P-199 ‘every day counts’ – pilot of a service for improving access and consistency in palliative care seven days a week

Abstract

Background The National Institute for Health and Care Excellence (NICE) has highlighted the need for access to specialist palliative care seven days a week in order to improve the quality of care, experience and outcomes for patients and their families. (NICE, 2004; NICE, 2015) Little is known about the demand for a seven-day Palliative Care Clinical Nurse Specialist (PCCNS) service in a small island of ~85 000 residents. Generalist services are available to patients on weekends and holidays. Aim The aim of this pilot was to determine the need for, use of and the impact of a seven-day PCCNS service. Method The pilot service was offered between 1 October 2016 and 31 March 2017 by the local hospice PCCNS team, the only specialist palliative care provider on the island. The service was established using the existing team of 5.2 full-time equivalent PCCNS, overseen by their manager. The PCCNS on duty for the weekend was available for urgent telephone calls and visits. For patients with anticipated need, contact was made as requested by PCCNS colleagues, and ‘routine’ work from the existing caseload was also undertaken. The service was publicised directly to existing patients, and health providers on the island. The number, source and reason for calls, visits and hospice or hospital admissions were recorded and analysed. Feedback was sought from patients, caregivers, the PCCNS team and health professionals. Results The PCCNS team received 84 urgent calls, generating 59 visits and 113 additional calls. Main reasons for contact were for anxiety support (32%), symptom management (28%) and end of life care (16%). Weekend service resulted in 12 in-patient admissions to hospice, 58% for end of life care. Conclusion The number of contacts supports the case for weekend and bank holiday cover. A seven-day PCCNS service is feasible and beneficial to patients and their families.