Ark Magazine: Vol 1

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The Voice of Healthcare ARK VOL.1 POWERED BY In this issue A SENSE OF CONTROL HOME ALONE ON THE FRONT LINE OF PALLIATIVE CARE PLAN FOR DEATH LIKE YOU PLAN FOR LIFE COMING HOME Caring for people is at the heart of everything we do

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In this issue: + A Sense of Control, + Home Alone, + On the front line of Palliative Care, + Plan for death like you plan for life, + Coming Home

Transcript of Ark Magazine: Vol 1

  • The Voice of Healthcare

    ARK VOL.1

    POWERED BY

    In this issueA SENSE OF CONTROL

    HOME ALONE

    ON THE FRONT LINE OF PALLIATIVE CARE

    PLAN FOR DEATH LIKE YOU PLAN FOR LIFE

    COMING HOME

    Caring for people is at the heart of

    everything we do

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  • Editor, Rachel McClelland and hergrandmother who turned 90 earlier this year.

    A SHARED VISIONI must admit that when we decided thefirst issue of the magazine would focuson palliative care, I was a littleapprehensive.

    I, like many others, am scared of dying.Theres a bizarre sense that if we talkabout it, we tempt fate. Crazy I know,because whats actually needed iscommunication. Open conversation atevery level - between patients and theirfamilies, patients and healthcareprofessionals.

    Over the last few months, my team andI have spent significant time researchingand talking to a range of healthcareprofessionals, key opinion leaders andpatients and their families, all of whombelong to the palliative care category.

    We have been met with genuinepassion and warmth and its becomeapparent that there is a shared and verypowerful vision; patients throughout thenation must have the right to choosehow and when they receive their care,and healthcare organisations, GPs andcharities must unite to ensure that asimple system can achieve this.

    This first issue of the magazine hascertainly impacted my life, instigating aconversation with family to ensure thatmy wishes are known.

    I hope that you enjoy the collection of articles and interviews; there aresome important messages and thought provoking stories in the pagesthat follow.

    Rachel McClelland.

    2

    a sense ofControl

    In his bestselling new book, Being Mortal,

    the surgeon and New York writer Atul

    Gawande argues that when people have a

    sense of control over the end of their lives,

    their last years, months and weeks are more

    fulfilled. Autonomy, the feeling of being the

    author of your own life, continues to matter

    to the old and the dying. And when

    Gawande has to make medical decisions

    whether to operate, for instance its much

    easier if he knows what matters to his

    patient. If she feels that life will only be

    worth living if she can continue to use

    email, or his main concern is being able to

    carry on watching sport, its easier to weigh

    up the benefits of intervening against the

    likely side-effects.

    So I was pleased that my mother was being

    asked to outline her preferences now, while

    she could. Unfortunately, all the NHS can

    capture is a snapshot of what she thinks at

    the moment. My mother has been

    diagnosed with dementia. What if, as her

    condition progresses, she changes her

    mind? And if she does, how will she tell us?

    When it came to the questions about what

    would happen if she could no longer live

    independently, she was violently and

    implacably opposed to living with us. As for

    residential care, she said if she couldnt live

    in her flat, shed rather die. She doesnt

    altogether accept her diagnosis; but the

    fact is, the chances that she will need care

    at some point are extremely high.

    Those who care for people with dementia

    often argue that even as memory, thinking

    and reasoning may be eroded,

    personhood, doesnt change. You are still

    you. So when my mum can no longer speak

    for herself, do we assume that the opinions

    she held for a lifetime, before parts of her

    brain stopped transmitting, still hold?

    My 85 year-old mother recentlyhad a letter from the local NHSTrust asking her to detail whatwould be important to her in anyfuture care. Great, we thought:the NHS seems to be interestedin quality of life rather thansimply in prolonging it. (My mumhas always been adamantlyagainst being kept alive, as shewould put it, for the sake of it.)

    by Geraldine Bedell

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  • when people have a sense of

    control over the endof their lives, their last

    years, months andweeks are more

    fulfilled

    Im not sure we can. People change their

    minds all the time. Its often observed that the

    closer people get to death, the more tenacious

    of life they become. Accepting that my mother

    is a person now and will be a person in two

    years time doesnt mean that all her views are

    going to be exactly the same through that

    period. And even if she would rather die than

    go into residential care, we arent going to be

    in a position to kill her, even if we wanted to

    (which we dont).

    There are all sorts of things that might change.

    I dont think that listening to or playing music

    appears anywhere on the form shes filled out,

    but music often becomes a lifeline for people

    with dementia. Musical responses persist,

    perhaps because music can be experienced in

    the moment (already, my mum cant follow an

    entire play in the theatre but she will happily

    listen to a symphony). Something that doesnt

    figure much now could come to be a reason

    for living.

    As the histories, beliefs and sense of

    accomplishments that make up our identity

    erode, we are forced back into finding a sense

    of self in our shared humanity. The humane

    approach to caring for someone with dementia

    is to focus on what a person with Alzheimers

    can do, what their life history has been and the

    importance of their relationships, past and

    present; and on how all those things can

    contribute to having a good day now. So, on

    balance, I am pleased that my mother is being

    asked to articulate these things now, while she

    can. But I cant help feeling that she is receding

    from me down a long dark tunnel and at some

    point in a years time, or five she may still

    feel strongly what she wants from her care, but

    she wont be able to tell me.

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  • arie Curie now recognises that itsnot just the clinical needs of theterminally ill that require servicing

    but the psychological strain of being homealone while facing illness.

    VOLUNTEER SCHEMEIn recent years, we have recognised thatpeople who perhaps live on their own and areapproaching the end of their life are oftenvery socially isolated, says Dr Collins.There has been quite a lot about this in thepress lately, particularly about men, so wehave devised a volunteer scheme calledHelper Volunteers, where a volunteer goesinto somebodys home for up to three hours a week. Their role is to provide emotional and practical support. But it mainly centresaround emotional support for people whoare rather isolated.

    Dr Collins describes Marie Curie as a roll yoursleeves up type of operation. Its core activityis providing nursing care in peoples homes.

    But while the obvious focus is the person whois terminally ill, its the families of thoseaffected, she says, who probably glean thegreatest benefit. Often it may be that the husband or wife isable to get a good nights rest knowing theirloved ones got with them someone whosvery experienced in caring for thoseapproaching the end of their life. The family isas important to the way we work as theperson who needs the care. We know the twomost important things for people approachingdeath is pain control and having family andfriends around.

    But she has a problem with the term end oflife, or at least the way most people perceiveit. Understandably, the image that springs to mind for most of us is of someonestruggling for breath as they enter their final hours and minutes.

    PRECIOUS TIMEIn fact,there is good evidence that end of lifecan be prolonged by encouraging the rightlifestyle. Exercise, for example, can booststrength and buy precious time.Thinking about a rehabilitation programmemight sound odd in the context of terminalillness but it isnt odd at all. People who arelosing weight because they have got aterminal illness may get into a vicious cyclewhere they dont get out and they dont getany exercise so they get weaker.

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    HOMEALONE

    At Marie Curie, Chief Executive Dr Jane Collins has been spearheading changes thatare taking the organisation beyond the confines of its traditional role in palliative care.

    The good news iswere all livinglonger. The badnews is nobodyseems quite surehow Britains healthand social careinfrastructure willcope with the far-reachingconsequences ofthis increasedlongevity.

    M

    by Pat Hagan

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  • What we want is for people to have as gooda life as they can, until they have their lastbreath. She points to the positive effects onlifespan from the terminally ill continuing topursue their favourite hobbies.For example, we are one of the beneficiariesof the National Gardening Scheme. Theresgood evidence that the benefits of seeingliving things and being out in the fresh air canbe a boost. Even being able to look out of thewindow and see trees can provide a benefit.

    STARTING OUTDr Collins passion for palliative care stems,ironically, not from years ofworking with those nearingthe end of life but thosejust starting out in it.A paediatrician bytrade, sheworked as aconsultantpaediatricneurologist atGuys Hospitalin London andthen at GreatOrmond StreetHospital, beforeserving an 11-yearstint as the lattersChief Executive.I felt it was time for achange and I have always beenreally interested in palliative care.As a neurologist I looked after children forwhom there were limited treatment optionsand recognised the devastating impact thathad on families, particularly if their child died.

    I had a longstanding interest in palliative carefor children and so when I was thinking whatam I going to do now and saw the job (MarieCurie Chief Executive) advertised, I felt that itwas a very natural move. But shes under noillusions at the size of the task she faces if theterminally ill and their families are to get thesupport they need as they face deathtogether. Dr Collins recognises that the lonevoice of a single charity however high profile wields less clout than the collective force ofinterested parties working in unison.Together with a number of other charities andeducational organisations (including the

    Cicely Saunders Institute at KingsCollege), Marie Curie has

    compiled a hit list oftopics that should getpoliticians attentionin the run-up tonext yearsgeneral election.She says: Oneof the mostimportant thingsfor people isgetting access tosocial care. We

    know from a varietyof different pieces of

    work that have beendone by us and by others

    that one of the reasons whypeople who want to die at home

    arent able to and get admitted to hospitalinstead is a lack of social care. Thats not tosay some people dont need to die in hospitalrather than home. But many dont. Socialcare is more complicated than health care

    because its means tested and so one of themain things were asking for is free social carein the last three months of life. Obviously, itsquite tricky to define when your last threemonths are, but its at least something whichpeople can start to get their heads round.Local authorities and their partners who areproviding social care will have to understandthat some people might not survive threemonths and some people might survivelonger. This is one of the things that we arevery much promoting. It already has somepolitical traction but wed like it to have more.We will keep talking about it and one of theadvantages of working in partnership is wehave a louder voice collectively than we doseparately.

    THE IMPACTBut why does a good death even matter?Dr Collins says, its not only about the personwho is dying but the impact on those theyleave behind. In short, people remember thebad times as much, if not more, than thegood. I meet people and tell them Im theChief Executive of Marie Curie and they willoften recount their experiences of somebodytheyve loved whos died. It could have beenvery recent, or it might have been 20 yearsago. But theres something enduring aboutthe experience for those left behind. If theirloved one didnt have what they wanted, theirpain wasnt managed or they just were notlistened to, that stays with people in a waythat is not helpful to them. What should webe aiming for? For everybody to feel that adeath was as good as it can be. That mightsound funny. But it is what we all want foreach other.

    Social isolationand an ageing population

    means a changing rolefor some traditional

    palliative care services,says Dr Jane Collins, Chief Executive of

    Marie Curie.

    Often it may be thatthe husband or wife isable to get a goodnights rest knowingtheir loved ones gotwith them someonewhos veryexperienced in caringfor those approachingthe end of their life

    Dr Jane Collins (left)

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  • ON THE FRONT LINE OF PALLIATIVE CARE

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    Gayle Hemstock began her career in medicine and respiratory, workingher way up from a staff nurse to a senior sister ward manager. A passion for palliative care led her to undertaking a degree in palliation and ultimately to her current post as a Specialist Sister Palliative care.

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  • What is it about palliative carethat interests you?Its the fact that we can make a differenceto a really awful situation, whether it be acomplex physical problem or offeringemotional support.

    Do most people know whatpalliation is?No, I dont think the general public knowswhat the word palliation means. Thats whysometimes I say Hi, I am a Macmillannurse because the majority of people haveheard of Macmillan rather than palliation. I have to be careful though - I cant say Hi I am Macmillan nurse to a patient witha non-malignant disease because I mightfrighten them into thinking they havecancer on top of their diagnosed condition.

    What are the highlights of yourwork?Theres probably not a day that goes bythat I dont think Im sure I made a bit of adifference there. Thats enough for me,because if I can go to a patient who is inawful pain, and the next day or the dayafter that theyre pain free, then thatsbrilliant. Theres huge job satisfaction inthat. Its also nice to be able to givepsychological support: we just talk through whatever is worrying them andthey get some sort of benefit from it. Itsounds really clichd but I love this job - Ill probably be doing it forever.

    Whats the hardest part of your job?Thats a difficult one because all of its hard. We just get used to it.

    Are there any special techniquesused in dealing with patients andtheir families in palliativecare?We all do advancedcommunication skills,which definitelyhelps, mainlybecause patientsand families tendto be distressed.We try to get themost out ofconversationsusing keystatements reallyjust to try and get tothe nitty gritty of whatthe problem might be. Ithink a lot of it comes withexperience really, most of us havebeen around long enough just to know howto communicate.

    Is there anything that isparticularly upsetting or stressfulabout your work?If we can relate to the patients weresupporting because of similarities with ourown families then it can really hit home. So we have to try and protect each other if there is a case like that - usuallysomebody else will go so that its not quite so challenging.

    From a nursing perspective, whatare the greatest challenges?Its sometimes difficult for people to reallyunderstand what palliation is and what thepalliative care teams actually do, and thatcan include clinicians too. Sometimes wefind that doctors and nurses refer someonewho is newly diagnosed, upset or in painbefore they have tried to reassure thepatient and given them paracetamol orcocodamol to ease their suffering.

    Are there any other challenges that affect your team?We could do with more community support- there is a definite lack of nurses andMacmillan nurses around at the moment.Our role is to see anybody with anythingthat is going to end their life and to providethem with whatever they need at that time.And its not just about cancer. People witha COPD or heart failure also need oursupport, whether theyre in hospital or inthe community, so we have to make surethat their needs are being met too.

    Where do palliation nurses go for support?

    We are pretty good at supportingeach other as a team. When

    we have time, we havean informal chat at

    the end of the day,just to gothrough thepatients andtalk it down.Its easier thento go homeand becomethe wife ordaughter that

    we are outside of our jobs. This

    works well in ourteam because we

    are all in the same boat and we all understand the

    patients that we are seeing.

    What advice would you give tonurses who want to move intothis area?I would tell them to get a few yearsexperience under their belts first. Thepatients that we see could have anything, it could be a gynaecological problem, it could be respiratory, it could beorthopaedic and so on. So youve got tohave a broad knowledge base and beenqualified for several years to get by.

    The patientsthat we see could haveanything, it could be a

    gynaecological problem, itcould be respiratory, it couldbe orthopaedic and so on. So

    youve got to have a broadknowledge base and been

    qualified for several years to get by.

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  • heres no doubting Professor MayurLakhanis professional credentialswhen it comes to spearheading

    change in the provision of palliative careand theres also no question that he hasthe personal experiences to match them.Sadly, Professor Lakhani watched both hisparents die from cancer at a time whenpalliative was very much a fringe service,from which only a small minority of patientsever benefitted.When my father died in 1989 there wasntreally that much palliative care available.Ten years ago, when my mother also diedfrom cancer, things had improved a goodbit. I remember the Macmillan Nurse cameto see her and she put the syringe driverup and gave her the pain relief sheneeded. I thought to myself that isabsolutely fantastic, but in the end mymother died in hospital. And as a familydoctor, I know a great many people aredying but are not recognised as dying, sothey dont get palliative care. So I decidedthat I would do something about it and Ibecame chairman of the National Councilfor Palliative Care.

    DYING MATTERS The NCPC is the umbrella charity for allthose involved in palliative, end of life andhospice care in England, Wales andNorthern Ireland. It was set up by the lateDame Cicely Saunders, widely regarded asthe founder of the modern hospicemovement, and campaigns for everyonenearing the end of life to have access tothe highest quality care and support,wherever they live and whatever theircondition.

    As chair, Professor Lakhani also plays apivotal role in Dying Matters, a coalition of30,000 members across England and Waleswhich aims to help people talk moreopenly about dying, death andbereavement, and to make plans for theend of life. Membership includes everyone

    from hospices, care homes and GPs tofuneral directors, lawyers and faith groups.The objective of Dying Matters is to have agreat national conversation about deathand dying and to get, in effect, advancecare planning. It hurts me that so manypeople dont get the care that they need.Its estimated that 92,000 people a year inEngland alone dont get palliative care, sothey either die in hospital or at home withuncontrolled symptoms. We need tochange that. Thankfully, things arechanging in the wake of the 2008 NationalEnd of Life Care Strategy. More people arebeing allowed to die at home and thingsare moving in the right direction.

    PLAN FOR DEATH LIKEYOU PLAN FOR LIFE

    8

    Its not an easy message. But planning fordeath is something we must all learn to do,says Professor Mayur Lakhani, who believesthe NHS needs many more GPs to providegood palliative care.

    THE ART OFBREAKING BADNEWSBreaking bad news is one of thehardest tasks in medicine, requiringa delicate balance of honesty andsensitivity. So whats ProfessorLakhanis formula?We have special training in this and havetrained a lot of GPs. First we make surethe room is well set out and there are nointerruptions so phones are switchedoff. We check what the family of theperson knows already, for sometimes theydo suspect whats coming. Then you startwith very gentle opening questionsaround I see youve come to discuss aletter from the Consultant today. Whatdo you know already so far, or how didyou feel when the Consultant told youabout whats wrong with you?. Onceyouve established what insight thepatient has, then say something of awarning shot, along the lines of when Isaw the letter, I got concerned because itwasnt the news I wanted to read, MrsSmith. As your doctor I was hoping formore positive news.That just prepares them a little and thenyou pause to let it sink in.

    It may take two or three meetings but Ithink its very important to be honest withpeople and to ask whats worrying them.The top three concerns of people who aredying are dying alone, being a burden tothe family and having pain. So wereassure them about the servicesavailable. People get scared but planningahead is really important, so they can saygoodbye, say I love you and do thingsthey want to do. Some people dont wantto know and we must respect that as well.As for us doctors, its important that itdoesnt become just a routine or a task. I think it does affect you and that helpsyou give good care. Showing a bit ofyourself to the patient can be very good.But doctors also have to take care ofthemselves because over involvement cancontribute to burnout.

    Professor Lakhani is chair of the coalitiongroup Dying Matters and also chairs theNational Council for Palliative Care.When not working as a practising GP, he also serves as chairman of NHS WestLeicestershire CCG.

    Tby Pat Hagan

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  • But Professor Lakhanis personal target is toget more GPs to identify in advance patients who are dying in time to helpthem draw up a proper care plan.Lets say youre 55 or over. Just thinkahead to whos going to make yourdecisions, or what would happen if youdeveloped a serious illness like cancer or aserious heart disease? The best advice is tothink ahead. Talk to your doctor, tell otherpeople about your decisions. In effect, planfor your death like you plan for birth. Its adifficult thing to talk about and I dontunderestimate the difficulties. I know a lotof my colleagues find it hard to discuss. Itsscary to tell someone that their life iscoming to an end.

    MORE TIMEBut theres a method to breaking bad news(see boxed article). Death is an inevitablepart of living but its possible to die wellwith early identification and good services.The major obstacle at the moment isnt alack of enthusiasm as much as a lack ofmanpower. Planning advanced palliativecare means GPs must allocate patientsmore time the one thing they do nothave much of.

    Professor Lakhani says: The numberone challenge is we havent gotenough GPs. We are 10,000 GPsshort in this country so that meanspeople are not identified forpalliative care as they should be.

    It is hard to get good round-the-clock care for patients inthe community and thatswhy they end up in hospital.We are struggling withworkforce and theworkload is rising. Weneed more GPs, thats adefinite, and I think weneed more resourcesin the shape of biggerprimary care teamsand more communitynurses.

    Constant NHS reform is often blamed for alack of continuity in services. But ProfessorLakhani believes the emergence of ClinicalCommissioning Groups has been a verypositive development. For the first time inmore than a decade, I have seen myPrimary Care Organisation really majoringon end of life care and the other two CCGsI work with are doing exactly the same.

    A LONG WAY TO GOThere is a long way to go and not everyoneis doing all that they can. But he has a

    clear message for other CCGs which haveyet to prioritise palliative care in the way itdeserves. Make the most of your powers.You have the budgets and the authority.Dont let providers come and tell you thisis what we need. Make the most of yourclinical leaders, the GPs, by asking themwhats working well and what isnt. The ideal palliative care model, he says,would be community based teamsorganised around federations. A federationof 30,000 to 90,000 population might haveits own palliative care nurses andgeriatricians. It would set a framework,ensure standards and slash bureaucracy.My message to the government anddecision-makers is simple - make end of lifecare a priority. How we care for peoplewho are dying is a litmus test for oursociety.

    It hurts me that so many people dont

    get the care that they need. Its estimated that 92,000people a year in Englandalone dont get palliativecare, so they either die inhospital or at home withuncontrolled symptoms.

    We need to change that

    Professor Lakhani

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  • 10

    wenty-First-Century palliative careshould, Im sure we all agree, focusprimarily on the patient.

    Unfortunately all too often, budgetaryconstraints, bureaucracy and conflictingstrategies inhibit the application of care,leading to tragic situations escalatingfurther. The NHS has, in recent years, beenworking with a number of key organisationsas part of their remit to improve palliativecare. Their involvement in projects like thePan London End of Life Alliance has begunto address issues and encourage people totalk about their needs and wishes.

    In 2009, my wife had a lumpectomy andthe start of treatment for breast cancer. Shehad a torrid time with chemotherapy andradiotherapy but after 13 months was giventhe all clear and told she didnt have toreturn to the hospital for a year. Wecelebrated by taking my grandsons onholiday and it was just as well becausewithin three months my wife was dead.

    Brians wife, Gill, had developed a rare formof leukaemia as a side effect of thechemotherapy. She was given eight weeksto live. The cancer was so aggressive thatshe died just 26 days later.

    When the news was delivered, Brian was incomplete denial, like a rabbit in theheadlights and that was the start of achallenging and devastating journey.

    Gill had expressed her wish to die at home,a seemingly simple last request, however, ittook seven days for them to escape, asBrian terms it, from the hospital system.Despite not needing or wanting financialassistance, somebody had applied ontheir behalf and that cost Gill andBrian seven days of their final 26together.

    Much to Brian and the familysrelief, Gill was finally able toreturn home; Gillsarriving home was aturning point. Thecontrast between theNHS and palliativecare was huge. Thenurses were fantastic.After five days Isacked the domesticcare; who wedironically got as aresult of the funding.The head carer wasmore interested in hertimesheets than anythingelse and when anothercarer arrived, she told usthat Gillian wasnt going todie because we were all goingto pray together and sweetJesus was going to save her.Im a man of faith but.

    COMING HOMEBrian Andrews, Chair of the Lay Representatives Board of the Pan London End of Life Alliance experienced at firsthand whatcan happen when palliative care doesnt quite get it right. In his heartbreaking story, Brian describes the trauma of losing his wife amidst a chaotic and ineffective system.

    Tby Rachel McClelland

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  • Six days before Gill died, the couplereceived a visit from the head of nursing atSt Christophers. They were told thatbecause of Gills condition there was astrong possibility that she could die at anymoment from a massive haemorrage. Brianasked what he should do if he were to bealone when that happens. The nursereplied, cuddle her, tell her you love her,it would only take a couple of minutes. Sheadvised him to have dark towels, ideallyred or brown, to mitigate the visible imageof what might happen in that event. Whilstshocking, the emotional support and thepractical advice was exactly what Brianneeded and it made a huge difference.

    We experienced seamless continuityexcept on one occasion; six days beforeGill died, she was in so much pain in themiddle of the night. As a last resort I calledthe emergency doctor. A couple of hourslater the emergency doctor arrived. Therewas an initial problem because his Englishwasnt perfect but more importantly hedidnt have a clue about Gills condition.He didnt want to give her medication, hewanted to send her back to hospital! Wehad do not resuscitate notices all over theflat and she was in significant pain and herefused to give her any medication - I hadto physically stop him from leaving the flatuntil he did so. Im not proud of that but Iwas desperate.

    Although Gill finally made it home,largely due to Brians persistence,there were significant flaws at everystage of the journey. Brianrecognizes that there aremany dedicated andprofessional carers andnursing teamsacross the UKand that

    the problems arise from an ineffectivesystem and bureaucracy. He believes thatwhat is needed is a One Stop Shop, onededicated individual who can access apatients total case history as well as onetelephone number, rather than the thirteenthat he had, that family members can usefor immediate assistance and support.

    Although still traumatised by hisexperience and the untimely loss of hiswife, Brian has channeled his grief andtirelessly campaigns to raise awareness inbid to change the system to ensure that

    peoples dying wishes are granted andthat their families dont suffer

    unnecessarily.

    Gills arriving home was a turningpoint. The contrast

    between the NHS andpalliative care washuge. The nurses

    were fantastic

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  • POWERED BY

    In December 2010, the National PatientSafety Agency (NPSA) issued a RapidResponse Report (RRR), regarding the use ofambulatory syringe drivers. The purpose wasto call upon healthcare organisations todevelop a purchasing for safety initiative forprocurement of safer ambulatory syringedrivers with a view to addressing a numberof reported safety issues with older devices.The actions in the RRR were to becompleted by 16 December 2011 with alldevices currently in use replaced byDecember 2015. The majority of syringe drivers and pumpsused in healthcare have rate settings inmillilitres (ml) per hour, however, some oldertypes of ambulatory syringe drivers haverate settings in millimetres (mm) of syringeplunger travel per hour (or 24 hour).

    This is not always the most effective andeasiest system for users. Inaccuratemeasurement of fluid length or incorrectrate setting of the device can result in errors.

    EVIDENCE OF HARMBetween 1 January 2005 and 30 June 2010there were eight deaths and 167 non-fatalreports involving ambulatory syringe drivers.Four of the deaths were reported in 2009.Many of these incidents described infusionsthat had either run through much quickerthan expected or had not infused at all.

    CURRENT SITUATIONAlmost four years on from the publication ofthe RRR around 75% of the older deviceshave been successfully replaced with CMEMedicals T34, which complies fully with all

    recommendations made in the report andcurrent safety standards. Although possibletraining issues were stated as aconsideration in the RRR comprehensivetraining and support packages have ensuredthe transition has been straightforward andsuccessful.

    The RRR and supporting information isavailable at:www.nrls.npsa.nhs.uk/resources/type/alerts

    GUIDANCE & ADVICEAny organisations that have not yet madethe transition can seek further informationand advice by contacting 01253 206700.

    NPSA ALERTAmbulatory SyringeDevices

    The Voice of Healthcare

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