1. Improving Services for Palliative Patients in a DGH through use of iWantGreatCare Forms.
All Wales Palliative Care Conference, Greygynog, 2012.
Dr Jenna Smith, ST4 Palliative Medicine, Wales Deanery
Dr Debbie Jenkins, Dr Simon Noble.

2. Palliative Care Implementation Group Wales
Key objective in 2008:
“Public engagement, using patient/ carer and public feedback to monitor that services continue to meet the needs of patients, using this information to modify or change services as necessary.”
“User evaluation through iWantGreatCare, (IWGC), and Dying Well Matters...[aim] to ensure services are receptive to patient needs.”

3. IWGC programme is the first nationally agreed service evaluation, implemented by all specialist palliative care services in Wales.
Allows for:
results comparisons with other organisations
time saving as patients can complete in own time and post back
reassurance of using a validated questionnaire with results that are disseminated back to the Teams to be actioned as appropriate.

4. Aspects of Care Trust Listening Recommend Efficiency Cleanliness
Respect
Delays in care
Fears
Meeting need

5. Audit Standards
ALL patients, (100%), shall have documentation as to whether an IWGC form is given.
IWGC forms should be given to EVERY patient, (100%), UNLESS this would cause undue distress or difficulties. E.g. patient too unwell, lacks mental capacity to complete the form.

6. Methods Auditing practice in a South Wales DGH. Prospective audit.
1st August-30th September 2011.
All in-patients seen by the team.
Data capture device on the initial assessment form used by the team.

7. Results Number of Patients Total number patients audited 120
Male:Female ratio
62:58
Malignant:Non-malignant
90:30
Age range
45-91 years
IWGC form given
(6%)
IWGC not given/not documented
(94%)
Reason not given documented?
(23%)
Patients meeting audit criteria?
(27.5%)

8. How to Effect Change? Team discussion
Easier way of giving forms? Less intrusive? Given out by third party?
Attach IWGC forms to new patient assessment forms.
Patients receive as a pack with OOH contacts and explanation of service.
Taken with the health professional to every patient where assessment can be made if it is appropriate to give the form.

9. Re-Audit New ways of working implemented November 2011.
Re-auditing began 1st December-31st January 2012.
All in-patients seen by the team.
Data capture device on the initial assessment form used by the team.

10. Results of Re-Audit Initial Audit Re-Audit
Total number patients audited
120
136
Male:Female ratio
62:58
62:74
Malignant:Non-malignant
90:30
112:24
Age range
45-91
44-93
IWGC form given
(6%)
(42%)
IWGC not given/not documented
(94%)
(58%)
Reason not given documented?
(23%)
(51%)
Patients meeting audit criteria?
33 (27.5%)
(71%)

11. Reasons Why Forms are not Given

12. Conclusions and Considerations for the Future
Team discussion and a minor change in ways of working can effect significant improvements in practice, aimed at patient benefit. (43.5% improvement over 6 months.)
Endeavour to ensure those patients where it is not felt to be appropriate to give the form at first meeting are not subsequently missed.
Improved practice needs to be sustained; suggest re-audit in 6 months.

13. Thankyou.