Technology – Living Well in Communities blog

The Living and Dying Well with Frailty Collaborative and COVID-19

Published on 12 March 202016 March 2020 by Living Well In CommunitiesLeave a comment

mers_coronavirus_particle — Image credit: NIAID / CC BY-SA

by Dr Paul Baughan. GP, Dollar Health Centre. National Clinical Lead for Palliative Care with Living Well in Communities, Healthcare Improvement Scotland

Healthcare Improvement Scotland is temporarily refocusing improvement resource to support work aligned with COVID-19 resilience. The primary care team in the ihub and LWiC have been working together to pull together some resources to help respond to increased service demand. The topics will include developing Hospital at Home services, using NHS Near Me, and proactive Anticipatory Care Planning. More information will be available soon.

People living with frailty are among the most vulnerable to severe illness and death from the COVID-19 infection, and so the activities which teams have undertaken to identify this group, and then to develop anticipatory care plans will likely prove to be extremely helpful.

Some practices may be able to use the information within their frailty registers in a proactive way to target support for people with frailty. The practice that I work in is planning the following activities:

Contacting people with severe frailty by phone to check that they understand what they need to do to minimise their risk of infection, and know how and where to seek advice if they have symptoms. We have produced a template for proactive COVID-19 – frailty work.
Asking people with severe frailty if they are happy to have a Key Information Summary (KIS), explaining that this will allow NHS24 to be aware of their medical conditions should they need to phone for help or advice.
Checking that any next of kin and power of attorney information is up to date on the KIS.
Adding a note on the KIS that this person has been identified through the electronic frailty index (eFI) as living with frailty.

Whilst the above activities fall short of a comprehensive ‘anticipatory care plan’, they will prove to be helpful should someone with frailty require to call NHS 24, or need help from a provider of unscheduled care.

These phone calls could be undertaken by several different members of the primary care team, and could even be undertaken by a well staff member with access to an NHS laptop who is self-isolating at home.

Please do not hesitate to contact a member of the team on hcis.livingwell@nhs.net if you have any questions about the frailty collaborative in the context of COVID-19.

Sharing knowledge through podcasts

Published on 16 January 202017 January 2020 by Living Well In Communities1 Comment

Paul and Calvin

by Laura Dobie, Knowledge and Information Skills Specialist

Dr Calvin Lightbody is a consultant in Emergency Medicine at NHS Lanarkshire, and he also produces the Talking Mortality podcast. He recently recorded an episode with our clinical lead for palliative and end of life care, Dr Paul Baughan, on supporting people with frailty in the community.

Everybody’s talking about podcasts…

Podcasts are becoming increasingly popular, and are available on a variety of platforms, which makes them very easy to access. They cover a wealth of subjects, and the format lends itself equally to presenting bite-sized chunks of information, to more in-depth exploration of a topic.

There is a podcast for everyone, whatever their interests or time commitment. This growing appetite for audio is also reflected in audiobook sales, which are growing as sales of print books are falling.

Getting into it

Calvin has 20 years of healthcare experience, and has recently been working to improve the care that hospital patients receive towards the end of life. He decided to give podcasting a try after putting a lot of time and effort into preparing and promoting a presentation at an event, which was not as well-attended as he had hoped. This prompted him to consider how he could reach more people, and he thought that podcasts could be the ideal medium.

Why podcasts?

Podcasts have numerous benefits. You can listen to them anywhere, at any time. They have multitasking potential: people can listen to them while doing other things, allowing them to take in information on their commute, while hanging up the washing, or cooking. They also cater to expectations for on-demand content: Calvin observed that people do not tend to watch live TV as much as they used to, and are increasingly shifting to streaming services to watch what they want, when they want.

Podcasts provide people with information and entertainment, in a format that fits around their busy lives. They also have considerable potential for learning and development: Calvin listens to a lot of medical podcasts that contribute to his CPD.

The Talking Mortality podcast

Talking Mortality explores the difficulties and challenges of human mortality. Individuals, society in general and health and care professionals all struggle with this issue. The podcast aims to start conversations on this topic. Previous episodes have covered areas such as dementia, palliative care, anticipatory care planning, and the death taboo.

Dollar Calvin’s recording studio for the day was Dollar Health Centre, where Paul works as a GP. His set up is fairly minimal: a USB microphone plugged into laptop to record the audio, and headphones to check the sound. The podcast format is an intro from Calvin, an interview with his guest speaker, and a recap of key learning from the podcast at the end. This really reinforces potential of the podcast for sharing knowledge and getting it into practice.

The recording with Paul is seamless. Calvin records a brief intro to check the sound, then they go straight into a conversation, which is recorded in one take. Half an hour flies by, taking in the importance of identifying people with frailty, what GP practices can do to support people with frailty, and anticipatory care planning, amongst other topics.

After editing, Calvin adds the podcast to Buzzsprout, a podcast hosting site. You can listen to Paul’s episode now, and access all the earlier episodes.

Want to continue listening?

There is a wealth of health and social care podcasts within easy reach of your headphones. Here are a few to get you started:

MDTea podcast – A series of podcasts aimed at healthcare professionals working with older adults.
Nice Talks – Individual stories behind NICE’s work to improve care through evidence-based guidelines.
Iriss fm – Research, projects and events on topics related to social work and social care.
GEMCAST – A geriatric emergency medicine podcast aimed at clinicians, nurses, or paramedics who take care of older adults, particularly in the Emergency Department.

Do you listen to podcasts? What are your favourite podcasts that cover health and social care?

“ACP is not for me!”

Published on 19 March 2019 by Living Well In CommunitiesLeave a comment

paul baughan

“I don’t have time to do an ACP.”
“That document is too big.”
“GPs have enough work without this.”
“Someone else should be doing it.”

These are all comments which I have heard my GP colleagues say when the topic of Anticipatory Care Planning comes up. And if I’m honest, there have been occasions when similar thoughts have gone through my head. But Anticipatory Care Planning is so much more than any document or the needs of a particular professional group, and I have come to realise that it is a fundamental component of our work in general practice.

Some of the most rewarding consultations I have had, started with an exploration of ‘what matters most‘ to someone. Recognition of such priorities enables the most effective use to be made of limited consultation time. And often I am surprised that the most important aspect of someone’s care is not what I thought it was going to be.

Take for instance my patient John, who has significant heart disease and was frustrated about the poor control of his blood pressure. I could see John’s irritation and was determined to find a new combination of drugs that would work better than the last. Each switch to a different medication required more blood tests and close monitoring, and unfortunately many of these new drugs made John feel dizzy and light-headed.

One day John told me that his greatest pleasure in life was spending time with his grandchildren, and until recently he would drive them to and from school each day. Side effects from his medication were preventing this, which in turn caused John to feel stressed. Only by understanding his priorities were we able to make progress. He was willing to accept the risk of a slightly higher blood pressure if it meant he could safely drive his grandchildren and ‘feel useful’.

So, after discussion we stopped his medication, put the BP monitor to the side, and instead explored other aspects of his future care which were important to him. His Key Information Summary was updated to include his thoughts about cardiopulmonary resuscitation and he set about appointing a welfare power of attorney. John was able to start driving again and his levels of frustration reduced, as did his blood pressure!

ACP desktop Anticipatory Care Planning is not a one-off event. It is a process that starts with a conversation and which can develop and evolve over time. The beauty of general practice is that we have opportunities to initiate that conversation and contribute to the development of an ACP over weeks, months and sometimes years.

Professionals working in other parts of health or social care can also make a big contribution to ACP. Tools such as My ACP can support this process, and stimulate helpful discussions within families. There is still a challenge translating information from hospital clinic letters and My ACP onto the KIS. I welcome recent progress with the new national digital platform, which in time will allow a wider group of people to contribute to an electronic shared ACP.

So, ACP is not just for me. It is for all professional groups working across health and social care, and most importantly it is for the person, their family and carers.

Paul Baughan, GP, Dollar Health Centre, Clackmannanshire

For more information and resources relating to ACP visit the ACP toolkit.

Palliative and End of Life Care: Focus on Identification

Published on 6 July 20189 November 2018 by Living Well In Communities2 Comments

Michelle Church, Improvement Advisor, reflects on our recent learning event, which explored ways of identifying people who could benefit from a palliative approach to their care.

On 31st May 2018, test site participants from six health and social care partnerships (HSCPs) and key delivery partners across Scotland joined the Living Well in Communities team to learn and share knowledge about tools that can support identification of people who could benefit from a palliative approach to their care.

Making the case for early identification

Kirsty Boyd, consultant and lecturer in Palliative Medicine, talked about the many benefits of earlier identification:

Helps people say what matters to them.
Increases the opportunity for people to participate in decision-making.
Reduces the risk of later regrets and poor outcomes.
Gives people time for planning ahead, resulting in fewer crises.
Reduces unplanned admissions of low benefit.
Encourages medication review and treatment planning.
Improves continuity and coordination of care by sharing information.

How can we do earlier identification?

Our national clinical leads, Dr Paul Baughan and Sandra Campbell, gave an overview of the visual resource the LWiC team have developed to help compare different identification tools that are currently used in Scotland. Sandra did a before and after survey of how aware and confident participants were about the variety of tools.

How did we mobilise knowledge?

Experts from across the UK shared their tools, knowledge and experience of doing identification. People got the chance to participate in interactive workshops looking at the tools that a number of palliative care test sites. Some insights from the sessions are included below:

Anticipal and eFI electronic tools

FAST and PPP tools

PPS and SPAR Tools

SPICT4ALL and carers identification

What did people think of the event?

People felt that they had learnt about why, when and how to use different tools to support identification and inform practice. People really liked that they had the chance to network with experts and colleagues.

Overwhelmingly, the take home message was that earlier identification and communication is key to supporting those who would benefit from a palliative approach to their care.

What did you like Take home message

What next?

HSCP palliative care test sites are now using the comparator to consider what tools will benefit local people and services and how people identified can be supported. This work will contribute to the vision that by 2021 everyone who could benefit from palliative care will have access to it and will support the Realistic Medicine ambition of shared decision-making and a personalised approach to care.

Discussions from our intermediate care and reablement event

Published on 5 May 20178 June 2017 by Living Well In CommunitiesLeave a comment

IC&R

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” →

Putting the Buurtzorg Principles into Practice: our third learning network workshop

Published on 16 January 20173 July 2017 by Living Well In CommunitiesLeave a comment

by Ben Lukins, Programme Manager, Healthcare Improvement Scotland. Follow Ben on Twitter at @blukins1

Our third learning network event took place on 13^th 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” →