Specialist Palliative Care
Services at HEYT
Dr Kirsten Saharia
Dr Elaine Boland
Consultants in Palliative Medicine
Definition
• Palliative care is the active, holistic care of
patients with advanced progressive illness
• Management of pain and other symptoms
and provision of psychological, social and
spiritual support is paramount
WHO definition, 1990
Palliative care
• Is multiprofessional
• Affirms life and regards death as a normal
process
• Neither hastens nor postpones death
• Provides relief from pain and other
distressing symptoms
• Integrates the psychological and spiritual
aspects of patient care
Palliative care
• Offers a support system to help patients
live as actively as possible until death
• Offers a support system to help the family
cope during the patient’s illness and in
their own bereavement
Specialist Palliative Care Services
Hospice
Hospital
Palliative
Care Team
Community
Palliative
Care Team
Specialist Palliative Care
Services
• 2008
• Now
– 1 Consultant (0.8
WTE)
– 4 CNS (4 WTE)
– 4 Consultants (2.05
WTE)
– 6 CNS (5 WTE)
– Inpatient specialist
palliative care beds
– No inpatient specialist
palliative care beds
– Excellent access to
specialist palliative
care beds at local
hospice
Hospital Palliative Care Team
• Consultants:
– Dr Kirsten Saharia (0.55wte HEYT + 0.3wte
Hospice)
– Dr Hannah Leahy (0.6wte)
– Dr Elaine Boland (0.9wte)
– Dr Rachael Dixon (0.8wte Hospice + 0.2wte HEYT)
Hospital Palliative Care Team
• 6 Clinical Nurse Specialists (5wte)
–
–
–
–
–
–
Jane Prutton
Steve Morris
Maggie Simkiss
Debbie Marsh
Gill Moy
Leanne Joseph
• 1 MDT administrator (part –time)
– Liz Lawson
The role of the Specialist Palliative
Care Team in Hospital
• Joint working with other specialist teams
• Management for complex symptoms & ethical
dilemmas
– All patients discussed in SPC MDT
• Promote advance care planning
• Support implementation of end of life care
strategy
• Education
• Clinical governance
Advisory Role
• Any patient, anywhere in the acute trust
• For any patient with life-limiting, advanced
progressive disease
– Physical symptoms
– Psychological issues
– Social and family issues
– Spiritual issues
SPC
Consultants
Pain team
SPC CNSs
Psychologist
SPC
Pharmacist
Specialist
Palliative
Care
MDT
SPC Social
worker
Chaplain
AHPs
SPC MDT
administrator
SPC Outpatient Clinics
• Consultant led
• Urgent pain and symptom management
• Tuesday afternoon, Thursday and Friday
mornings
• Held in oncology outpatients
• Anyone can refer
• Offer educational opportunities
Education
• Communication skills
• Symptom
management
• End of life care
• Principles of palliative
care
• Ethics
• Undergraduates
– Medical
– Nursing
• Postgraduates
– Medical
– Nursing
– Allied health
professionals
– Auxillary staff
Clinical Governance
•
•
•
•
•
Patient safety
Audit
Guidelines
Peer review measures
Engagement with HYCCA
Research
• EPAT study
– Edinburgh Pain Assessment Tool
– Looks at documenting pain as one of the vital
signs in cancer patients
– Protocols to follow depending on pain scores
and type of pain
– Pilot study shows improved pain management
Service developments in the
last year
•
•
•
•
•
In-reach service to acute services at HRI
Daily visits to HRI
Collaboration with Dove House Hospice
Building links with community services
Building links with non-malignant disease
services
– Heart failure MDTs
– Joint working with liver team
Inpatient Referral Patterns
2010
2011
2012
2013 (to end
May)
Number of
referrals
received
689
763
877
454 (1089
projected)
Number of
referrals seen
584
647
724
377 (904
projected)
Advice to
professionals
only
Not recorded
46
95
47
QCOH
404 (69%)
469 (72%)
487 (67%)
178 (47%)
HRI
66 (11%)
68 (11%)
152 (21%)
157 (42%)
CHH
114 (20%)
110 (17%)
84 (12%)
42 (11%)
Numbers of non-malignant
referrals
Year
Number of patients with nonmalignant disease
2009
11
2010
33
2011
29
2012
84
2013 to end of May
101
The Future
• Developing a seamless service across
palliative care providers
• Developing a 7 day service
• Further developing links with nonmalignant disease areas
• Improving End of Life Care in the acute
hospital
Thank you
Any questions?