BackgroundThe Care Quality Commission’s report ‘A different ending’ (2016) highlighted the health inequalities that LGBTQI (lesbian, gay, bisexual, transgender, questioning and intersex) patients, and their carers, experience with end of life care. The hospice values accessibility, so a group was set up to determine whether our services are accessible and inclusive to LGBTQI patients and their carers.Aim(s)To understand the issues facing LGBTQI patients, and their carers, at the end of life. To recognise their experience of using the hospice’s services and explore service development ideas with staff and external stakeholders.MethodsA multidisciplinary working group was set up, which included medical and nursing staff, the communications manager, volunteer chaplain and external representation from the local LGBTQI community. The group used a service audit tool (LGBT Age 2015) to discuss the current services and generate ideas. A literature review was conducted to understand LGBTQI issues at the end of life and a staff survey performed to understand their knowledge and attitudes about LGBTQI issues. Expert advice was sought from Marie Curie, Macmillan, other hospices and a local LGBTQI healthcare professional group.ResultsThe hospice will increase its visibility to the LGBTQI population and service users by promoting the project through local and social media, attending the local Pride festival and displaying the synonymous rainbow flag in reception. Hospice policies, monitoring form and leaflets have been reviewed and will be made public, which include clear confidentiality and anti-discriminatory statements. Education sessions for staff will be designed and members of the working group will become LGBTQI champions.ConclusionsBy increasing the hospice’s visibility to the LGBTQI community, understanding their needs and making it clear that we are an accessible and safe service to use, our LGBTQI patients, and their carers, will have a better end of life care experience at the hospice.

BackgroundActive nursing rounds, also known as intentional, care or comfort rounds were first developed in the USA (Struder Group, 2007) and later introduced into UK hospitals in 2012 alongside other measures to improve the quality of nursing care (www.harmfreecare.org). They have been associated with reductions in pressure ulcers, falls and increased patient and staff satisfaction (Cornwell, 2012). A pressure ulcer audit (Hospice UK, 2016) on a hospice inpatient unit (IPU) highlighted the need to improve nurses’ skills in the prevention, management and documentation of skin integrity.AimTo design a comfort round tool specifically for use within the hospice IPU, implement comfort rounds and evaluate the impact on patients and nurses.MethodNurses on the IPU were consulted regarding the overall concept, naming and design of the tool. Training was provided and following implementation, feedback sought from IPU nurses and patients regarding the impact of comfort rounds on patient care and experience.ResultsNurses’ feedback: Healthcare assistants experienced job satisfaction with their involvement in continuity of patient care and evidencing care they provided. They felt areas for improvement included managing time pressures, patient choice, document design, training and team working. Patient feedback: 14 responses, all of whom were positive about the comfort rounds. They felt areas for improvement included communication about the rounds, patient choice and ensuring these discussions are communicated across the team.ConclusionComfort rounds have enabled our patients to feel less isolated and provided reassurances to family members. They support the consistent nursing care of our patients, including improving the involvement of the healthcare assistant workforce, optimising hydration and the prevention of pressure ulcers and falls. Initial assessment of patients admitted to the IPU needs to include discussion about the comfort rounds and creating individualised plans of care including the patient’s needs and preferences relating to comfort rounds.

Background It is current practice for the Community Palliative Care Nurse Specialist (CPCNS) service at Wigan & Leigh Hospice (WLH) to provide all assessments in patients' own homes. While the value that patients place upon CPCNS services has been extensively explored in the literature, their views regarding the location of assessments have not been considered. Aims To explore the value that patients who are functionally able to attend clinics, place on the location of their CPCNS assessments. Methods Semistructured interviews of CPCNS service users assessed as functionally able to attend a clinic. The interviews were transcribed and thematically analysed. Ethical approval was obtained through The Department of Health Research Ethics Committee at Lancaster University and the research panel at WLH. Results Home-based assessments add a distinct quality to the CPCNS assessment, positively facilitating communication, empowerment, information and advice provision as well as responsiveness and flexibility. Concerns regarding clinic environments included confidentiality, unpleasant waiting room environments, long waiting times, inflexibility and the burden of travelling. Clinics enveloping principles of ‘at-homeness’, such as friendly staff and pleasant waiting areas were perceived as more helpful than those described as more clinical. Conclusions The cost-effectiveness of CPCNS clinics for current service users is questionable due to their perceived burden of travel and fluctuating clinical conditions, which may impact upon higher levels of appointment non-attendance. CPCNS clinics may offer an opportunity for the wider access of people for short term, multidisciplinary interventions earlier in their disease trajectory. Such clinics should envelop the principles of ‘at-homeness’, responsiveness and flexibility, that are so valued by service users. Further research is required into how CPCNS, Palliative Medicine and the wider multidisciplinary team can better integrate to continue in the quest for high quality, needs appropriate, timely and cost-effective palliative care for all who require it.