Background Emotional Freedom Technique (EFT) is a simple and common self-help technique, which is also known as ‘Tapping’. It combines elements of exposure therapy, cognitive behavioural therapy and somatic stimulation. It is widespread in the public domain; Meta-analyses show that EFT is effective for anxiety, depression and Post Traumatic Stress Disorder (PTSD). There are no studies examining the effect of EFT for palliative patients. Case Presentation This case report presents three cases of emotional distress in palliative patients. Case Management Each patient was treated using EFT. Case Outcome Following treatment using EFT, all of the patients’ emotional distress was decreased and within a very short time. Conclusions EFT is a very simple, effective and safe technique. EFT has the potential to be a powerful tool to improve the care of palliative patients who have distressing emotions. Future research on EFT and its effect on distressing emotions in palliative populations and their families is warranted.
Hospices have traditionally been seen as 'the place you go to die.' Hospice UK suggested in its 2015 guide 'Hospice enabled dementia care' that it was time to challenge this perception and share the expertise of hospices for palliative care more widely in the community because of the growing incidence and inequality of dementia care. As a result, an educational specialist/dementia lead role was created in a hospice to ignite the passion about dementia and palliative care. Dementia resources in the local community were reviewed and incorporated into a bespoke training day called 'Walking alongside dementia'. Aim The aim was to increase understanding of dementia and its care supported by hospice and community resources for a wide range of healthcare professionals. Methods Invitations were publicised via the hospice education programme to both primary and secondary healthcare professionals. The day covered: Types of dementia, diagnostics and current research Communication, advance care planning, identification and implementation of end-of-life care Collaboration and coordination with local resources 14 objectives were measured with a pre- and post-confidence questionnaire on a scale of 1(low) to 5(high). Results In financial year 2016–2017 two sessions were originally planned. However, these quickly became oversubscribed, resulting in the need for six additional sessions. It was clear that a major need and passion had been ignited, as these additional sessions were also oversubscribed. Analysis of the eight sessions showed: 135 participants attended from 18 organisations with 27 different roles; An overall satisfaction rating for the day of 9.6 out of 10 The average confidence level on the objectives rose from 2.5 to 4.5, with most impact noted on community resources available. Conclusions Collaboration transcends inequalities in palliative care and reframes the hospice role. As a team our communities have amazing power – as hospices we must strive to unlock this.
Introduction The role is often carried out by Infection Prevention Link staff who also have the role of providing care to the patients. LOROS changed this profile three years ago by employing a dedicated qualified infection prevention specialist. As most of the patients within the hospice are vulnerable to infection this role was to look at areas which could be improved and reduce the risk of hospice acquired infections and promote patient, staff and visitors’ safety. Aims The aims were to ensure that LOROS was compliant with national and local guidelines on Infection Prevention. To identify any areas for concern or non-compliance and how it could improve the patient’s journey and ensure infection prevention and safety were everyone’s business. Method A review of national and local infection prevention literature was undertaken and the Infection Prevention Lead was part of the Infection Prevention Society (IPS) whose vision is that ‘no person should be harmed by a preventable infection’. They have also produced a suite of infection prevention audits that can be used in all healthcare settings. These were used as a starting point for starting to identify any good/excellent areas of compliance and any areas which may need improvement. The hospice also wanted to ensure compliance with the Department of Health’s Health and Social Care Act 2008 The Hygiene Code. This Act established the CQC and sets out the overall framework for the regulation of health and adult social care activity. Outcome 8 of the CQC was the driving force for some of the changes that were implemented. Conclusion From the initial audits areas of good practice were identified, for example the general cleanliness of building, staff adherence to uniform/dress code and hand hygiene but they also identified area for improvement. The list below is an example of some of the changes implemented but it is not an exhaustive list and work continues to identify good practice and areas for improvement The purchase of all new commodes Fabric riser recliner chairs started to be phased out Green labels were introduced identifying equipment had been cleaned Detergent cleaning wipes Link Staff had a dedicated two day training day Oak Ward refurbishment Safer needles Introduction of Sepsis Pathway Patient leaflets Cleaning schedules and policy Development of an audit Programme.
Background There is increased interest in how hospices can improve patients’ independence whilst supporting them living with a life-limiting illness. Aim To explore how a rehabilitative approach can be integrated into a 15-bedded hospice inpatient unit using participatory action research. Methods Two volunteers, one non-clinical and five clinical members of staff participated in a co-operative inquiry group (CIG) whose aim was to bring about a change in hospice practice whilst reflecting on the activities undertaken and how it affected practice. Purposive sampling was used to ensure that nurses and therapists were represented in the CIG to reflect the potentially different perspectives to providing inpatient palliative care. The CIG and a patient advisory group assessed whether a rehabilitative approach was suitable in this setting using data from the Integrated Palliative Outcome Scale (IPOS) and Minimum Data Set. The CIG then planned what action to take and after each period of activity, assessed the outcome before further action was planned and executed. Data collection was concurrent, iterative, informed by the activity that took place and used to influence smaller changes as the study progressed. It was also retrospective and included: notes from ten CIG meetings (25 hours), field notes, research diary, organisation documents and data from 16 questionnaires. A thematic analysis approach was adopted. Results Preliminary analysis showed that a group of staff and volunteers identifying, owning and acting collaboratively (Pascale & Sternin 2005) can successfully integrate a rehabilitative approach in to an inpatient setting. However: the terminology, rehabilitative palliative care (RPC), can be both a facilitator and barrier to change finding the balance between enabling and caring can be difficult. RPC challenges traditional role boundaries between healthcare professionals. Conclusions Conceptually, there is agreement that RPC is desirable but implementation can be challenging. A multidisciplinary team working collaboratively can mitigate and overcome resistance.
Background Admiral Nurses are specialist dementia nurses who use a range of psychosocial, educative and practical approaches to support families living with dementia. Providing Admiral Nurses with a full programme of professional and practice development is a strategic aim of Dementia UK, therefore identifying learning priorities at the end of life is vital. Aim Admiral Nurses have the support of a practice development approach to their learning based on a competency framework developed by the University of Worcester (2016). Admiral Nurses have supported time away from practice, to develop skills and knowledge to support the people in their care, including end of life. This work explores how a practice development approach enables Admiral Nurses to develop their understanding, skills and knowledge of end of life issues for people with dementia. Method A literature review was undertaken and two focussed discussions with Admiral Nurse Groups exploring end of life care challenges in practice. Feedback around gaps in practice then informs learning within future practice development sessions. Results One example of a gap in practice identified was the cessation of the Liverpool Care Pathway. Davies et al. (2015) developed a toolkit of heuristics for practitioners when caring for people with dementia at the end of life which was subsequently shared with the group and further discussion on how to use this toolkit in practice. There are now further discussions exploring the skills and confidence of Admiral Nurses having challenging conversations at end of life, including Advance Care Planning, and how a practice development approach could assist development in this area. Conclusion A practice development approach to Admiral Nurses learning on end of life care will ensure that their development is person centred, innovative and valuable. This model of supporting specialist nurses in their practice allows better understanding and awareness to collaborate with palliative care colleagues.
Aims This study explored the thoughts and feelings of hospice nurses regarding Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) discussions and the potential extension of their role in this including formal documentation of the outcome of that discussion by signing the DNACPR form. Methods Eight semi-structured interviews were carried out with senior hospice inpatient and day therapy nurses. Interpretive phenomenological analysis was used to explore the shared lived meaning of this phenomenon. Results Four themes emerged: 1. Current practice around hospice nurses 2. How proposed changes to practice may enhance patient experience 3. The benefits to hospice nurses 4. The challenges of this change in role. Participants appeared confident with the concept of nurses discussing and documenting DNACPR decisions. They could envisage that seamless advance care planning would enhance patient care, and that nurses’ rapport with patients made them best placed to have these conversations. Hospice nurses reported numerous potential barriers to extending their role including: impact on peer relationships and relationships with doctors; anxiety about having DNACPR discussions with some evidence of censoring of conversations and selection of which ones they would engage with; anxiety about the responsibility for such decisions if the patient changed place of care. Although participants did not perceive stable or prolonged illness trajectories as a barrier for discussing DNACPR, they did consider a patient’s uncertainty about the prognosis to be a barrier. Conclusion Hospice nurses exhibited cognitive dissonance; they had discord between knowing what good practice was and completing it in action. They appeared to value ‘niceness’ over honesty and their censoring of conversations resonates with communication awareness theories.
Background Standard practice at our hospice did not encourage routine weighing of patients on admission, which potentially limited ability to meet best practice standards for medicine management and nutritional assessment. Aim This project measured if patients were weighed at or soon after admission. Many were prescribed medication where dose was dependent on weight. The opinions of staff and patients towards routine weighing was also investigated. Methods An audit of 40 patients measured if patients were weighed on admission or a reason for not doing so recorded and whether weight dependent doses were in line with the British National Formulary or other specialist advice. A staff questionnaire gained the opinions of 79 clinical staff towards weighing patients, their understanding of the reason for weighing, and rationale for their opinions. A patient questionnaire gained the opinions of 38 patients on being weighed and their understanding of the reason for being weighed. Results 97% patients did not find being weighed distressing. However, 51% staff members were opposed to routine weighing.13% of patients had a weight recorded. 13% were prescribed low molecular weight heparin, 80% of these patients were weighed and only 60% were on the correct dose. Conclusions Routine weighing has been introduced for all patients or a recorded reason for not doing so. Clinical staff now receive training that demonstrates the inaccuracy of estimating body weight. An alert sticker is now attached to the medicine chart, for patients prescribed weight dependant medication and a prompt on the shelves where the medication is stored acts as a reminder to check body weight. There is a plan for regular audits of the weighing of patients to maintain the profile of the importance of weighing and these results will be fed back real time to the clinical teams.
Background Up to 80% of people with advanced cancer experience cachexia and of these most have accompanying anorexia, characterised by poor appetite and weight loss. Cachexia has profound psychosocial impact on patients and families including negative emotions associated with reduced food intake and involuntary weight loss, and the social consequences of these symptoms. Weight loss can be unacknowledged by healthcare professionals (HCPs), even in settings where patients are weighed regularly. Little is known about the meaning of weight loss from the patient’s perspective, and what support patients expect from HCPs. Aim(s) • To describe the experience of weight loss in people with advanced cancer and explore what psychosocial support they believe HCPs could provide • To make recommendations for clinical practice. Methods Individual, semi-structured interviews with hospice patients diagnosed with advanced cancer and who had expressed distress around weight loss, analysed using thematic content analysis. Results Nine patients took part. Participants described the emotional impact of weight loss as an indicator of overall deterioration or impending death. Concerns about weight loss were perceived to be unacknowledged by HCPs, and participants would welcome more opportunities to discuss their fears. Findings were categorised into four themes: • The meaning of weight loss to the person • A changed relationship with food • The experience of being weighed as ‘a tick box exercise’ • ‘Listen to me’ – a message for healthcare professionals. Conclusions HCPs should acknowledge weight loss in patients with advanced cancer to explore the impact and meaning. Increased awareness of the impact of cachexia and communication skills training may enable these difficult conversations to take place. With appropriate emotional and social support, patients and their families can identify and address what is important to them, which may reduce distress and improve quality of life.
Background The benefits of exercise for people with life-limiting conditions are widely recognised. Woodlands Hospice runs a weekly exercise group which is well attended. Feedback is positive and the environment provides more than simply physical benefits. It has become a safe place that instils positivity and humour where patients can share feelings and coping strategies, gain support and strength from their peers and staff, ask for help whether physical, emotional or spiritual and where they can just ‘be’. Aim To further develop this group to enhance the experience for patients. Specifically: Music. To introduce music in the form of a personal group playlist where all patients are involved in sharing a song and a reason for its choice. This music is played during the group and made available to take home. Tai Chi. To teach simple chair based Tai Chi to be practised at the end of each session to promote a calm and contemplative atmosphere. Palliative Outcome Scale (POS). Using this recognised tool on a monthly basis helps patients to discuss any new concerns, allows staff to signpost patients appropriately and streamlines outcomes throughout the hospice. Methods Literature review on clinical benefits of Music therapy and Tai Chi Consultation with group members Practise Tai Chi sessions Multidisciplinary consultation regarding introduction of POS. Results Music A feeling of ownership and camaraderie promoting discussion ranging from shared memories to the spiritual needs of the present Tai Chi This new skill has facilitated relaxation, breathing control and aided sleep POS Its use has identified a gap in care when patients are not accessing other hospice services and ensured their needs are met. Conclusion The exercise group has proved to be a good leveller with patients feeling confident to share experiences whilst gaining physical and emotional strength.
Background Ultrasound is a diagnostic tool that can supplement clinical examination. Members of the Princess Alice Hospice medical team have attended a course which teaches clinicians how to use ultrasound to assess for the presence of ascites and whether the urinary bladder contains fluid. The hospice has purchased a portable ultrasound machine. Aims To review whether ultrasounds are being performed for Hospice at Home (H@H) patients and what impact this has. Method A retrospective service evaluation of the use of the ultrasound in H@H patients over a one-year period. Results 10 ultrasounds were performed in H@H patients over one year, seven were in the patient's home and three were in hospice outpatient appointments. Nine ultrasounds were performed to assess for ascites and one to assess for urinary retention. Of the nine ultrasounds performed to assess for ascites, three demonstrated large volume of ascites that was amenable to drainage. Of these three patients, one had a drain inserted on the hospice inpatient unit and two were referred to hospital for drainage. The other six patients were found to have small volume or no ascites. The patient who had an ultrasound to assess for urinary retention was found not to have a distended bladder. Conclusion The use of ultrasound in H@H patients does influence patient care and supports clinical decision making. The value of hospices performing ultrasounds comes from the ability to avoid unnecessary visits to hospital for ultrasounds, as well as avoiding unnecessary admissions to the hospice inpatient unit or hospital for assessment or drainage of ascites. Rapidly establishing whether a patient has ascites and whether it is amenable to drainage in the community, reduces delays and distress for the patient, as well as reducing the burden on the wider health service.
Background Following a literature review and visiting other hospices, it became clear that regular exercise groups can be effective in maintaining fitness and activity levels as well as improving mood and reducing fatigue. We were keen to ensure that we were meeting the needs of patients with potential to maximise fitness and independence in a way that was good use of time and resources. Aim To assess the value and effectiveness of hospice-based exercise groups, to inform future planning, ensure best practice and optimise patient experience. Method Appropriate patients were recruited to a weekly circuit-based exercise group run by a physiotherapist and volunteers. Baseline data were collected and goals set. Reviews took place after a minimum of two months attendance, with assessments repeated, goals reviewed and subjective views collected. This evaluation was carried out a year after the group was set up. Results Eight people attended the group regularly, with a variety of terminal diagnoses. Regular attendance, satisfaction and goal achievement were seen as an indication of effectiveness and value. Improvement in outcome measures were seen (75% of two-minute walk tests and 80% 5×sit to stand) but this was considered of secondary importance in this population of patients with deteriorating terminal illness. Participant feedback underlined the importance of regular supported exercise and goal achievement, resulting in increased confidence, activity and independence as well as reduced reliance on medications. The importance of social support and improved mood was also highlighted. Lessons were learned that have informed future planning and the setting up of additional exercise groups. Conclusion Group exercise is an effective way to support people living with a terminal condition, enabling them to remain as active and independent as possible at the same time as providing social support.
Background At the end of life silence seems to take increasing prominence in encounters between professional caregivers, patients and their family members but its value as an element of spiritual care has been little explored. Whilst silence lends itself to spiritual and existential dimensions of care, unfamiliarity with the phenomenon can lead to anxiety or avoidance. Greater understanding could support caregiving practice. Aim To gain deeper understanding of silence as an element of palliative spiritual caregiving. Methods A two-phase phenomenological approach, using heuristic inquiry and hermeneutic phenomenology. Data were gathered through self-inquiry and unstructured interviews with 15 palliative care chaplains. A descriptive and hermeneutic analysis facilitated explication of the lived experience to produce an interpretation of the nature, meaning and value of silence in end-of-life care. Results 'Spiritual caregiving silence' emerged as a way of being with another person, complementary to speech and non-verbal communication, in which the caregiver takes both an active and participative role. This demands engagement and commitment. It evokes a sense of companionship and connexion and creates accompanied space that allows the other person to be with themselves in a way that they may not be able to be alone. It provides a means of and a medium for communication that is beyond the capacity of words and a supportive environment when words fail. Silence has the potential to enable change by creating opportunity for acknowledgment, expression and articulation of truth. Chaplains observed outcomes of acceptance, restoration and peace. Conclusions Spiritual caregiving silence is a person-centred phenomenon that supports the wellbeing of patients at the end of life and their family members. Understanding has been deepened through the interpretive and reflexive phenomenological process drawing upon cross-disciplinary knowledge and specialist experience. Findings may find resonance with other caregivers, to stimulate further reflection and discussion and support clinical practice.
In 2016 The Cheshire and Merseyside Palliative and End of Life Care Audit Group conducted an audit of the management of delirium in palliative care patients across settings. Willowbrook Hospice (a 12-bedded specialist palliative care unit) took part in this audit. The audit found that benzodiazepines were often used first line for the management of delirium which is not supported by the evidence from the literature. This was felt to be because some staff do not distinguish between agitation and delirium in the dying person. The audit group produced guidelines for the recognition, assessment and management of delirium and recommended the use of the Confusion Assessment Method as an assessment tool. In response Willowbrook have developed a THINK DELIRIUM policy and accompanying Quick Reference Guide which takes a stepwise approach (similar to the WHO analgesic ladder) to delirium and agitation recognition, assessment and management. In addition we developed a teaching tool that could be delivered easily 1:1 or at daily handovers. All staff were updated over a period of a few weeks. Staff now report increased understanding of the differences between delirium and agitation and confidence in management. We are planning a second audit over the next few months. This poster describes the THINK DELIRIUM project and the stepped approach to management including the outcome of further audit and a survey of the confidence of staff in recognising and management of delirium and agitation after the educational intervention
In recent years there has been a significant increase in policy and guidance, across many countries, to promote palliative and end-of-life care for non-malignant life-limiting conditions. Most notably for people with dementia (PWD) at the end-of-life and facilitate better access to palliative care. PWD, particularly those in the advanced stages, may experience poor end-of-life care because they may not be perceived to have a terminal illness. There is concern in some settings and services that staff are ill – equipped to care for PWD, in respect of knowledge and skills. Both Hospice UK and Dementia UK thus launched the 'Dementia in palliative and end-of-life care Community of Practice' to bring together practitioners keen, in the spirit of mutual learning, to share knowledge and practice and provide high quality palliative and end-of-life care for families affected by dementia. At the inaugural meeting a nominal group technique was used to identify learning needs across both groups of clinicians. Thirteen learning needs were identified, of which five were ranked as priorities to be met during future meetings. Shared learning through a community of practice is a way of harnessing the expertise across the two care domains, with the common objective of improving the lives, and deaths of PWD and in better support of their families. We hold two community meetings a year and due to increase in engagement will be hosting a conference in 2017. Events are well evaluated and membership is growing.
Background Hypomagnesaemia is a common electrolyte abnormality, in the chronic state its symptoms are insidious and often non-specific. It is often undiagnosed and thus untreated. There is evidence from animal studies to suggest that magnesium is involved in pain control including an animal model of hyperalgesia which is induced by hypomagnesaemia. However the role of magnesium as an analgesic in patients is unclear. We report two cases of patients with advanced cancer who were admitted to a hospice for pain control which improved when their hypomagnesaemia was treated. Cases Case 1 was a 73 year old man with non small cell lung cancer with metastatic bone pain. Case 2 was a 64 year old man with large cell neuroendocrine cancer with rib wall invasion. Case Management Both patients were found on admission to have asymptomatic hypomagnesaemia and were treated with IV magnesium. Case outcome treatment for hypomagnesaemia resulted in an improvement in pain control such that analgesia was significantly decreased. Conclusions The incidence of hypomagnesaemia in palliative patients is unknown although it is thought to be common. These cases suggest that treating hypomagnesaemia may improve patients' pain control.
Background Patient and family feedback is fundamental to care as it provides information about the quality of care experiences and involves patients and the public. Feedback methods vary e.g., face to face conversations, questionnaires, touch screens etc. However, near real-time, online feedback about care and services is under developed in palliative and end of life care (PEOLC). We report upon a ‘work in progress’ quality improvement project using an online platform which enables patients/families to feedback recent PEOLC experiences, leading to learning and change in the organisation. Experience with online feedback suggests that both patients and staff feel that clinical teams should be directly involved in responding online. Aim(s) The aims over two years are to: 1. Test the value and effectiveness of near real-time online feedback in 10 UK-wide PEOLC hospital, hospice or community teams 2. Teach and support the teams how to use the online platform and use feedback for learning, service development, change and demonstrate patient-led outcomes. Methods(s) May 2017 to Sept 2019; 10 PEOLC clinical teams (up to 20 people per team) are being educated and supported in using online feedback in their service. This includes creating email alerts, responding, reporting, and data visualisations. The programme offers a ‘community of practice’ (CoP) approach to supporting staff in learning to use feedback for quality improvement and wider cultural change. Results A mixed method evaluation using qualitative (to understand the experience) and quantitative (to measure the activity) data, from patient, team and organisation perspectives, including: online platform data, experiences, outcome measurements, staff confidence, patient/family views, QI activity, CoP interaction and turning learning into care. Conclusion Over two years the project will provide an ongoing understanding of the challenges, opportunities and outcomes in using near-real time feedback via an online platform in PEOLC. With recommendations for implementing in other PEOLC settings.
Background Symptom control of malodour in patients with Malignant Fungating Wounds (MFW) can be challenging as there is little evidence or guidelines. Malodour can be a taboo in society. Human response to smell is complex. A literature review showed that malodour is a major concern to patients, families and staff. As a nurse working in a hospice, I wanted to look at how we could develop a standard for assessing malodour. Aim My presentation shares my experience in setting a standard for auditing the assessment of the symptom of malodour for patients with MFWs in a UK hospice. I chose this area because malodour from MFWs is a challenge in practice. Methods I carried out a literature search to see what evidence and guidelines there were to inform my audit standard. I analysed the information and reflected on my 11 years’ experience as a hospice nurse. Results Patients with the symptom of malodour from MFW are affected physically, emotionally and socially. The symptom also affects their family and friends and can be distressing for other patients and staff. I felt the practice of assessing malodour at the hospice could improve so would start a clinical audit with my standard that; ‘All patients that are admitted to the hospice with a malignant fungating wound will have the symptom of malodour holistically assessed to support the development of a patient- centred plan of care aimed at improving quality of life.’ Conclusions I was then able to audit the assessment of malodour as a basis for change in our practice aims at improving the management of this distressing symptom. The results have informed my leading a multidisciplinary group to devise a holistic assessment tool for assessing the symptoms of malignant fungating wounds.
Background Parkinson's disease (PD) is a common, chronic, progressive neurological condition (NICE, 2006). Its prevalence rate in 2009 was calculated as 27.4/10,000 and is predicted to increase by 28% by 2020 (Parkinson's UK). NICE guidance for PD recommend that palliative care should be considered throughout all phases of the illness (NICE, 2006). Methodology The audit reviewed all patients over a three-year period who were referred to St Gemma's Palliative Care Services between October 2013 and October 2016. The computer database SystmOne was used to capture patients who had a coded diagnosis of PD. Results A total of 38 patients were referred to Palliative Care Services, of whom 20 were still alive at point of collection. There were equal numbers of male and female patients referred and the mean age at referral was 78 years. The mean average documented time from diagnosis to death was 8 years. The average time from referral to death was 6.419 months. However, to specifically focus on the 18 patients who died, eight were referred to palliative care services within the last one month of life and four were referred within the last week. The most common referral reasons to palliative care services were request for help with advance care planning (ACP), marked decline in physical function and dysphagia. Of the patients that were referred, 76% (29/38) had documentation of ACP and 63% (24/38) had documentation of DNACPR decision and Gold Standard Framework recommendations. 15/18 patients of those who died had documentation of ACP. Discussion Patients with PD are much more likely to be referred to specialist palliative care services in the last phases of their illnesses despite NICE guidance. Despite good working relationships with the PD Nurse Specialists, the subgroup of patients referred is a much smaller cohort in comparison to the incidence of PD throughout Leeds.
Background A holistic approach to supporting a person with life-limiting illness and their families requires a consideration of their social context, including the availability of social support (defined as the resources gained from relationships with others). Hospices offer social environments, enabling opportunities to interact with others, maintain self-esteem and engage in group activities which are reported to be valuable opportunities to improve wellbeing. There has been limited research into the role of social support in palliative care, and whether the provision of such support has a measurable impact on patient outcomes. Aims This three-year project will use mixed methods to explore services offered by hospices that facilitate social support, leading to a detailed understanding of social support in palliative care. Methods A survey, disseminated to all hospices in the UK, will contribute knowledge on the establishment and variety of services that offer social support. Qualitative investigation including observations and interviews with service providers will seek to establish the meaning of social support in life-limiting illness and gain detailed understanding of services. A prospective study of patient reported outcome measures will be used to test the effectiveness (and if possible, cost-effectiveness) of these services. Results An analysis of the results of the survey and preliminary qualitative findings will be presented. Conclusions The project will contribute knowledge on the variety and significance of social support services in UK hospices and provide evidence for policy and decision makers on the necessity of social support in the context of life-limiting illness.
Sepsis is a significant cause of morbidity and mortality and patients in the palliative phase of their illness are particularly vulnerable. In 2016 health care organisations were asked to review their management of the deteriorating (often septic) patient through a Patient Safety Alert from NHS Improvement. Patients being cared for in hospice in- patient units are increasingly complex and earlier in their disease trajectory. This means that robust protocols must be in place to support staff in recognising acute deterioration, making an appropriate assessment and putting a management plan in place that takes account of the particular clinical complexities of the patient and their wishes and preferences with regard to care and treatment, including transfer to an acute setting if appropriate. Hospital scoring systems and management approaches are often inappropriate in hospice in-patient units and it was with this in mind that we decided to develop our own protocol for care of the septic patient This poster describes the development of a 'Sepsis Care Bundle' for Willowbrook Hospice specialist palliative care in-patient unit and the education that underpinned this. The Care bundle was designed to be easily accessible to and followed by staff, including flow charts and aide memoires.
