I am absolutely delighted to have taken on the role of National Clinical Lead for Palliative and End of Life Care for Nursing.
Having been in post for a few weeks I’m now beginning to link in with key individuals in each of the Health Boards to truly represent nursing across Scotland, ensuring the nursing voice is fully heard on behalf of patients and those important to them.
My passion is communication and I believe fully in the human connection that we as nurses have with our patients.
Compassion is about the human experience of noticing, feeling and responding.
Delivering compassionate care has to be fundamental for all staff, and supporting nurses to be able to do this is one of my main goals.
Strategic Framework for Action
The Scottish Government is committed to working in partnership to support a range of improvements in the delivery of palliative and end of life care in Scotland. Continue reading “Introducing Sandra Campbell”
Our intermediate care and reablement event took place at 200 St Vincent Street on 21st March 2017 and shared findings from our intermediate care scoping work, and learning from services across Scotland. The event was supported by the Scottish Government, Social Work Scotland and the Health and Social Care Benchmarking Network.
Isla Bisset from the Scottish Government presented data on delayed discharges from January 2017, and Deanna Campbell gave an overview of the intermediate care minimum dataset, which records different interventions, their impact, and whether an anticipatory care plan was in place. Outcomes included avoided hospital admissions and early supported discharge. Continue reading “Discussions from our intermediate care and reablement event”
Around 54,000 people die each year in Scotland, most following an illness. Four times as many are affected by the loss of a loved one.
How do we best support these people to live well, help manage conditions and give quality and meaning to their life as their health declines?
This is the question I ask myself, as the Improvement Advisor for Palliative Care within Living Well in Communities, and as a daughter who looked after her Mom during the last few months of her life.
I loved my Mom so very dearly, and I started grieving while still caring for her. It was a time I found incredibly difficult.
Mom wanted to stay home but the say of doctors and the power of the system dominated the decision-making around her care. It seemed to me you were either in the system (hospital) or out (on our own).
Her palliative journey was one of pain and crisis. As her main carer, I gradually became exhausted and, whilst we tried to treasure her final months, her last few days were chaotic and full of interventions rather than the peace and respect she so very much deserved.
Many things have changed since then. Continue reading “Introducing Michelle Church”
by Laura Dobie, Knowledge and Information Skills Specialist
A person with frailty can experience serious adverse outcomes following even a relatively minor illness. Timely identification of frailty can help to reduce the likelihood of a poor outcome following an intervention (or eliminate the need for an intervention entirely) and support the long-term management of people’s health needs.
If we can identify people with frailty in the community, we can offer preventative support that could improve their quality of life and reduce the risk of unscheduled admissions.
There are a number of tools which professionals can use to screen people for frailty (see the British Geriatric Society’s Fit for Frailty guidance). However, many of these tools are based on questionnaires that require practitioners to have direct contact with individuals and can only be used to assess people who are actively engaged with services. It would be resource-intensive and challenging for services to screen large population groups for frailty using these individual assessments.
The risk stratification tool, Scottish Patients at Risk of Re-admissions or Admissions (SPARRA) identifies individuals within the whole population at risk of hospital admission based on nationally-collected data on acute admissions and community prescribing. However, it does not discriminate frailty from other high-risk population groups and can only identify individuals who are known to services, as they have had recent acute admissions or have been prescribed high-risk medications. Alternative population screening tools are needed to identify people with frailty living in the community. Continue reading “Using a population screening tool to identify people with frailty in the community: the e-frailty index”
The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) launches today. This is a UK initiative to support Anticipatory Care Planning (ACP) and the ACP process.
It is not planned to adopt ReSPECT immediately in Scotland after this UK launch, but we are considering a trial implementation of the ReSPECT process in a single health board later this year. The impact and benefits of this will be evaluated to inform discussions about the place and long term role of ReSPECT in Scotland.
Scotland has led the way with national frameworks that improve communication and the care of patients in the emergency setting. Prime examples of this are the national Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) integrated adult policy and the Children and Young People Acute Deterioration Management (CYPADM) policy. ReSPECT is intended to build on these and strengthen the person-centred nature of care people receive.
The ReSPECT form is designed to summarise recommendations and patient’s wishes so that this can inform care and treatment decisions they receive, should they become unwell in an emergency and they are unable to make their wishes known at the time. To do this, the ReSPECT process is intended to encourage good conversations around anticipatory planning. It should help create opportunities to discuss realistic treatment options and the aims of care that people would want more generally, and come to a shared understanding. Continue reading “Launch of Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) in the UK”
by Ben Lukins, Programme Manager, Healthcare Improvement Scotland. Follow Ben on Twitter at @blukins1
Our third learning network event took place on 13th October and allowed test sites to share their progress to date and further explore applying the principles of Buurtzorg. It was well-attended, with representatives from health, social care and the third sector and from across Scotland taking part in a lively day of discussions. You can view the Twitter highlights from the day in our Storify.
Sharing early learning from the test sites
Staff from the test sites shared their reflections on developing models of neighbourhood care and their motivations for change. The strong desire to deliver the best care possible to people resonated with everyone and fuelled the enthusiasm for the day. The discussions which followed reaffirmed the importance of this, and people acknowledged that it was acceptable to apply the principles of Buurtzorg in different ways across the different sites.
Enablers and challenges
Discussion about the enablers and challenges of progressing the work highlighted the strength drawn from the common goals of the work: improving care for individuals, and empowering staff. Groups discussed the importance of protecting the test sites and the challenge of doing so, in particular regarding regulation and inspection. People also felt that it was necessary to address misconceptions about obstacles which in fact may not exist, or may be easily addressed. Continue reading “Putting the Buurtzorg Principles into Practice: our third learning network workshop”
by Ben Lukins, Programme Manager, Healthcare Improvement Scotland. Follow Ben on Twitter @blukins1.
At the start of December we held a workshop exploring the evaluation of neighbourhood care at a national and local level. The workshop was well-attended and included academics with evaluation backgrounds, staff from some of the Scottish test sites, representatives from Buurtzorg, staff from the Public Health Agency in Northern Ireland and individuals from our national partners.
The importance of reflecting the local context was recognised and it was acknowledged that there was a richness in the qualitative information, drawn from staff’s experiences. The group reflected that the evaluation was about looking at how the principles of Buurtzorg had been applied and not about evaluating the principles themselves.
Buurtzorg principles in Scotland
We spent time determining the principles that were being applied in Scotland and agreed on the following:
- Putting the person at the centre of holistic care.
- Building relationships with people to make informed decisions about their own care, which promotes wellbeing and independence with active involvement of family, neighbours and the wider community, where appropriate.
- Everyone, including support functions, enabling person-centred care at the point of delivery.
- Small self-organising, geographical-based teams.
- Professional autonomy.
I would like to take the opportunity to introduce myself as the Programme Manager with Healthcare Improvement Scotland, responsible for coordinating the work on applying the principles of Buurtzorg to develop Scottish models of neighbourhood care.
I have been reflecting on how quickly time has flow by since coming into post in September. From the offset I was keen to immerse myself in Buurtzorg to understand the model, and to think about how we as a national body could best support the local work in Scotland. A key part of this has been meeting with a number of people from different organisations, backgrounds and professions who have been part, or are keen to be part, of this work.
This has been a great opportunity to listen to myriad perspectives and thoughts. I have been struck by the enthusiasm of those I have talked to, many of whom are motivated by achieving the best possible outcomes for people, as well as making the role of those providing care truly fulfilling. The Buurtzorg model resonates so powerfully for so many, as it brings to the surface the reason they came into the caring profession, drawing from the richness that comes from building and sustaining meaningful relationships. Continue reading “Meet Ben Lukins!”
By Laura Dobie, Knowledge and Information Skills Specialist, Healthcare Improvement Scotland
On 5th December I went along to the Argyll and Bute Care Homes Quality Improvement for Falls Prevention event. It was a really interesting day, and it was great to hear about the work that care home staff are doing to reduce falls and improve quality of life for their residents.
PDSAs and data
Dr Christine McArthur, Project Lead, introduced the day and Sheila Morris, Occupational Therapy Care Home Lead, gave an overview of Plan Do Study Act cycles and the role of data in improvement. She emphasised the importance of carrying out small tests of change and having a clear plan.
The project participants then had the opportunity to discuss a case study of a 72-year-old lady who had had a number of falls, considering risk factors such as polypharmacy and multiple complex conditions, and reviewing the data in the falls diary to identify whether there was a pattern to her falls.
The care home staff observed that people are increasingly coming in to care homes with more mobility problems and multiple conditions and co-morbidities. Sheila commented that everyone in the care home sector is at risk of falling and should have a multifactorial falls assessment. Continue reading “How care homes in Argyll and Bute are working to reduce falls”