Evaluation of Midazolam Prescribing Practices of a Large Tertiary Paediatric Palliative Care Centre in the UK: A Retrospective Case Note Review

2019 ◽  
Author(s):  
Jonathan Downie
Keyword(s):  
Palliative Care ◽  
Case Note ◽  
Care Centre ◽  
Prescribing Practices ◽  
Retrospective Case ◽  
Paediatric Palliative Care ◽  
The Uk ◽  
Case Note Review

scholarly journals Transitions to palliative care for older people in acute hospitals: a mixed-methods study

2013 ◽  
Vol 1 (11) ◽  
pp. 1-138 ◽  
Author(s):  
M Gott ◽  
C Ingleton ◽  
C Gardiner ◽  
N Richards ◽  
M Cobb ◽  
...  
Keyword(s):  
Palliative Care ◽  
Focus Groups ◽  
Care Transitions ◽  
Case Note ◽  
Hospital Inpatient ◽  
Care Needs ◽  
Retrospective Case ◽  
Acute Hospitals ◽  
Palliative Care Needs ◽  
Case Note Review

BackgroundImproving the provision of palliative and end-of-life care is a priority for the NHS. Ensuring an appropriately managed ‘transition’ to a palliative approach for care when patients are likely to be entering the last year of life is central to current policy. Acute hospitals represent a significant site of palliative care delivery and specific guidance has been published regarding the management of palliative care transitions within this setting.Aims(1) to explore how transitions to a palliative care approach are managed and experienced in acute hospitals and to identify best practice from the perspective of clinicians and service users; (2) to examine the extent of potentially avoidable hospital admissions amongst hospital inpatients with palliative care needs.DesignA mixed-methods design was adopted in two hospitals in England, serving diverse patient populations. Methods included (1) two systematic reviews; (2) focus groups and interviews with 58 health-care professionals to explore barriers to, and facilitators of, palliative care transitions in hospital; (3) a hospital inpatient survey examining palliative care needs and aspects of management including a self-/proxy-completed questionnaire, a survey of medical and nursing staff and a case note review; (4) in-depth interviews with 15 patients with palliative care needs; (5) a retrospective case note review of all inpatients present in the hospital at the time of the survey who had died within the subsequent 12 months; and (6) focus groups with 83 key decision-makers to explore the implications of the findings for service delivery and policy.ResultsOf the 514 patients in the inpatient survey sample, just over one-third (n = 185, 36.0%) met one or more of the Gold Standards Framework (GSF) prognostic indicator criteria for palliative care needs. The most common GSF prognostic indicator was frailty, with almost one-third of patients (27%) meeting this criteria. Agreement between medical and nursing staff and the GSF with respect to identifying patients with palliative care needs was poor. In focus groups, health professionals reported difficulties in recognising that a patient had entered the last 12 months of life. In-depth interviews with patients found that many of those interviewed were unaware of their prognosis and showed little insight into what they could expect from the trajectory of their disease. The retrospective case note review found that 35 (7.2%) admissions were potentially avoidable. The potential annual cost saving across both hospitals of preventing these admissions was approximately £5.3M. However, a 2- or 3-day reduction in length of stay for these admissions would result in an annual cost saving of £21.6M or £32.4M respectively.ConclusionsPatients with palliative care needs represent a significant proportion of the hospital inpatient population. There is a significant gap between NHS policy regarding palliative and end-of-life care management in acute hospitals in England and current practice.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

scholarly journals A retrospective case note review of laparoscopic versus open reversal of Hartmann’s procedure

2014 ◽  
Vol 96 (7) ◽  
pp. 539-542 ◽  
Author(s):  
CL Walklett ◽  
NP Yeomans
Keyword(s):  
Case Note ◽  
Hartmann’S Procedure ◽  
Reversal Rate ◽  
Teaching Hospitals ◽  
Laparoscopic Technique ◽  
Complication Rates ◽  
Retrospective Case ◽  
Hartmann's Procedure ◽  
The Uk ◽  
Case Note Review

Introduction First described in 1921, Hartmann’s procedure is the gold standard treatment for complicated sigmoid diverticular disease. It is also used commonly for other causes of perforation of the large bowel. However, the reversal rate in the UK is much lower than in comparable countries, at only 18–22%. Furthermore, laparoscopic reversal (LRH) is used far less frequently than open reversal (ORH) despite evidence that a laparoscopic technique reduces patient morbidity and decreases patient recovery time. Methods This retrospective case note review undertook an analysis of all the patients who had undergone Hartmann’s procedure at two centres in Leeds Teaching Hospitals NHS Trust between February 2007 and February 2012. Out of 305 patients, 235 were identified and included in the analysis. Comparisons were then drawn between LRH and ORH groups. Results The reversal rate was 21%. Three-quarters (76%) were performed using an open technique, 20% were laparoscopic and 5% were converted to an open procedure. The mean hospital stay was longer for the ORH group (9.82 days, standard deviation [SD]: 5.85 days, 95% confidence interval [CI]: 2.99 days) than for the LRH group (7.29 days, SD: 4.65 days, 95% CI: 11.58 days) p=0.006). Seven ORH patients (21%) were reoperated but only one LRH patient (13%) had a reoperation at six months. Five factors were found to have a significant effect on the likelihood of reversal of Hartmann’s procedure. Conclusions The overall reversal rate for Hartmann’s procedure remains low. Shorter hospital stays, lower 6-month reoperation rates and reduced 30-day complication rates are associated with LRH when compared with ORH.

31 A multi-site retrospective case note review for clinical practices of constipation in specialist palliative care settings

2018 ◽  
Vol 8 (3) ◽  
pp. 371.2-371
Author(s):  
S McIlfatrick ◽  
DHL Muldrew ◽  
E Carduff ◽  
M Clarke ◽  
J Coast ◽  
...  
Keyword(s):  
Palliative Care ◽  
Clinical Practice ◽  
Advanced Cancer ◽  
Management Strategies ◽  
Case Note ◽  
Specialist Palliative Care ◽  
Clinical Practices ◽  
Retrospective Case ◽  
Pharmacological Management ◽  
Case Note Review

BackgroundConstipation is a common symptom for patients receiving palliative care. Whilst national clinical guidelines are available on the management of constipation for people with advanced cancer in specialist palliative care (SPC) settings questions exist around clinical practice and the extent to which the guidelines are implemented in practice. This study examine current clinical practice for management of constipation for patients with advanced cancer in SPC settings.MethodsA multi-site retrospective case-note review was conducted consisting of 150 patient case-notes from three SPC units across the United Kingdom between August 2016 and May 2017. Descriptive statistics were used to compare clinical practices to national policy guidelines for constipation.ResultsA physical exam and bowel history was recorded for 109 patients (73%). Whilst the Bristol Stool Chart was used frequently across sites (96%) involvement of the multidisciplinary team varied. Almost a third of patient charts (27%) recorded no evidence of non-pharmacological management strategies. Pharmacological management was recorded frequently with sodium docusate or senna as the preferred laxatives across all sites however 33% of patient charts recorded no information on the titration of laxatives. There were no consistent management strategies recorded for opioid induced constipation or bowel obstructionConclusionAssessment and management of constipation in SPC settings is highly variable. Variations in assessment; limited use of non-pharmacological and preventative strategies and absence of consistent strategies for opioid induced constipation or bowel obstruction are evident. Further education is needed to equip HCPs with the necessary knowledge and skills to assess and manage constipation.References. Friedrichsen M, Erichsen E. The lived experience of constipation in cancer patients in palliative hospital-based home care. Int J Palliat Nurs [Internet] 2004;10(7):321–5. Available from: http://search.ebscohost.com/login.aspx?direct=true&profile=ehost&scope=site&authtype=crawler&jrnl?=13576321&A?N=13991056&h=XKMF4r08srZuhDY0j7C95oLLyYKNHUcvoeEuhyXNnsIM2BI%2BEhmcY1pPP%2BN1pvrMzQ9Bn9b5j45X6WzyBRydEA%3D%3D&crl=c [Accessed: 21 August 2017]. Gilbert EH, et al. Chart reviews in emergency medicine research: Where are the methods?Annals of Emergency Medicine1996;27(3):305–8. Available at: http://www.ncbi.nlm.nih.gov/pubmed/8599488 [Accessed: 17 May 2018]. National Clinical Effectiveness Committee. Management of constipation in adult patients receiving palliative care national clinical guideline No. 10November 2015.. Tvistholm N, Munch L, Danielsen AK. Constipation is casting a shadow over everyday life? A systematic review on older people’s experience of living with constipation [Internet]. Journal of Clinical Nursing2017;26:902–14. Available from: http://doi.wiley.com/10.1111/jocn.13422 [Accessed: 21 August 2017]. Wickson-griffiths A, et al.Revisiting retrospective chart review: An evaluation of nursing home palliative and end-of-life care research. Palliative Medicine Care2014;1(2):8. Available at: www.symbiosisonlinepublishing.com [Accessed: 23 November 2017]

Balloon sinuplasty: our first year

2010 ◽  
Vol 125 (1) ◽  
pp. 43-52 ◽  
Author(s):  
C Hopkins ◽  
E Noon ◽  
D Bray ◽  
D Roberts
Keyword(s):  
New Technology ◽  
Case Note ◽  
First Year ◽  
Subjective Improvement ◽  
Retrospective Case ◽  
Balloon Sinuplasty ◽  
Additional Costs ◽  
The Uk ◽  
Snot 22 ◽  
Case Note Review

AbstractIntroduction:Balloon sinuplasty is a new technology which has only recently been introduced in the UK. We review the current literature, and we present our first year's results for the technique together with a description of indications, outcomes and problems.Methods:Retrospective case note review of 27 consecutive patients undergoing sinuplasty alone in the first year in which this procedure was performed. The main outcome measures used were subjective improvement and Sino-Nasal Outcome Test (SNOT-22) score.Results:Dilatation was successful in 98 per cent of sinuses in which it was attempted; however, subjective improvement was noted in only 62 per cent of patients thus treated.Conclusion:We believe that balloon sinuplasty has a place in routine rhinology practice but that its applications are limited, and that its additional costs must be considered. We present advantages and possible limitations of the technique.

Can we predict Acute Medical readmissions using the BOOST tool? A retrospective case note review

2016 ◽  
Vol 15 (3) ◽  
pp. 119-123
Author(s):  
Geraldine A Lee ◽  
◽  
D Freedman ◽  
Penelope Beddoes ◽  
Emily Lyness ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Risk Assessment ◽  
Risk Factor ◽  
Hospital Discharge ◽  
Assessment Tool ◽  
Case Note ◽  
Retrospective Case ◽  
The Uk ◽  
Case Note Review

Background: Readmissions within 30-days of hospital discharge are a problem. The aim was to determine if the Better Outcomes for Older Adults through Safe Transitions (BOOST) risk assessment tool was applicable within the UK. Methods: Patients over 65 readmitted were identified retrospectively via a casenote review. BOOST assessment was applied with 1 point for each risk factor. Results: 324 patients were readmitted (mean age 77 years) with a median of 7 days between discharge and readmission. The median BOOST score was 3 (IQR 2-4) with polypharmacy evident in 88% and prior hospitalisation in 70%. The tool correctly predicted 90% of readmissions using two or more risk factors and 99.1% if one risk factor was included. Conclusion: The BOOST assessment tool appears appropriate in predicting readmissions however further analysis is required to determine its precision.

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