Dr Sam Kyeremateng, Medical Director and Clinical Lead for Programme Development reflects on our recent utilising outcome measures into palliative care conference in partnership with Hospice UK, the Cicely Saunders Institute at King's College London and the Wolfson Palliative Care Research Centre, University of Hull.

“We were delighted to host a further conference focusing on the impact and power of utilising patient reported outcome measures (PROMs) in palliative care.” said Sam.

“Throughout the day we shared the latest evidence supporting the use of PROMs in palliative care settings, as well as real life case presentations of how PROMs have been embedded into practice. The event also provided a unique opportunity for organisations to highlight the key challenges they are facing and to share their own innovative solutions.

It was an extremely informative and insightful day, and drew together palliative and end of life care commissioners and providers working in hospices, acute hospitals and NHS community settings from across the UK, all eager to utilise PROMs in their own areas.

Validated PROMs are integral to the measurement and improvement of care quality, service user experience and patient safety. They can facilitate more efficient detection and monitoring of symptoms, enhance clinician-patient communication, whilst empowering clinicians to act and address issues. The data gathered underpins our working practices, informs staff skill mixes and workflows, and can help us demonstrate the impact of services to stakeholders at both service and organisational levels.

Engagement of service users and staff at all levels of the workforce is essential to successfully integrate PROMs into practice. Staff need to fully understand the value of incorporating PROMs and the data gathered must be utilised in their everyday clinical practices. Providing training, sharing knowledge, addressing barriers, undertaking audits and feeding back findings is crucial to keep everyone engaged and to drive changes forward.

Embedding PROMs into practice is not without its challenges, and the time commitment to drive changes forward and investment in staff and IT infrastructure and support should not be underestimated. It is essential to develop robust and user-friendly systems, and to ensure that data collected is complete and of a high quality for it to be useful.

A key challenge being faced by many is how to effectively extract, utilise and display the information gathered, so that it can be used in a meaningful way. Developing a standard minimum dataset of palliative outcome measures is essential to enable comparison of services and care settings, as well as the establishment of a set of national and international benchmarking standards that support research and improvements in care.

Embedding PROMs into practice is not easy, but through working together and sharing our ideas, knowledge and experiences we can develop a community of practice that supports integration.”

Ahead of our utilising outcome measures into palliative care conference at Clifford House later this month, Dr Sam Kyeremateng, Medical Director and Clinical Lead for Programme Development shares his thoughts and aspirations for the day.

“Following the overwhelming positive response to our implementing outcome measures into clinical practice conference in October, we are thrilled to be hosting a further conference in partnership with Hospice UK, the Cicely Saunders Institute at King's College London and the Wolfson Palliative Care Research Centre, University of Hull.” said Sam.

“Utilising outcome measures into palliative care will share the latest evidence supporting the benefits of incorporating patient reported outcome measures (PROMs) into clinical practices in both hospice and NHS settings, as well as sharing practical solutions and top tips to support teams with integrating them into their own areas.

Throughout the day we will be sharing our experiences of analysing the data collected and describing how the information gathered can be used and displayed to demonstrate the impact of services to commissioners and stakeholders. We will also be showcasing new and innovative tools and technologies that are currently being developed to support the delivery of high quality end of life care in the future.

As well as hearing our guest speakers experiences of utilising PROMs, interactive workshops will provide the opportunity for attendees to discuss key issues and challenges they are facing and to share their own solutions. Through everyone sharing their knowledge and experiences it is hoped that we can develop a community of practice that supports effective integration of PROMs into everyday practices.

We look forward welcoming all of our delegates to what promises to be an extremely insightful and thought-provoking conference very soon. Please do visit us again in early April when I will be sharing all the highlights and outcomes from the day.”

Judith Park, Deputy Chief Executive reflects on our recent implementing outcome measures into clinical practice conference held at Clifford House.

“We were delighted to work in partnership with Hospice UK and our sponsor Eduserv, a not-for-profit provider of technology advice, engineering and support (https://www.eduserv.org.uk/), to host a one day conference focusing on implementing outcome measures into clinical practice.” said Judith.

 “The conference drew together healthcare professionals and service improvement leads from hospices across the county, all at varying stages in their journey of incorporating patient reported outcome measures (PROMs) into practice.

The day was a tremendous success and featured a variety of interesting and though-provoking presentations around the importance of using PROMs in palliative care and the evidence supporting their use. We also shared our knowledge and top tips to support other hospices with incorporating them effectively into their own areas.

Evidence is growing around the impact PROMs can have in palliative care settings on processes and outcomes of care, as well as improving communication and congruence between patients and healthcare professionals. There was a lot of lively discussion around the difference PROMs can make with measuring and demonstrating the benefits of services not only to individual patients but also at service, sector and national levels. They can help us to establish an evidence base to drive service improvements, to ensure the delivery of high quality care and facilitating a benchmarking system to compare hospices nationally.

It was however identified that integrating PROMs into clinical practice is not always easy and to do so it requires considerable cultural and organisational changes, as well as engagement of teams at all levels. Strong leadership and ownership over the process are key to drive changes forward, as well as adopting a transparent and consistent approach with an effective feedback mechanism to keep teams engaged. Investment in IT resources and staff is also essential to have systems in place to collate, store and analyses the data collected.

The utilisation of PROMs in palliative care is gathering momentum year and year, and together through sharing our knowledge and experiences we can achieve great things.”

Click here to download the videos and presentations from the conference.

Judith Park, Deputy Chief Executive reflects on our upcoming implementing outcome measures into clinical practice conference.

“Following on from the success of our outcome measures in palliative care conference last year, we are delighted to be working in partnership with Hospice UK to host another conference on 20 October 2017.” said Judith.

“Implementing outcome measures into clinical practice will explore the use and impact of utilising patient reported outcome measures (PROMs) in palliative care settings, as well as showcasing new tools and technologies.

PROMs are an integral part of palliative care and the conference will draw together healthcare professionals and service improvement leads from across the country who are keen to incorporate them into their own practices.

On the day we will be joined by a variety of guest speakers who will be sharing their knowledge, expertise and top tips on using PROMs, as well as seeking our delegate’s thoughts on what they feel they would find most useful to support them with integrating PROMs into their own areas. Using these findings we hope to develop a comprehensive training programme to help and support hospices to effectively integrate PROMs into their everyday practices.

I would also like to thank the headline sponsors of the conference Eduserv https://www.eduserv.org.uk/. Eduserv are a not for provider of technology advice, engineering and support and we are working closely with them on projects currently. Their support for, and involvement in, the conference is hugely valued and showcases the important and pioneering work taking place in our sector.

It promises to be an interesting and insightful day with a variety of interactive and thought-provoking presentations and workshops. We look forward to welcoming everyone to the conference very soon and following the conference I will be sharing the highlights and outcomes from the day."

An update will be posted after 20 October.

Everyone likes a good neb.  I’m always having a peer and a peek at what’s going on outside on the road.  I’m lucky enough to know and speak to the neighbours who live side-to-side with me, opposite and (randomly) me behind over the garden hedge due to a strange alignment of children being at the same school, a willingness to take in parcels and a fairly low hedge.  People in Sheffield look out for each other and when an unrecognised car pulls up outside the home of a neighbour there will be a bit of “nebbin’”, curtains twitch and everyone will wonder who’s come to call.

In January 2017, Gilder loaned St Luke’s Community Service a Honda CRV.  The new magenta St Luke’s logo was subtle on the driver and passenger’s doors and also on the boot.  During the last two winters, since I have worked for the Community Team, we have been grounded by the snow and lost two visiting days due to poor conditions. Gilder Honda have agreed to help maintain a Palliative Care presence in the city come rain or shine.

The people of Sheffield who know the name “St Luke’s” probably know about the Hospice building – a place of calm and care where, yes, people can choose to be looked after until their death but also a place where symptoms can be managed and where anxieties eased.  However, it’s the St Luke’s Community Service, the nurses who come to the homes of the people living with terminal disease who see the majority of patients known to St Luke’s.  In other words, your loved one may never walk into St Luke’s Hospice itself but may be supported by the nurses at home – no matter where in Sheffield they live.

So far, I’ve driven across farm yards in Bolsterstone, taken on Jenkin Road, nipped over Hagg Hill and then ventured out to Mosborough.  The Gilder Honda CRV takes it all in its stride.  However, I’m aware as I drive that people see the St Luke’s badge.  I arrived at a patient’s home and a neighbour enthusiastically approached me asking if he’d “won the Hospice lottery” and if I was “delivering a big cheque”.  I politely informed him this was unfortunately not the case and I was visiting a neighbour.

This is where discussion has developed with in my team.  To pull up outside the home of a neighbour with the “logo” on board – doesn’t that breach patient confidentiality?  Well, we wear uniform, and District Nurses visiting sick patients also wear uniform.  There is no “secret” in arriving at someone’s door looking prepared to care.  So far, I have had only one family member express annoyance at the presence of a branded vehicle. 

A phrase I use often when I sit on a patient’s sofa is that “no-one would want a St Luke’s Nurse sitting on their sofa.”  No one expects to be living with a terminal disease, suddenly contemplating the years they will not have to live.  Whether the person is 25 or 85 they have the same fears and symptoms.  They have the same pain.  As part of the Rapid Response Service, I visit patients with unstable symptoms or who have rapidly deteriorated.  When the car arrives, most relatives are relieved that someone is there to help. 

So, as I drive up-and-down the Ridgway or out to Bradway, through Derek Dooley Way to Penistone Road, crawling up Fulwood Road past Weston Park Hospital and out into Wharncliffe Side, trying to miss the school traffic around Gleadless, Oughtibridge and Grenoside, Nether Green or Shire Green, Darnall, Tinsley, Millhouses or Woodhouse Mill, Skye Edge or Nether Edge, past Hillsborough or Bramall Lane I know it’s important to show that St Luke’s are more than just a building.  We are out there.  The Community Service - the only specialist palliative care support service in Sheffield who will come to the homes of people living with life limiting illnesses.

So, if you like a bit of “nebbin’” then make sure the next time you see the car go past or, if it’s parked up close to your house, realise it’s probably because someone close by is poorly.  Don’t be afraid of that.  Someone probably needs more than to have curtains “twitched” in their direction.  Knock on a door or stop them in the street and see if they need anything – palliative care isn’t just for us nurses, it’s for all of us in Sheffield.

David Jones, Charge Nurse in St Luke’s Community Service.

St Luke’s Young Ambassadors are a group of young professionals from a variety of sectors across Sheffield.  We got together in 2016 to share our skills, knowledge and influence to build awareness of the vital work of St Luke's within and beyond our professional and personal networks.  Our aim is to spread the word about St Luke’s valuable care and how the services they provide are reaching out to more and more people across the city. This year we’ll be continuing to take part in St Luke's events, as well as organising some exciting ones of our own - we hope to see you at one soon! Keep an eye out for our Young Ambassador blog updates on Facebook and Twitter, to keep in the loop on what we’re up to. We’d also love to hear from anyone who would like to get involved with our group! If you’re passionate about spreading the word about St Luke’s care – email us.

We were delighted to work in partnership with Hospice UK, Kings College London, Cicely Saunders International, NHS England, Public Health England and St Christopher’s Hospice to host a one day conference on the application of outcome measures in palliative care. The conference was extremely insightful and showcased inspiring presentations around the benefits and power of utilising outcome measures in palliative care settings, as well as providing practical solutions and considering future challenges. Commissioners and specialist palliative and end of life care providers attended from across England and Northern Ireland, and there was a great sense of excitement from attendees about the positive impact outcome measures could make to both patients and services providers and a real desire to implement them within their own organisations.

Embedding patient reported outcome measures into clinical practice is extremely important and they can improve both end of life care and patient outcomes, as well as facilitating the delivery of patient-centred care. They provide a robust mechanism to assess and validate the effectiveness and cost-effectiveness of services and can guide service improvement and development, establish a case mix, inform staff resourcing, enhance staff development and guide research strategies. The results can also be used by hospices to inform business intelligence and to influence stakeholders and commissioners by providing an evidence base to demonstrate the value of their services and their contribution to the local health economy. Going forward they could also be used to establish a benchmarking system that would enable meaningful comparison of similar organisations nationally.

There was much discussion around the fact that outcome measures can be used to deliver efficient holistic care that ensures consistency and equity for all patients across all services, by developing a structured framework for conducting multi-disciplinary team meetings, ward rounds and handovers. They can also improve staff communication through the development of a common language.

Speakers shared their personal experiences and offered practical advice on how to effectively incorporate outcome measures into practice. It was felt by all that a multi-faceted approach was essential, and investment in both staff and robust information technology systems was essential to incorporate outcome measures into clinical practice with maximum effect and ensure meaningful information is generated.

The importance of engagement of staff at all levels including Executives, boards and trustees was highlighted and the need to educate them on the use and benefits of outcome measures, as well as sharing results with them to demonstrate their impact. Implementing champions to drive the initiative forward and change staff cultures and utilising Healthcare Assistants to collect information are essential.

It was clear that in order to encourage national engagement further work is needed to increase awareness to both commissioners and service providers on the importance and power of incorporating outcome measures into clinical practice in end of life care.  Additionally, the development of resources and training to support organisations to incorporate them into practice and utilising the intelligence generated was thought to be equally as important.

The conference highlighted that the development of a co-commissioning relationship focusing on the needs of a shared population that ensures better outcomes for beneficiaries is essential. Commissioners, hospices and the NHS need to work together, share good practices and resources and develop more integrated working. The use of a standard IT system would also facilitate integration of outcome measures and sharing of information.

The conference provided a fantastic opportunity to demonstrate the impact and power of utilizing outcome measures in palliative care settings and together through integration, collaboration and communication we have the potential to create something magnificent.

Judith Park and Dr Sam Kyeremateng

Click here to download the videos and presentations from the conference.