Improving palliative care in acute settings

Categories: Care.

Representatives from the Scottish Patient Safety Programme and NHS Forth Valley presented their latest work alongside the Scottish Partnership for Palliative Care (SPPC).


Alison Hunter, an improvement advisor to the acute adult safety programme in Scotland addressed a full room of delegates at the Royal College of Physicians to introduce the topic.


In an hour-long session, the attendees were offered an understanding of the Scottish response to providing palliative care in these acute settings, with a focus on advance and anticipatory care planning.


The Scottish Patient Safety Programme began work in 2008 and Alison said that following a collaboration with the SPPC, the 2013 acute adult model of care is now more developed:


“We’re looking at things in a much more strategic way,” she said. “Thinking about the culture and the team work.”


‘The whole pathway’

She asked the delegates to consider the leadership in their workplace and question: “How important is patient safety on your ward?”


But Alison was also keen to promote the need for a solid infrastructure, required to make any model of care successful.


Speaking generally, Alison said that five years ago “we would find a patient with physiological decline and we would rush them off to intensive care or high dependency.” She said that in Scotland, they “have been much less successful at looking at the whole pathway of deterioration.”


Following national and international collaborations to improve patient care and safety, in 2013 Alison hopes to see a deteriorating patient identified through an early warning model and subsequent effective planning and care decisions made.


Regular communication

The session highlighted one particular care plan that will be implemented: the Person Centred Structured Review.


It is defined as “a regular process of communication between the multi-disciplinary team, patient and family.”


When a patient first triggers the early warning signs of deterioration, it is suggested that the Person Centred Structured Review is commenced. The review has the following stages:

  • The risk of deterioration reviewed and documented
  • Limited reversibility assessed (e.g with the SPICT tool)
  • Written management plan reviewed and updated
  • Anticipatory Care plan required?
  • DNACPR status considered
  • Communication with patient and family about management plan documented

Evelyn Paterson, palliative care team leader at NHS Forth Valley, suggested that many of the goals of intensive care and palliative care are shared.


She went on to emphasise that discussions with the patient and family about resuscitation status needs to be carried out by professionals with the appropriate skills and sufficient time.


Challenges in the acute setting

Using the case study of a deteriorating patient who was admitted to hospital with complex health problems, the session then explored the challenges of caring for a palliative patient in an acute setting.


Delegates were encouraged to discuss the missed opportunities throughout the case study’s admission; opportunities that could have been utiltised to provide appropriate palliative care.

They were also asked to highlight the challenges faced by the acute sector. These included a lack of continuity, limited out-of-hours service, the demand for beds and the volume of work.

Evelyn said that tools such as the Person Centred Structured Review can be used to help professionals predict increasing palliative care needs and therefore influence decision-making and care.

‘Here and now’

But she also recognised that health professionals in acute settings are often only able to consider the “here and now.”

“They’re in the moment,” she added.

She said that staff need to “shift the mindset,” but had no intention of criticising staff, stating it is a “fact and a reality.”

But Evelyn told delegates that although advanced care planning can be difficult for the individual, there is a “positive benefit to the patient and the professional.”

Derek Blues from the Scottish Partnership for Palliative Care concluded the session by encouraging communication between specialties.

He said that patients are often cared for well in each setting they are admitted to, information is often lost in transition: “It needs to be across the whole patient journey.”

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