Background Audits in 2008 and 2009 show documentation was incomplete in 50% and 57% of cases: below an ideal standard of 91-100%. Omissions were due to poor utility by nurses and unsuitable pro-forma design, (duplication, lack of clarity, haphazard) and time consuming when transcribing to additional sheets at discharge. Nurses re-designed their pages which redressed problems highlighted and facilitated its use at discharge to community Health Care Professionals (HCPs). The resultant pro-forma was audited. Aim To ascertain completion of the new documentation compared with previous audits, confirm its use to community HCPs, and identify areas for improvement. Method The documentation was audited retrospectively using a copy of the pro-forma as the audit tool. Analysis was RAG rated: RED less than 70% completed, least acceptable, actions required. AMBER 70% -90% completed, acceptable but scope for improvement. GREEN 91% -100% completed, ideal standard. Results 15 sets of notes were audited (65% of one month's admissions). Data were collected on pages completed by nurses, which totalled 117 fields. Overall, 74% of the fields achieved either GREEN or AMBER status with the remaining 26% in the RED. Information commonly omitted related to community services, such as was the patient registered as 'palliative' with their out-of-hours GP provider, community HCP's contact details, and care planning post discharge. Data missing on admission included; co-morbidities, metastasises, contact numbers and expected discharge date. Results for tests/investigations were not documented in most cases. Each patient's community HCPs were sent a copy on discharge. Conclusion Significant improvements made using the new documentation; 26% in the RED compared with 100% in both pervious audits. Patient information is more succinct, de-duplicated, streamlined, and comprehensive enough to use at discharge to community HCPs; a survey of the latter underway. Nurses encouraged, and are, more diligent in recording information. Community information pending further review.

Near-peer teaching (NPT) has been shown to be useful in undergraduate and postgraduate medical teaching, but there is sparse knowledge of its applicability in clinical settings, such as the ward round. The current study assessed the suitability of NPT on a consultant ward round and ascertained its advantages and disadvantages as a teaching method in this setting. NPT was trialled on three consecutive consultant ward rounds on a palliative medicine inpatient unit in a cancer centre. Both learner (three junior doctors) and facilitator (one consultant) views were sought via questionnaires and interviews. Data were analysed using thematic content analysis. All participants felt that NPT gave a better educational experience compared with traditional ward rounds. Participants found NPT improved their own teaching ability, was quick and easy to use, and was tailored to the learner. More advantages were cited than disadvantages. Disadvantages were only mentioned by senior doctors and included time off the ward round and lack of teaching for the senior member of the near-peer pair. Thus, NPT could be a useful educational tool to provide differentiated learning in busy clinical settings. However, more research is needed to ensure that it can meet the learning needs of senior trainees.

Background Sleep disturbance is a common and distressing problem in patients who are terminally ill and may intensify symptoms such as pain, depression, and/or anxiety. Staff in a Specialist Palliative Care inpatient unit felt that they were inadvertently and partly responsible for unnecessarily disturbing patients during the night, however, the frequency and precise nature of what caused patients to wake was unknown. A survey was undertaken to identify causes of disturbance and explore ways of reducing them. Methods Data were collected on all direct patient contact between 10pm and 6am. Data including time of disturbance, mode of seeking attention, and the primary reason for nurse assistance were recorded along with secondary data relating to additional needs and outcomes. Results 301 disturbances occurred in 27 nights. 86% (60/70) of inpatients had at least one need (range 1-4). Most needs were between 22:01-24:00 hrs (29%) followed by 00:01-02:00 hrs (25%) and 02:01-04:00 hrs (23%). Patients used their call bell (58%), called out (18%) or were observed by a healthcare professional. Primary reason for seeking help related to elimination (31%), symptomatic (26%), wanted food/drink (13%), repositioning (10%), confused/talking in their sleep (6%), others (15%). Of the 10 symptoms reported pain was the most common followed by breathlessness, insomnia, cough/hiccups. Patients frequently articulated additional needs once their primary need had been met, for example, wanted analgesia, then asked for hot drink, assistance to the toilet, fan, etc. These subsequent needs resulted in 500 activities being carried out. Nurses and/or their activities were not reported as a cause for waking patients, however, when meeting an individual's needs other patients opportunistically expressed help/needs. Conclusion Nursing activities do not appear to disturb patients. Ways of reducing nocturia in this client group are limited, however, more could be done to explore symptom management, such as prophylactic medication use. Pre-bedtime snacks should be provided and encouraged.

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BackgroundThe transition home for Specialist Palliative Care (SPC) patients is often complex; requiring multiple medications, equipment, healthcare agency support. Many patients go home to die which causes additional stress for patients/carers. Nationally, discharges are frequently unsatisfactory; a telephone survey of local outcomes was undertaken.AimTo identify any concerns/problems arising and improve the patient experience by providing SPC post-discharge support/advice.MethodsA pro-forma comprising 11 questions was designed for call handling. All patients were called within 3 days of their discharge home. All patients were known to the experienced SPC nurses making the calls. Over an 8 weeks period 14 out of 45 discharges was audited.Results79% (11/14) were called within the timeframe. Respondents were patients (7), family (4), other (3). Two patients had died. All knew what their medications were for, how to take them and what their side effects were. Eleven had enough medications until they could arrange a repeat prescription, one had three days supply; pending dosset box. Thirteen (93%) were given the SPC 24-hour advice line number. District Nurses (DN) and personal carers had attended as arranged (21% and 57% respectively) and equipment supplied (29%); the remainder reporting that these were “not applicable”. Two ‘concerns’ were identified: one DN unaware injection required and another had taken patient's discharge summary.DiscussionIt is not known why a DN took the discharge summary or why another was unaware of the injection; this information had been sent to them. Most SPC patients have at least one DNs, professional carers and/or equipment therefore the response ‘not applicable’ may have occurred because the call was made before their arrive; this needs further exploration.ConclusionPatients were followed up in a timely manner and few concerns arose; those that did were resolved. The need for subsequent follow-up call/s is under review.