Diane Laverty

Lutrol gel: A potential role in wounds?

Excoriated skin from malignant wounds or from their effluent are uncommon but difficult situations. Many preparations are available that may relieve discomfort; however, difficulties arise because such wounds often occur in areas where dressings are difficult to apply and keep in place. Lutrol gel is a thermoreversible gel, first reported as a potentially useful base substance by MacGregor in 1994. We report three cases where lutrol gel appeared to reduce discomfort, improve functional ability, and quality of life for the patient. We also discuss other potentially useful agents for similar situations.

The Royal Marsden Hospital Handbook of Wound Management in Cancer Care: Naylor/Royal

Contributors Foreword Acknowledgements Introduction Physiology of Wound Healing Wound Assessment Management of Specific Wound Types Management of Wounds Related to Cancer and its Treatment A Guide to Wound Management Products References Further Reading Appendix Index

Registered nurse verification of expected adult death: new guidance provides direction

Despite UK national guidance on care after death, it is clear that the bereaved family can experience distress while waiting for the patients death to be verified. This distress can escalate if there is a delay in verification. Anecdotally, such delays particularly occur out of hours and in community settings. Verification of death is a clinical task and an act of care whereby the identity of the person and death is confirmed. In addition, the subsequent providers of care to the deceased, such as families, mortuary teams, funeral directors and cremation services, have their health and safety protected by the provision of pertinent patient-specific information, for instance, infection risk and implantable devices, within the bounds of confidentiality. During this time, the bereaved family may also receive emotional support and information from the skilled clinician. Registered Nurse Verification of Expected Adult Death (RNVoEAD) guidance and associated competencies have recently been developed to ensure that the registered nurses involved in the patients care can feel confident about their responsibilities and competent in the process of verifying death. It is hoped that this guidance will help to avoid delays that may cause additional distress to grieving families. This article sets out the rationale for the guidance, as well as discussing outstanding concerns and proposals for future considerations.

P126 Respite Care Reframed - A Palliative Care Service For The Future

Respite care is currently disregarded as an essential component of palliative care despite interest on the part of Government and others to support home based end of life care and to increase access for people with chronic degenerative conditions. During the last 2 years an East London hospice has delivered an updated model of respite care that recognises and responds to new emerging groups of users and seeks to enable more people to remain at home during their illness. A new, nurse led service, headed by a nurse consultant, has been established which delivers planned respite care. The service proactively seeks to support people with non malignant conditions including young adults undergoing transition from children to adult services. This shift results in time being given to a multi professional review of the patient and carer’s needs as a basis for establishing an updated care plan, designed to enrich the patient’s life and maintain their function and wellbeing. Access to other hospice services is also made available. It is particularly effective when the patient is admitted in a relatively stable state and can consider / negotiate different approaches to care in a safe environment. Seven beds are now open to provide this care. Development of this new model has required a different culture of care, development of staff skills and new working relationships within and outwith the hospice. The service has been well used (average occupancy 80%). Review of activity data reveals a higher than average use of these beds by people with non cancer conditions (47%) and increasing utilization of young people undergoing transition (12 episodes). User satisfaction is high and the impact of care, measured through SKIPP is positive. Carer feedback, via focus groups indicates that the service is a vital one & suggestions about improvements will help inform service development plans.

Shifting mindsets: work in progress

The past few months have seen a hive of activity related to the publishing of reports and documents in the UK. July heralded the arrival of the long-awaited final report on the Palliative Care Funding Review (Hughes-Hallett et al, 2011).