Kate Marley

P-140 Musical chairs – more than just an exercise group

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.

P-77 Audit of outcome measure use in a hospice

Background The Outcome Assessment and Complexity Collaborative (OACC) created a standardised, validated suite of outcome measures for use in palliative care. The key features are the holistic approach, with involvement of the Multidisciplinary Team (MDT) and the patients/families themselves. Our hospice currently uses three outcome measures: the Integrated Palliative care Outcome Scale (iPOS), the Australia-modified Karnofsky Performance Status (AKPS) and Phase of Illness. All three outcome measures are discussed in the weekly multidisciplinary team meetings, both in the in-patient unit (IPU) and the day hospice. Aim The use of outcome measures was first piloted in the IPU and day hospice in 2012, but there has been no recent audit of their use. Anecdotally the outcome measures are consistently available for review at the MDT meeting but there is not always an available explanation when the iPOS is incomplete. This audit aims to quantify the compliance. Methods This is a retrospective audit, aiming to capture all patients in a one month period who were admitted to the IPU or who attended the day hospice for assessment. The standards (all with 100% targets) will include: iPOS offered to patients on admission (IPU) or at first assessment (day hospice) iPOS offered weekly thereafter – Reason for non-compliance documented when iPOS not completed AKPS and Phase of Illness discussed weekly at the MDT meeting (both IPU and day hospice). A secondary project will involve documenting baseline scores and changes in scores during admission or time attending the day hospice. Results Full results awaited. Conclusion This project encompasses an audit to assess compliance and a secondary project to explore changes in outcome measures during an episode of care. We hope this information will help to further promote the use of outcome measures in clinical practice throughout the hospice.

P-19 Our roots, our liverpool, our journey... the benefits of an art project in bereavement group work

Woodlands Hospice runs a monthly drop-in bereavement group to provide a sensitive environment for people to share feelings, experiences, gain mutual support, make friends and gain confidence. An art project was proposed to represent the bereavement journey. The group agreed on three themes: Backdrop of the Liverpool sky line Roots from a tree representing, pain, growth and family Personal sentimental items, each piece is unique to that person and tells an individual story that can be shared. Together forming an illustration of genuine understanding of the impact of losing a loved one. Project objectives were to: promote inclusive activity, enabling people to drop in and out at any time use creative therapy as a method of expressing grief use the activity as a way of enhancing group support build resilience and gain ideas for coping strategies work together in a safe, empathic environment complete a project that could be shared and enjoyed by others tell a story that connects people on a personal level and reaches out to other bereaved people to bring comfort and hope. To ensure inclusivity and recognise the diverse nature of loss, grief, culture, beliefs and values, no one person took responsibility for leading the work. Workshops were facilitated by a member of staff and were designed to give support to any group member needing help to deal with heightened emotions and feelings that may have emerged. Results The completed project is powerful and moving, symbolising a journey that connects people through experiences of loss and grief. The safe environment enabled ease of expression; and the opportunity for people to enjoy a new skill leading to a natural bond and an ease of storytelling. Conclusion The project provided opportunities for individuals to connect on a social level, reducing isolation and loneliness. It enabled participants to share how they could gain relief from sadness and build confidence to continue with their lives.

P-148 Made to measure: improving access to comprehensive specialist palliative care for community based patients

Background Woodlands Hospice previously operated a traditional specialist palliative day hospice service, four days weekly, with limited therapy out-patients and domiciliary care. Patient satisfaction was high. However the model of care provided support for a limited number of patients and did not meet needs of all, specifically younger patients, those not wanting to stay all day and those requiring specific and targeted interventions. Aim To improve access to individually tailored, evidence based specialist palliative care for community based hospice patients. Method Stakeholder consultation: patients, hospice staff, trustees, volunteers, healthcare professionals Literature review Visits to other hospices Outcome Reconfigured service improved patient choice and access. Face-to-face contacts increased (2012–2013 = 4032; 2014–2015 = 5059). Building Project (Hospice UK funded): purposely designed rooms enable 1:1 appointments, group therapies and a rehabilitation room for group exercise New Hospice Programme: Twice weekly day therapy- for complex unstable or deteriorating patients with needs that cannot be met in other services Individual out-patient and domiciliary appointments with any member of the multi-professional team Multi-professional group program- enables more patients to access care and peer support: Exercise Breathlessness management Fatigue/anxiety/sleep management Creative arts and legacy work Self-management programme (nurse facilitated, topic based education and peer support) Patient led peer support Bereavement support Introduction of validated outcome measures to evaluate care Conclusion Access to comprehensive individualised specialist palliative care for community based patients has been improved. Patients move seamlessly between 1:1 appointments, groups and day therapy according to need. Structured evaluation of care continues to influence service improvements.

SIMPLE SKILLS SECRETS: A VISUAL MODEL OF CORE COMMUNICATION SKILLS FOR GENERIC STAFF

Background Every healthcare worker, of any grade or role, can be faced with situations they find difficult to handle, particularly in end of life situations. Rolling out communication skills training to large numbers of people is a challenge. The ‘Simple Skills Secrets’ model was developed to provide an easily remembered visual model for any staff member, in any setting or situation where faced with unanswerable questions or lost for words. The model distils the essence of safely responding to cues, listening, encouraging, summarizing and assisting the formulation of the patients own plan whilst resisting the urge to rush in with solutions. Aims To assess the impact of a ‘Simple Skills Secrets’ model of communication skills training on staff confidence and willingness. Method A mixed methods evaluation of impact on staff who had undertaken training included pre and post course assessment of confidence and willingness for 149, and qualitative interviews of fourteen, 6–8 weeks post course, using a purposive sampling approach. Results Statistically significant improvement in both willingness and confidence for all categories and staff of all grades. (Overall confidence score, t(148)=–15.607, p=<0.05; overall willingness score t(148)=–10.878, p=<0.05). Greatest confidence change was in communicating with carers (pre course mean 6.171; post course mean 8.171). The value of the model in clinical practice was reported and several themes emerged from the qualitative data including: a method of communicating differently, a structured approach, an easy to remember visual model, thinking differently, increased confidence, using small amounts of time effectively, gaining additional skills and helping the person come up with answers themselves. Conclusions This model appears to be easily remembered, increase staff confidence and willingness to engage which may result in earlier, shorter, interventions, minimizing distress, improving patient and carer satisfaction.

An evaluation of the use of traditional opioids and immediate-release fentanyl in the management of breakthrough cancer pain in an integrated cancer network

Introduction Breakthrough cancer pain (BTcP) is common and is associated with significant morbidity. Immediate release Fentanyl products are licensed for the management of BTcP; however, some practical concerns exist about their safety and routine use in clinical practice. Aims and Methods To identify the multi-disciplinary team (MDT) experience in managing BTcP in relation to APM guidance. To identify the MDT experience of using immediate-acting Fentanyl products in the management of breakthrough cancer pain. To develop new regional guidelines to help health professionals manage breakthrough cancer pain. A literature review informed the development of two audit surveys which examined the health professionals experience of: (i) Managing a patient with BTcP. (ii) Using immediate-acting Fentanyl products. Electronic surveys were distributed to multidisciplinary members of four integrated cancer networks during August 2011. Results Twenty-eight BTcP surveys and 29 Fentanyl products survey proformas were completed. BTcP was identified correctly in most instances (80.8% of individuals had their background cancer pain controlled). Oxynorm was the most popular short-acting opioid (32% of occasions); Abstral was the most popular immediate-release Fentanyl preparation across hospice, hospital and community settings. Most episodes of BTcP were relieved in 30 minutes (56%). Concerns about storage and disposal (45%), delay in accessing medicines (45%), prescribing issues (62%) and education of generalists (62%) were highlighted by respondents. Conclusion Most episodes of BTcP were correctly identified and in 56% of cases resolved within 30 minutes of receiving analgesia. Concerns around prescribing of immediate-acting Fentanyl products and the education of generalists were highlighted.

The management of breakthrough cancer pain (BTCP) and the use of immediate release fentanyl products

Background Breakthrough pain is a common problem for people with cancer, and is associated with significant morbidity in these individuals. The association of palliative medicine (APM) has produced guidelines for the management of breakthrough cancer pain (BTcP). Immediate release fentanyl products are licensed for the management of BTcP; however, some practical concerns exist about their safety and routine use in clinical practice. Aims (1) To identify the multi-disciplinary team (MDT) experience in managing BTcP in relation to APM guidance. (2) To identify the MDT experience of using immediate-release Fentanyl products in the management of breakthrough cancer pain. (3) To develop new regional guidelines to help health professionals manage breakthrough cancer pain. Methods A literature review informed the development of two audit surveys which examined the health professionals experience of: (1) Managing a patient with BTcP. (2) Using short acting Fentanyl products. Electronic surveys were distributed to multidisciplinary members of four integrated cancer networks during the month of August 2011. Results Twenty-eight BTcP surveys and 29 fentanyl products surveys proformas were completed. BTcP was identified correctly in most instances (80.8% of individuals had their background cancer pain controlled). Oxynorm was the most popular short-acting opioid (32% of occasions); Abstral was the most popular immediate-release Fentanyl preparation across hospice, hospital and community settings. Most episodes of BTcP were relieved in 30 min (56%). Concerns about storage and disposal (45%), delay in accessing medicines (45%), prescribing issues (62%) and education of generalists (62%) were highlighted by respondents. Conclusion Most episodes of BTcP were correctly identified and pain tended to resolve within 30 min of receiving analgesia. Concerns around prescribing and the education of generalists were highlighted by respondents. The findings were presented and discussed at the Regional Specialist Palliative Care Audit Group Meeting. Local guidelines and standards were agreed for publication.