ICSPCT News

The Specialist Palliative Care Virtual Ward opened its doors to patients in phase 1 on 27th February 2023. The virtual ward uses a combination of telemedicine and specialist review by Specialist Nurses or Palliative Care consultants. The telemedicine includes a digital daily question set for patients and the ability to take remote observations. Should the telemedicine flag an alert for a patient they will be directed to appropriate care or called directly by the nurse on the Virtual Ward. Should it be required, the patients can be visited at home and be supported by nurse or HCAs. There is a daily MDT where treatment plans are decided and reviewed.

We accepted referrals during this phase from the palliative care team at UHL and saw 6 patients discharged early into our care for daily digital monitoring and care from specialist nurses, medics, and healthcare assistants.

On 17th April we moved onto the first stage of phase 2 and are triaging referrals from patients sitting on the waiting list for a LOROS bed for symptom management. We are also expanding the offer to allow ICSPC CNS' to refer patients onto the virtual ward who may need more intensive monitoring and support for a time, avoiding a hospital or hospice admission if possible.

The virtual ward has not been without its challenges in these early stages but with the enthusiasm of our current ICSPC staff who have been working in the ward on rotation and their dedication to patient care, we have seen the service make real differences to the patients we have cared for. Currently we are reviewing and developing the service to best meet the needs of our patients.

Our first patient admitted: Paul's story

Paul was admitted to the virtual ward by a LOROS consultant working in UHL. He was admitted for management of pain related to his Squamous Cell carcinoma and was with us for 18 days.

Below are Paul and his wife Tracey’s opinions of the experience which they were keen to share:

• "It was brilliant- it really felt like we had a safety net. We were very happy to have been offered this option to get out of hospital early."

• "We were both really reassured by it, knowing someone would get back to us quickly if needed and access to a doctor’s opinion each day was absolutely fabulous. The tablet was easy to use and they knew they would get a call very quickly if Paul felt worse than the day before.  We felt confident in the system and had face to face, telephone and video support in a much more timely manner than usual."

• "Paul was especially reassured that Tracey also felt well supported by the system."

• "The only suggestion for improvement was that there was no option on the question set for ‘feeling better than yesterday’- this should be added as often Paul felt better day to day."

April has seen us pilot a ‘plan for every patient’ virtual 30 minute meeting every day (Monday-Friday). This meeting was developed due to a recurring theme in concerns and complaints- that care was not as effective or joined up when the named CNS was absent, whether that be planned absence or sickness.

The idea behind the ‘plan for every patient’ meeting is that CNS' in each locality would meet and discuss the patients they are concerned about, they review tasks for absent colleagues and ensure timely follow up that is shared among the group.

An additional benefit identified is to encourage teamwork within the CNS team. As each CNS manages their own caseload and since nurses are based more from home since the COVID-19 pandemic, there can be a sense of isolation. Whilst CNS' are used to working independently it is hoped that this more regular team support will be beneficial for the nurses as well as the patients.

This pilot will be reviewed as a team in early May and a decision made regards it’s effectiveness, frequency and timings.

By Liz Jarvis

After working for over 46 years within the NHS I am finally going to retire. I started my career in 1976 and completed my State Registered Nurse training at Sheffield school of nursing. I qualified and was employed as a staff nurse on a medical ward before moving to Doncaster School of midwifery to complete midwifery training. By 1982 I received a Midwife of the year award!

I then moved to community nursing and back to Sheffield to complete my District Nursing Diploma at Sheffield Polytechnic. I then worked in the community as a District nursing sister for over 30 years.

I had many happy years based at Measham medical unit working in and based in a truly inspirational practice inspired by Senior partner, Dr Michael Tellis. We had no computers and no mobile phones back then, we worked hard and played hard and I managed a totally loyal and proactive team.

My passion has always been palliative care inspired by my time at Measham and working along side the Macmillan nurses. Over the last 7 years I have worked as a Macmillan nurse and then the Integrated care team. I was inspired by Mandy Mitchell a truly inspirational “can do” member of the team.

I have cared for people from the cradle to the grave and I have no regrets in my career choices. Carry on the marvellous work team and keep smiling!

Au revoir and thankyou x