Barriers to achieving care at home at the end of life: transferring patients between care settings using patient transport services
Publication date
2009Keyword
After-Hours Care/organization & administrationAmbulances/organization & administration/supply & distribution
*Attitude to Death
Caregivers/psychology
Charities
Focus Groups
Great Britain
*Home Care Services
Humans
Palliative Care/*organization & administration
Patient Preference
Patient Transfer/*organization & administration
Qualitative Research
Resuscitation Orders/legislation & jurisprudence
Terminally Ill/psychology
Time Factors
Transportation of Patients/legislation & jurisprudence/*organization &
administration/standards
Metadata
Show full item recordAbstract
Enabling patients to be cared for in their preferred location often involves journeys between care settings. The challenge of ensuring journeys are timely and safe emerged as an important issue in an evaluation of palliative care services, which informed a service redesign programme in three areas of the United Kingdom by the Marie Curie Cancer Care 'Delivering Choice Programme'. This article explores perceptions of service users and key stakeholders of palliative care services about problems encountered in journeys between care settings during end-of-life care. This article draws on data from interviews with stakeholders (n = 44), patients (n = 16), carers (n = 19) and bereaved carers (n = 20); and focus groups (n = 9) with specialist nurses. Data were gathered in three areas of the United Kingdom. Data were analysed using a framework approach. Transport problems between care settings emerged as a key theme. Four particular problems were identified: (1) urgent need for transport due to patients' rapidly changing condition; (2) limited time to organise transfers; (3) the management of specialist equipment and (4) the need to clarify the resuscitation status of patients. Partnership working between Ambulance Services and secondary care is required to develop joint protocols of care to ensure timely and safe transportation between care settings of patients, who are near their end of life. Commissioning of services should be responsive to the complexities of patients' needs and those of their families.Citation
Ingleton, C., Payne, S., Sargeant, A. and Seymour, J. (2009) Barriers to achieving care at home at the end of life: transferring patients between care settings using patient transport services. Palliat Med, 23 (8), 723-30.Link to publisher’s version
http://dx.doi.org/10.1177/0269216309106893Type
articleCollections
Related items
Showing items related by title, author, creator and subject.
-
Evaluation of educational preparation for cancer and palliative care nursing for children and adolescents in England(2008)This paper reports the findings of a study which was carried out to evaluate the educational preparation of cancer and palliative care nurses in England. The study was carried out in three stages and covered the following areas; documentary analysis of curriculae, assessment of practice, patients and professionals views of threshold and expert practice. The findings suggested that although there was widespread compliance with a national standard for cancer nursing, this was not the case for palliative care nursing. There was uncertainty about what should be assessed in practice and ambiguity about what was actually assessed. Partnership with children and their parents, clinical skills, multi-disciplinary working, and personal attributes were the main foci for expectations of threshold practice but an expert panel had difficulty in describing the attributes of higher level practice. The paper also describes how some of recommendations from the study are being taken forward in current policy and practice.
-
Improving the safety of chemotherapy administration: an oncology nurse-led failure mode and effects analysis(2011)PURPOSE/OBJECTIVES: To assess and improve the safety of hospital-based adult chemotherapy administration. DESIGN: Prospective, systems-focused clinical risk assessment. SETTING: An adult inpatient and outpatient oncology unit in a large urban hospital in the United Kingdom. SAMPLE: 8-person nurse-led multidisciplinary team, which included managerial staff and patient safety researchers. METHODS: Failure mode and effects analysis (FMEA), a prospective, systems-focused risk assessment methodology, was undertaken in biweekly team meetings and included mapping the chemotherapy administration process, identifying and numerically prioritizing potential errors (failure modes) for each process step, and generating remedial strategies to counteract them. MAIN RESEARCH VARIABLES: The analysis aimed to identify chemotherapy administration failure modes and to generate remedial strategies to address them. User feedback on the FMEA process also was collected. FINDINGS: Several specific chemotherapy failure modes were identified, the majority of which had not previously been recognized, and several novel strategies to counteract them were generated. Many of the strategies were specific, environment-focused actions, which are simple, quick, and inexpensive to implement; however, more substantive, longer-term initiatives also were generated. User feedback generally was very positive, and the process of undertaking the analysis improved multidisciplinary teamwork and communication. CONCLUSIONS: Although time and resource intensive, FMEA is a useful safety improvement tool. IMPLICATIONS FOR NURSING: Nurses should be aware of and informed about FMEA as a tool they can use in partnership with management and other disciplines to proactively and collectively improve the safety of high-risk oncology procedures such as chemotherapy administration.
-
Snakes and ladders: human resources in nursing(2012)� McIntosh and Watt focus on a recent research that many female registered nurses who return from a career break at a lower grade relative to their experience and training. They note that the reintegration of the most highly trained and experience registered nurses will not only reduce the need and cost of training but will critically enhance the quality of delivery. The NHS must make greater use of these highly skilled and experienced registered nurses, not just for sound economic reasons but for improved health outcomes as well. Patients and clients all deserve the most skilled, experienced and able registered nurses, regardless of their life circumstances.; Many female registered nurses return from a career break at a lower grade relative to their experience and training, which has a detrimental implication for the National Health Service in terms of operational efficiency. It is imperative that human resources are used to the maximum benefit of the nursing service. Adapted from the source document.