however, fi ve sub-categories emerged that may be signifi cant in meeting the demands of specialist palliative nursing. These were: clinical decision-making; staff support; maintaining confi dentiality while handling sensitive information; patient involvement; and type of information exchange. All themes are presented within this article. The literature review suggests that traditional verbal nursing handover may be the most advantageous handover method within inpatient specialist palliative care, though attention to structure and focus is vital.
BackgroundDespite a plethora of literature and multiple guidelines, uncontrolled cancer pain remains hugely burdensome to patients. To address inconsistencies and misunderstanding surrounding the use of opioid analgesia in clinical practice, the UK National Institute for Clinical Excellence (NICE 2012) recently introduced national guidance in the form of the opioid care pathway to assist Health Care Professionals with the initiation and titration of opioid analgesia for patients with palliative disease.AimThis audit measured current practice in the initiation, prescription and administration of opioids in adult cancer patients with palliative disease in an acute hospital setting. Data was collected retrospectively from patient records and prescription/administration charts, to ascertain whether standards on opioid treatment set by NICE (2012), the UK National Patient Safety Agency (2010), UK Nursing and Midwifery Council (2010), and local hospital standards were being achieved.Results86 sets of clinical records were retrieved between December 2011 and November 2012. Results demonstrated significant concerns regarding the administration of opioids and a high incidence in PRN prescribing alone, with only 45 patients commenced on regular opioid prescriptions. Of the fifteen audited standards, only a third demonstrated compliance +/-10%.ConclusionsDespite intensive education, opioid initiation, prescription and administration in this group of palliative care patients was not consistent with published guidance and standards. Variations in clinical practice means that audit tools such as NICE (2012) should strongly encourage the recording of explicit exceptions to ensure accurate measurement of practice. Dissemination and collation of feedback is required to inform proposed recommendations, draft prescribing and administration guidance and a re-audit plan.
Kerry Messam ( k.messam@nhs.net ), Deputy Lead Nurse for Specialist Palliative and End of Life Care, Northampton General Hospital, achieved a Bronze Award in the BJN Awards 2023 Nurse of the Year category
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