This paper reports on undergraduate students' evaluation of a new hospice-based interprofessional practice placement (IPP) that took place in the voluntary sector from 2008 to 2009. Ward-based interprofessional training has been successfully demonstrated in a range of clinical environments. However, the multidisciplinary setting within a hospice in-patient unit offered a new opportunity for interprofessional learning. The development and delivery of the IPP initiative is described, whereby multidisciplinary groups of 12 students provided hands-on care for a selected group of patients, under the supervision of trained health care professionals. The placement was positively evaluated and students reported an increased understanding of both their own role and that of other professionals in the team. The evaluation also suggests that additional learning opportunities were provided by the in-patient palliative care unit. The results of this evaluation suggest that the in-patient unit of a hospice caring for patients with life-limiting illness provides a suitable environment to demonstrate and learn about interprofessional practice.

Steroids cause significant but under-appreciated and poorly managed glucose intolerance. In this case we describe a patient with steroid-induced hyperglycaemia who obtained a large positive impact on glycaemic control from a small reduction in her steroid dose, sufficient to alleviate the need for insulin. Developments in the treatment of steroid-induced hyperglycaemia may mean that a more active approach needs to be considered when treating steroid-related diabetes in patients whose management is palliative. We advise checking for steroid-induced hyperglycaemia by testing capillary blood glucose values 2 hours after the lunchtime meal and recommend a single morning dose of long-acting insulin to treat the condition.

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BackgroundNICE quality markers for COPD state that all patients with end stage COPD should have access to specialist palliative care support. To improve identification and management of patients with end stage COPD in North East Hampshire, an integrated multidisciplinary team (MDT) was established between the local hospice, hospital and community teams. This evaluation reviewed the activity of the MDT after 1 year.MethodThe list of patients discussed at each meeting (June 2012 – June 2013) was reviewed and cross referenced with the patient's electronic patient record to determine whether they were referred to the hospice. For patients who were known to the hospice, outcomes including ongoing specialist palliative care input, discharge and place of death were recorded.Results34 patients were discussed over 4 meetings. 24 (71%) were already known or referred to the hospice during the year. The majority (74%) had a diagnosis of COPD. 12 (35%) patients died over the year with 58% dying at home or in the hospice. 15 (44%) patients had ongoing specialist palliative care needs requiring input from the hospice MDT as well as the community matron. 2 patients were discharged to the care of the community matron.ConclusionsA community respiratory MDT meeting provides an important forum for discussion of patients with end stage disease. The meeting facilitates information sharing and coordination of care between the key health professionals involved in the patients management. Although the majority of patients were reviewed by the specialist palliative care team, community matrons remained integral to patient care. As the MDT develops, it will be important to ensure that patients who wish to die at home or in the hospice are identified and supported to meet their wishes. This may result in a reduction in the number of patients dying in the acute hospital environment.

Background A collaborative, cross boundary multidisciplinary team (MDT) was established in January 2012. The purpose of the meeting was to support best care for patients living with neurodegenerative disease by enhancing partnership working across the different services. The aim of this evaluation was to review the activity and impact of the meeting over the first year to identify what was going well and where the meeting could be improved. Methods The evaluation involved: 1) retrospective analysis of the MDT documentation including plans for nutritional and respiratory support and advance care planning, 2) review of patient deaths including preferred and actual place of death, 3) a questionnaire survey of the MDT members to quantitatively measure views on a range of statements relating to the operation of the MDT, with space for free text comments. Results 22 patients were discussed over 10 meetings. Following discussion, plans for nutritional and respiratory support were in place for 86% and 77% of patients respectively. Plan for advance care plan was recorded in 55% of patients. 8 patients died during the year. Preferred place of care was recorded for 4 patients. 6 patients died at home or in the hospice. 9 multidisciplinary team members completed feedback questionnaires. Feedback was positive and suggested that the key goals of the MDT were being met. Improved multidisciplinary communication enhanced delivery of patient care by expediting management plans and interventions. There also appeared to be professional development by sharing experience. Conclusion A multidisciplinary team meeting for patients with neurodegenerative disease provides an important forum for communication and information sharing. The meeting enhances patient care by generating and expediting clinical management plans and provides a written record which is shared with key professionals. There is scope for improvement in exploration and documentation of preferred place of death and advance care planning.