Conference Posters

As part of our role within the wider palliative community, our staff regularly attend relevant conferences to ensure our practice is up to date. Part of that attendance includes submitting abstracts in order to demonstrate the variety of work that we have undertaken here at St Wilfrid’s Hospice.

The latest abstracts that have been accepted as poster presentations can be seen on this page. Thank you for your interest in our work.

Conference poster: Empowering clinicians to be digitally literate. Background: Technology is evolving at pace and the health and care sector need to invest in both IT and their staff, to be able to deliver on high quality care in a digital age. There are recognised barriers to adoption of IT, including negative attitudes, capabilities and time pressures². However, improving digital knowledge and literacy is key to building an empowered and forward thinking workforce. After securing funding from The Burdett Trust for a nurse led IT project, our hospice recruited a paramedic from our community team into the role of Digital Health Lead (DHL), in post for one year, which we subsequently extended into a second year. Aims: • To support and train clinical staff in our inpatient and community services with IT systems. • To champion ideas and innovation. • To investigate apps / technology which could improve both patient and staff experience. Ongoing Work: IT competencies. 85% of 113 clinical staff have completed an IT competency which was adapted by the DHL from an HEE England document. Digital inclusion. The DHL engaged with staff and working groups to increase awareness of digital inclusion. Continued work with community engagement to identify the needs of our population. Virtual Reality (VR) headsets. Funding allowed purchase of a Quest 2 VR headset, giving patients the opportunity to visit places they otherwise wouldn’t see, or bucket list experiences. Pilot started to gather data on usage, impact on symptoms and wellbeing. IPU handheld device. The DHL supported this pilot and the roll out of moving from paper based notes to digital by the bed side on our Inpatient Unit. Staff were given training to use the device to take clinically relevant photos and upload directly to Electronic Patient Record system. SharePoint development. The DHL re-designed areas of the intranet to encourage staff to use digital resources e.g. new ‘Learning Hub’ and online contacts directories. SystmOne roll out. We transferred our Electronic Patient Record system from Crosscare to SystmOne. The DHL was involved in the design of the system, staff engagement and provided training to more than 120 staff. IT champions. 11 Staff members were recruited across clinical services, with 1:1 support given by the DHL. Champions are encouraged to engage with colleagues and suggest ideas.
Conference poster: Just like the real thing? Using simulation as a resource for enhancing MDT learning. Background: Increasing complexity in all health care settings requires a range of creative educational strategies for multidisciplinary team (MDT) learning. Our hospice data demonstrated increasing patient complexity over the last three-year period. In addition, a staff questionnaire identified varied beliefs about what constituted ‘a complex patient’ and the challenges of addressing these, as well as some learning needs. Aims: • To establish a simulation room and run case-based learning scenarios as an accessible learning resource for clinical staff. • To maximise competence, confidence and collaboration in problem-solving for complex cases, across the clinical MDT using simulation exercises. Methods: • Following evaluation of previous training delivery and analysis of the feedback, a literature search revealed benefits of simulated learning environments in improving critical thinking and team communication as well as technical skills, in a safe and non-threatening environment. A SWOT analysis was then carried out. • A suitable space within a clinical area was identified and equipped (within resource limitations). • A questionnaire was sent to all clinical staff to ascertain their past experience and level of confidence in participating in simulation exercises. • Two pilot simulation exercises were planned and facilitated, based on two recently encountered (retrospective) complex clinical scenarios. • The Clinical Learning Environment Comparison Survey (CLECS) was used to evaluate learning in the two simulation experiences. Results: Key findings (Year 1 of 2) • 33 clinical staff completed the questionnaire, (a 28% return rate). This revealed the need to consider new ways of enabling MDT discussion and problem-solving as this was not currently always being achieved effectively in existing MDT case discussion forums. • 36% had no previous experience of taking part in simulation exercises. • The same questions in relation to confidence, MDT communication, value of simulation and confidence in participating were repeated after the exercises. • The validated Clinical Learning Environment Comparison Survey (CLECS) was used to evaluate within six domains; self-efficacy, teaching-learning dyad, holism, communication, nursing process and critical thinking. Higher scores indicate that learning needs were met. Limitations and recommendations for part 2 of the project: The sample size to date has been small, both in terms of numbers of simulation exercises run to date and numbers of staff participating. Over the coming year we will be rolling this initiative out to respond to ‘real- time’ complex clinical scenarios and evaluate this method of learning and the impact on both clinical staff and patients and other stakeholders. The demographics of stakeholders will also be analysed.
Conference poster: Development of a standardised Quality Improvement Project tool, using ‘Plan-Do-Study-Act’ (PDSA) methodology, for use across the whole organisation. Background: Our organisation believes ‘quality is everyone’s responsibility’. Nonetheless, quality improvement projects (QIPs) analysis identified minimal diversity in project teams, with representation from a limited range of professions and levels of practice, aligning with traditional views of hierarchy in healthcare². Exploration indicated a culture of ‘not my role’ in taking part in quality improvement (QI) grounded in lack of confidence. There was no formalised support or information for process and requirements, which excluded parts of the workforce with limited previous exposure to project management. We created a tool to formalise the process and requirements, as well as support users, for QIPs. The tool uses the Plan-Do-Study-Act (PDSA) model for improvement, and provides a framework for developing, piloting, and implementing changes. The PDSA model is cyclical, meaning you can test changes on a small scale, learning from changes throughout the cycles, prior to implementation of a change. Methods: October 2022 – November 2022: Analysis of engagement with QIPs; literature review; consensus decision of methodology for tool; developing PDSA tool. December 2022: small scale project pilot testing of tool; pilot evaluation. January 2023 – April 2023: internal consultation using purposeful sampling; thematic analysis of feedback; revision of tool, leading to approval; support through inclusion of tool in annual quality improvement priorities. April 2023 – present: identified three QIP projects including ‘implementation of virtual hospice,’ ‘virtual reality project,’ and ‘enhancing opportunities for MDT learning to complex case management’. Results Following the pilot and internal consultation feedback, four themes were identified: 1. Suggestions for change/additions. 2. Initially appeared overwhelming, but felt logical and supportive when used. 3. Suitable to standardise for all organisation projects. 4. Suggestions for increased scope of tool. Limitations The tool was launched at the same time as the Quality Improvement projects, therefore the planning phase of the tool wasn’t completed before the start of the projects. In the future, the planning phase of the tool will be completed, shared with, and approved by the Clinical Effectiveness Group prior to starting. Conclusions: Evaluation of pilot and feedback from internal consultation demonstrates successful production of PDSA tool to use for all QIPs across the organisation. Project continuation through a Quality Improvement Priority for 23/24: • Embed the PDSA cycle further. • Evaluation and revision of tool based on user experience. • Thematic analysis of feedback. • Review and implementation of policy to promote culture change.
Conference poster: Evaluating the quality and effectiveness of GP Update letters between a Specialist Community Palliative Care service and General Practitioners. Background: Accurate and timely (within seven days) communication between primary and secondary care is essential for delivering high-quality patient care. Communication and collaboration between primary care and palliative care providers is needed to deliver complex care management and to coordinate care, and letters form an important modality for this. Letters remain one of the main methods of communication between General Practitioners (GPs) and secondary care and should facilitate ‘effective collaboration of teams across care boundaries.’ They should be ‘clear, concise and contain sufficient information for the General Practitioner… to ensure uninterrupted patient care and management’. Quality is known to be variable. There is increasing evidence that GPs prefer to receive concise structured clinic letters from specialists, with clearly communicated problem lists and outcomes. The Professional Record Standards Body sets standards for outpatient letters with mandatory, required and optional levels of information. Evidence has shown medication to be a significant area of error in written communication. Incomplete or erroneous information about medications can contribute to poor decision making and inadequate patient monitoring. This is particularly relevant in the palliative care setting where we are often dealing with controlled drugs such as opiates and gabapentinoids, or steroids. Methods Evaluate our template-based GP update letters from diverse members of the community palliative care multi-disciplinary team over a period of two months, assessing accuracy, timeliness, and clear conveyance of key information including recording: • Specific problem(s) for which the specialist team are offering advice. • Investigations and change of management plan. • Clear prescription requests with indication / duration / dose / rationale for changes, noting many prescription requests come from non-prescribers in the team. • Controlled medication requests given specific instructions / doses. • Actions requested of General Practitioners in clear courteous manner, including urgency of action. Results: Interim data at 4 weeks: 79 letters sent. 85% sent same day, 100% sent within 48 hours. 100% recorded primary diagnoses. 93% clearly outline relevant specific problems. 84% made a clear prescription request. 24% of letters requesting controlled medications did not specify doses. 90% of letter deemed to be courteous and clear. Conclusions: The interim results indicate that the our template-based GP letters largely meet the standards required. Our template letter format provides pre-population of mandatory patient information. It also has a clear box at the end of the letter for requests made to GPs. The main area of concern is that 24% of controlled medication requests did not specify doses. These were all requests for ‘Just in Case’ (JIC) medications without mention of specific drugs. JIC medications should be well within the prescribing remit of GPs so there is a debate about whether we should specify doses for them. This ongoing project is concurrent with further enquiry of the GP view via survey, and assessing an opportunity for letter writing training for the wider multi-disciplinary team, also by survey of confidence.
Conference poster: From the virtual to reality Establishing a palliative care virtual ward in a hospice / community setting. Background: Virtual wards are being developed to support people at home and avoid hospital admission. St Wilfrid’s Hospice in Eastbourne, East Sussex, is introducing a virtual ward as an alternative option to hospice Inpatient Unit (IPU) admission for selected patients. In addition to enhancing care delivery through meeting individualised care and patient choice, a virtual ward may ease pressure on our IPU admissions as well as enable an earlier IPU discharge by creation of a step-down option. Virtual ward development in palliative care is evolving. However, there is little evidence on optimal processes involved in palliative virtual ward set up. Aims: To describe the process of establishing a palliative care virtual ward and report on its impact. Methods: Plan-Do-Study-Act methodology was used, and a Task and Finish group was formed to oversee the process. Qualitative feedback undertaken with patients, GPs and hospice staff about their views on palliative care virtual wards. A literature review of evidence on palliative care virtual wards and a scoping exercise with other hospices with established virtual wards was undertaken. Evaluation methods for the pilot developed, including: 1. Service data collection including demographics, IPOS, Phase of Illness, AKPS, potential IPU bed days saved and outcomes. 2. Cross-sectional survey of patient, hospice staff/ GPs experience. Results: 1. Qualitative feedback from 3 patients, 3 GPs and 3 hospice staff identified the following themes: - Need for daily service co-ordination and senior specialist palliative care clinician oversight. - Concern about who is responsible for tests/prescriptions and service delivery overnight and at weekends. - Patient themes focused on coping with technology and what would happen if they deteriorated. 2. An internal nursing secondment to act as lead nurse and co-ordinator was achieved for an initial 6-month pilot. 3. Admission criteria developed from the literature review and scoping exercise included complex unstable patients on the existing hospice caseload. To distinguish the ward from local NHS virtual wards, the service has been named Virtual Hospice. 4. Virtual Hospice Model developed - Admission for a maximum of 14 days with daily face-to-face or virtual patient contact. - Creation of a bespoke electronic patient record template. - Smart phones loaned from a local firm to support virtual consultations for patients without a suitable device of their own. - Patients to be discussed at daily huddles overseen by a consultant in palliative medicine. The hospice team to issue any new medications required as well as action any investigations requested. - The existing community nursing team to cover weekends. Deteriorating patients to be considered for IPU admission or other setting. - Patients to be discharged back to their usual level of hospice care after 14 days. Conclusion: A palliative care virtual ward pilot using existing resources and reconfiguration has been developed. Evaluation will report on the impact of the service and feasibility.
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