New handover form allows for continuity of care for palliative care patients outside of GP hours

Categories: Care.

The GP Out-of-Hours Palliative Care Handover Project has been rolled out nationwide after a successful pilot in Cork and Kerry last year. The project, which was developed as an initiative of the Irish Hospice Foundation and Primary Palliative Care Programme, informs the out of hours service of a patients care plan and preferences.

The form allows for the recording of a patients diagnosis, prognosis and preferences in the event of deteriorating health amongst other information.

The project commenced in 2012 with the development of the form after a gap service was identified by Fiona Kiely, Specialist Registrar in Palliative Medicine.

The form was initially a four page document based on the HSE national referral form and the Electronic Palliative Care Summary in Scotland. It was pre-piloted in 2013 and subsequently condensed to one page for ease of use.

The document was first piloted over a six month period within South Doc, the out of hours co-op covering Cork and Kerry. A guidance document and information leaflet was also developed to support implementation.

Following this pilot stage an independent evaluation took place, consisting of interviews with GPs, Community Specialist Palliative Care nurses, nurses working in residential care and quantitative analysis of the data from the 60 forms received.

The evaluation found that the form would allow for improvement in communication between doctors and out of hours services and would be beneficial for patients with palliative care as it allowed for continuity of care.

Dr Eamon Shanahan of The Farranfore Medical Centre in Killarney, who was involved in the pilot stage, said the form is a useful tool which provides reassurance to patients.

In advance of the project he said GPs did communicate with the out of hours services in an ‘ad hoc’ fashion if they believed a patient may have required medical attention outside of regular hours,  but said the form represents a more formal and effective system.

He said a GP could have an average of three to four end-of-life stage patients in their care at any one time.

He said the form had been designed in such a way that as much information can be entered in a short period of time and allows the out of hour service to have a succinct awareness of a patient’s condition and wishes.

Commenting on the system he said, “The biggest problem is awareness, everyone needs to be aware that this is available and I would encourage patients and their families to enquire of their GP how they can avail of the service.”

For more information on the form go to

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