Moray Palliative Care Day Centre – Operational Policy
Updated version 12th January 2007
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Moray Palliative Care Day Centre – Operational Policy 1
Introduction 3
Aims and Objectives: 5
“Drop-in” Information and Support Service 6
Specialist Palliative Care Day Unit 7
Catchment Area 7
Patient Groups 7
Routes of Referral 7
Admissions Policy 7
Discharge Policy 8
Communication 8
Established clinics and services 9
Palliative Care Clinic 9
Chronic Oedema Clinic 9
Complementary Therapy Clinic 9
Moving on Clinic 9
Breathlessness Clinic 10
Other Services 11
Volunteer support 12
Liaison with existing Primary Health Care Services 13
Communication and Liaison with Existing Palliative Care Services 13
Administration and Management 14
Hours Available 14
Medical Input 14
Clinical Governance 14
Audit, Evaluation and Research 15
Training, Development, Education and Support for Staff and Volunteers 15
Complaints Procedure 15
Clinical Risk Management 15
Health and Safety 16
Catering Services 16
Pharmacy Service 16
Domestic Services 16
Secretarial Services and IT Systems 16
Gardening 16
Introduction
One Grampian resident in three will develop cancer in their lifetime and one person in four will die from cancer.
(Grampian Health Board “Review of Cancer Services in Grampian”, January 1997)
Cancer is likely to remain one of the major causes of morbidity and mortality for some time to come. As such, cancer and palliative care services will continue as a priority area for development for the Health Services.
In Moray (a) around 400 residents are diagnosed each year as having a malignant tumour;
(b) about half of these patients will die of their disease, either within a short time of diagnosis, or many years later because of complications or recurrence;
(c) in 1994, 235 people in Moray died of a malignant disease, some of which will have been diagnosed years earlier;
(d) 90% of cancer deaths were of people aged 55 or over.
(MHS Cancer Services Review 1996).
In 1997, the Hospice in Moray (H.I.M.) Steering Committee published their proposals
for a Day Hospice in Moray. The efforts of the H.I.M. campaign have been key to the development of this project. In 1998, the Scottish Health Feedback Action Research
report was published. One of it’s key recommendations was also the provision of a Day Hospice/Resource Centre in Moray. There followed the establishment of a Grampian Health Board Working Group, chaired by Dr. Gordon Paterson, to put together proposals for improving cancer and palliative care services in Moray, and to look at the issues around the setting up of a Day Hospice.
The Oaks Palliative Care Day Unit opened 2nd June 2003 and then was officially opened by HRH Prince Charles on 5th August 2003 with the full support of Grampian Health Board, NHS Grampian Trust, the Moray Hospice Steering Group, and Macmillan Cancer Relief.
The facility aims to provide increased support to patients being cared for at home,
and to their carers. In providing this support it is hoped to enable more people to
spend longer being cared for at home, and for that time to be of better quality.
More than 70% of people wish to die at home; less than 30% of people actually do.
The over-riding aim is to provide an holistic approach to care which will meet
the most important needs of individual patients and their carers at any particular time.
The key elements to the type of care provided are well described in the World
Health Organisation definition of palliative care, viz. “the active total care of
patients…..the goal of palliative care is achievement of the best quality of life for
patients and their family….palliative care affirms life,…..provides relief from pain
and other distressing symptoms, …..integrates the psychological and spiritual aspects
of patient care, ….offers a support system to help patients live as actively as possible until death,…. offers a support system to help families cope during the patient’s illness and in their bereavement”. This will involve providing clinical care and treatments in an outpatient setting, with access to specialist staff, encouraging rehabilitation, providing psychosocial and spiritual support, and providing respite for carers. The integration of all these various elements of supportive care will be the exciting challenge of the Palliative Care Day Centre. The Day Centre will function as a sister unit of the specialist palliative care services based at Roxburghe House, Aberdeen.
Though a focal element of the Centre is a Specialist Palliative Care Day Unit, the non-clinical elements are considered equally important – the Centre incorporates a “drop-in”/ information and support service; volunteers and the local community are encouraged to be intimately involved in supporting this aspect of the Palliative Day Centre. The Centre also offers clinic space and acts as an educational resource.
The Palliative Care Day Centre for Moray is just one element in an integrated set of proposals for improvements in cancer and palliative care services for the region. The key to this whole process is the provision of expert supportive care to all patients by a team of multi-professionals and volunteers. Elements of the services available within the Day Centre are outreach in nature, with some team members being able to visit patients in other care settings, and with carers and professionals from other settings gaining experience in the Unit which they can bring back to their own places of care.
Aims and Objectives:
· To develop further the existing supportive and palliative care services for Moray, focusing on enabling people with cancer and other chronic illnesses to live as independently as possible in their own homes and communities.
· To reduce the need for admission of patients to hospital for terminal care.
· To provide specialist palliative care in a day unit setting.
· To provide other care and treatments in an out-patient setting.
· To be actively involved in the rehabilitation of patients, where appropriate.
· To provide a range of activities to suit individual needs and abilities.
· To provide psychosocial and spiritual support to patients and their carers.
· To provide access to specialist staff, including medical, nursing and AHPs
· To offer respite to carers.
· To improve communication and liaison between Primary Care and Specialist Palliative Care.
· To provide information on cancer and progressive illness to patients, their carers, the general public and health care professionals.
· To support the educational needs of Primary and Secondary Care professionals in Moray.
· To provide a facility available to the community for varied activities related to promotion of health and healthy living.
“Drop-in” Information and Support Service
The key to the ongoing success of the Palliative Care Day Centre is the extent to which the community of Moray have a feeling of “ownership” of it, and the extent to which they use the Unit for a wide range of activities.
The Information and Support Service is open to the general public, Monday - Friday each week from 0930am - 1630pm. The day-to-day running of the Information and Support Service is co-ordinated by the Information Support Nurse, though the Unit Manager retains overall management responsibility. The Information and Support Service incorporates:
An Information Centre See Appendix 1 for a copy of the Operational Policy for the Cancer Information and Support Service.
Reception area Staffed by volunteers
Providing welcome and direction to people arriving at the unit.
Answering phones, and directing calls
Basic admin support
Café and lounge area Provisions include: tea/coffee/soft drinks and snacks. The setting is informal, serviced by trained volunteers and managed by the Volunteer Services Manager.
The lounge area incorporates a children’s area.
Seminar Room A separate seminar room allows for activities to take place at any time during the day or evening.
To be used for lectures and educational activities, and for support groups to meet. This large room is capable of being sub-divided into two to allow smaller groups to meet. No more than 25 people can be accommodated. This room is accessed by unit staff and Macmillan teams.
Light refreshments are available to people attending sessions in the Seminar Room with a minimum donation.
The building may be used out-of-hours for lecturing, groups to meet, and other associated services at the discretion of the Centre Manager.
Specialist Palliative Care Day Unit
Palliative care should be an integral part of all patient’s care. Specialist palliative care is required by a significant minority of patients. The Specialist Palliative Care Day Unit within the Day Centre provides one element of an integrated Specialist Palliative Care Service for Moray, complementing the existing community Macmillan Nursing service.
Catchment Area
The Specialist Palliative Care Day Unit offers a service to those who live across Moray or within a reasonable travelling distance from Elgin, and for whom travel arrangements are possible.
Patient Groups
All patients admitted to the service must have cancer and/or palliative care needs. This service is aimed at anyone over the age of 18. The Centre endeavours to provide information and advice to support the needs of sick children and their families in an appropriate way.
Routes of Referral
· Community/ hospital based Macmillan Nurses
· Primary Health Care Team
· Palliative Care Team
· Oncology Teams
· Acute Service Teams
· Hospital Palliative Care Team based at Aberdeen Royal Infirmary
· Specialist Nurses
· Social Work Department
· Self
Admissions Policy
Though a referral to the SPC Day Unit can originate from any source, all referrals should be discussed with the relevant GP or consultant prior to the referral proceeding.
For all patients, the GP remains the lead clinician in caring for patients who are in the community.
All referrals to the SPC Day Unit must have specific palliative care needs, and referral must be discussed with the patient and their carers.
Patients and carers are encouraged to visit the unit at time of referral.
A medical member of the team will be available to examine the patient at an appropriate time following their referral to the Unit.
Discharge Policy
On admission to the SPC day unit, a plan for care will be discussed with the patient and carers. This plan of care is reviewed on an ongoing basis every 8-12 weeks to ensure appropriate care. For some patients, if their condition stabilises, and the problems leading to referral have been resolved, ongoing follow-up might better take place through another element of the palliative care service, (e.g. Primary Care Team with or without the support of the community Macmillan nursing team; the “Drop-in” service and the variety of clinics). These patients are discharged from the SPC day unit, but referral again in the future may be an appropriate part of their ongoing care.
Patients may be discharged from the SPC day unit for the following reasons-
· Transfer to another service
· Moving outwith the area
· Due to deteriorated condition patients are unable to travel any more
· Initial referral reason has been resolved and needs met
· Improvement or “plateau” reached in condition, so that Day Care becomes neither desired nor beneficial
· Severe confusion when this condition cannot be safely managed, or where, despite intervention undue distress is being caused to others
Decisions on discharge are discussed and agreed with the Palliative and Primary Health Care teams, with the Nurse Manager taking a lead role, alongside the patient and/or carer.
Communication
Effective verbal and written communication is essential to the efficient functioning and integration of the service.
The team members working in the Day Unit ensure frequent communication with members of the Primary Health Care Team as appropriate. In particular, any changes in a patient’s condition and any recommendations regarding changes in treatment is communicated directly to the patient’s GP by the appropriate team professional.
Effective communication within the Day Unit is critical – individual case notes are kept up to date for each patient. Patient records are kept in the Nurse Managers room in a filing cabinet that can be securely locked. The case notes of patients no longer attending the SPC Day Unit are stored within a locked/ keypad room within the centre.
Communication with social services and secondary care is also important. IT communication links are established with Dr. Gray’s Hospital.
Website
Information regarding The Oaks services and clinics, general information and forms
can be accessed via NHS Grampian homepage. The 05/06 Annual report will be available electronically via the website in June 2006.
Established clinics and services
Palliative Care Clinic
Dr Tim Morgan provides a symptom control/ palliative care clinic every Thursday. At this clinic he assesses all day patients that attend the unit and reviews individuals following assessment by nursing staff. As well as the day patients Dr Morgan sees outpatients and carries out domicilliary visits in Moray with the Macmillan nursing team or General Practitioners. The referrals for this service are managed by The Oaks Centre Manager / secretary depending on priority of need stated by the referrer.
Chronic Oedema Clinic
The Chronic Oedema clinic in Moray was set up in 1998. The clinic moved from Dr. Grays to The Oaks when it opened. A Community Macmillan Nurse runs the clinic on a Wednesday weekly. Treatments include skin care, massage, compression and exercise. Following the initial phase of assessment and treatment patients are offered regular monitoring. Treatment can be adapted or changed if required. The referring doctor/nurse is kept informed of the patient's progress.
Complementary Therapy Clinic
The Oaks Complementary Therapy clinic has been set up to benefit people in Moray who are affected by cancer by providing a range of complementary therapies at a reduced cost.
Those attending the clinic must have either a cancer diagnosis, be an immediate carer of a person with a cancer diagnosis or be seen at the discretion of the therapist. The clinic runs on Fridays between 10am and 4pm and currently offers the following treatments:
· Reflexology
· Aromatherapy
· Massage including: Swedish and Indian Head Massage
· Reiki
· Hypnotherapy
· Art Therapy
The Clinic was set up in February 2004 and uses a variety of therapists.
An initial consultation is charged at £20 and all further individual treatments are charged at £15 per session which is payable to the therapist. Each session lasts up to an hour. It should be noted that these charges go directly to the therapist and that The Oaks receives no profit from the clinic.