We are pleased to announce that we now have Stephanie’s excellent presentation on communication at the end of life.
It can be found in the article below, along with the really useful drug chart and drug kit.
As with any of these new documents we would welcome your feedback, either as comments below or via email to the usual address.
Feedback on the presentation at the refresher course has so far been excellent, with many people requesting copies of the Drug Kit and Drug Chart either in electronic or paper copy.
I have now uploaded these forms to my previous post for your enjoyment. Please remember that the drug chart has not yet been fully sanctioned by the PCT DTB but is still at a pilot stage.
It would be really helpful if you use these forms for us to get some feedback on them. Please either email your comments and suggestions to me or post them as comments under this post.
Last Wednesday I was invited to lecture on our local GP Revision Course. This is always a good chance to meet colleagues I haven’t seen for a while as well as some familiar faces and is usually fun. This year I was presenting with Stephanie Barker who is our Nurse Consultant and a very well respected and qualified family therapist. We were looking at End of Life Prescribing and Communication skills at the End Of Life.
It all seemed to go well and there weren’t too many left field questions!
Below are the presentations we gave along with the associated documentation discussed. Some of the documents are awaiting approval by the DTB at the PCT but once this is completed we will post them.
End of Life Prescribing: Dying to Talk-End of Life Prescribing
End of Life Communication : Communication at the End of Life
Drug Kit Documents : Drug Kit Documents
Drug Chart: Drug Chart
After three years as Macmillan’s GP Facilitator for Central Norfolk the funding for my post eventually comes to an end on Thursday. Despite the numerous projects in which I am currently involved the current financial climate has made it very difficult to secure funding from the usual healthcare sources. As a consequence this role will cease from the 1st April 2010.
It is hoped that a short term injection of Charitable Funds will tide the role over until the PCT or Marie Curie Delivering Choice agree to longer term funding but there are no guaranties unfortunately.
I am not moth balling this site just yet, but the stream of content, which I admit has never been that quick, will slow considerably!
A few months ago I posted an enthusiastic article about the proposed E-ELCA. I was really looking forward to the excellent content which had been promised and was one of the first in line to get access.
The problem with being first in line is that by the time the site goes live it is very easy to have forgotten your password! With five different jobs and numerous personal and work combination locks to remember even my thirty three year old brain can find it tough to remember things. Usually this is fine and websites have a handy “have you forgotten your password” link which will ask a few questions, e-mail you a password and order and balance is again restored. Unfortunately with the E-ELCA site, as I was to find out, even getting to log in is a nightmare!
As soon as I had the appropriate codes I tried to log in, but was unable to open the site in Firefox (my preferred browser) or IE. Having tried a number of times over a week with no success I wrote a polite e-mail to E-ELCA enquiring whether their server was down. Their e-mail response helped me to better understand that it was actually my fault for not checking the technical requirements of the site (how could I have been so stupid!) Obviously I should have spent five minutes waiting for the “technical requirements” site to assess my settings and then I would have known that I didn’t have the appropriate “next generation Java Plugin” and would have been able to spend another five minutes accessing the tutorial website which would have shown me how to reconfigure my Java Control Panel to allow the Plugin to work! Now being a reasonably IT savvy chap I was able to make the requisite adjustments relatively easily and eventually after a week or so get to the login page. With baited breath I entered by seven digit code and the password they had provided but the site refused to accept either! By this time I was somewhat “fraught” and felt unable to e-mail E-ELCA again after their last response.
Whilst writing this article I have again tried to access the site to see whether they have a handy “password forgotten” link, however my Java Settings appear to have reverted back to “normal” and even with some now knowledgeable tweaking the login page is not available!
It seems ludicrous that accessing the doubtless fantastic content on this site should require such tinkering. As an IT literate supposedly intelligent man in my thirties I can make the required changes “under the bonnet”, but many people will not feel able to do so. Even I get bored with having to do it every time and when I can’t even access the login page it becomes somewhat tedious. Like many doctors I use computers across a number of different settings, and in a number of cases I have no control over my Java Settings, being at the mercy of whatever has been defined by the admin. Therefore, even if I was able to access the site, I would be restricted to doing it from my home PC or laptop and wouldn’t be able to use it in the other health care settings I work in!
Luckily I have a diary date when I will be seeing Claire Henry and I am sure this will come up in conversation!
Watch this space.
As a busy GP and self professed geek I am always interested in E-Learning which I can do at my own pace.
I am particularly excited by this latest offering from E-Learning for Health- E-ELCA ( E-End of Life Care for All). This project commissioned by the DOH and delivered in partnership with the Association for Palliative Medicine of Great Britain and Ireland, is designed to support the implementation of the DOH’s EOL Strategy. By early 2010 they should have over 150 interactive e-learning sessions on Assessment, Advance Care Planning, Communication Skills and Symptom Management. These will be free of charge to all health and social care professionals. There will also be a few sessions available for patients and carers. With people like Claire Henry (National Programme Director, National End of Life Care Programme), Bill Noble (President, Association for Palliative Medicine of Great Britain and Ireland) and Bee Wee (Clinical Project Lead, and Consultant/Senior Clinical Lecturer in Palliative Medicine, Sir Michael Sobell House and Harris Manchester College, Oxford University) involved this should be a high quality educational tool well worth watching for.
Back in early September I was invited to Fakenham surgery to talk about “Palliative Care”. This is a colossal subject on which I could have spoken for hours given the chance! I decided instead to concentrate on looking at the results from the PPoC Pilot project, our recent primary care audit and several symptom control areas including nausea and vomiting, breathlessness and setting up a syringe driver.
You can find a copy of the presentation here. Fakenham Presentation
If information is required on setting up a syringe driver then you need look no further than our YouTube video on setting up a driver which can be found on this site ( Drivers), as can information on diluents and compatibility ( What to put in)
Like most people I don’t like returning from my holiday! The longer I have been away the more difficult it is to return to my various roles, no matter how interesting they may be.
Therefore having returned in the last week from the US after three weeks travelling, the combination of jet lag, huge piles of post and e-mails and my general apathy has meant that it has taken me a few days to get to the nuggets which arrived in my absence.
The new information booklets for patients, about the single point of contact number for advice, support, information and help have now been circulated. These look really good and are appropriate for patients at any point in their journey. The number is a freephone number (0808 808 00 00) and callers will be transferred to the most appropriate person when they call. It is really exciting to have this service and I would encourage all colleagues to both signpost this number to patients and order some of these booklets from be.macmillan (http:// www. be.macmillan.org.uk) for distribution to patients. Whilst there, you can have a look at the reams of excellent information leaflets and booklets also available for your practice.
Unfortunately work commitments prevented me from being in the new Macmillan Adverts which have been showing on TV for a month or so. Despite the lack of my talented contribution the campaign seems to be going well nevertheless and can be found on the updated Macmillan website (http://www.macmillan.org.uk) which looks really nice and if anything is even easier to navigate than the original. There are some excellent updated sections and even the stuff I wrote is at least half decent!
End of life is back in the news this week, just peeking from under the blanket coverage of the swine flu, but still there never the less.
The BMJ this week have an excellent interview with Lord Falconer regarding the proposed changes to prosecution for those who accompany someone who wishes to end their life via assisted suicide. The amendment was defeated in the Lords and he discusses both the reasons for attachment of the amendment and also why he feels it is important.
Also in the BMJ, Professors Dan Munday and Jeremy Dale’s paper on exploring preferences on place of death with terminally ill patients is published. This qualitative work was based around interviews with GPs and community nurses and found there was a real need for development of better education and support for GPs and community nurses around having these type of conversations, as well as establishing more clearly what importance place of death has for patients and carers/family. The findings from this paper resonate locally where our recent Preferred Place of Care pilot found similar conclusions.
As promised having delivered my findings from the Berlin conference to our local clinical governance group, I have attached them below.
Medication to match the BTcP Profile
I have tried to summarise the key points made by each of the very eminent speakers, any mistakes are mine not theirs!
As I mentioned in the previous post, these are interesting times for pain control in end of life. With the launch of two separate drugs for breakthrough pain in a short period of time and a third nasal preparation expected soon, breakthrough pain has become the current “must treat” problem. It will be interesting to see who triumphs in the ensuing battle!
On a separate note, when I was checking the spelling for my title for this post (German spelling and grammar not being my strong suit) I was interested to read that Kennedy’s much discussed fluff in June 1963 in Berlin is actually an urban myth. Apparently the phrase had been meticulously translated for him by a German journalist and he had been coached extensively as his German was rather poor. The story goes that he should have said “Ich bin Berliner”- “I am a Berliner” but this would have patently been false given his American accent! Instead he opted for “Ich bin ein Berliner”-”I am one with the people of Berlin” Much more sensible and appropriate to the location and political situation. Like most grammar it is all about the context, saying “Ich bin ein Berliner” doesn’t mean “I am a doughnut” in the same way “I am a New Yorker” doesn’t make you an American newspaper!