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.
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.”
• 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.
Aspects of Care
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Trust
Listening
Recommend
Efficiency
Cleanliness
Respect
Delays in care
Fears
Meeting need
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.
Methods
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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.
Results
Number of
Patients
Total number patients audited
Male:Female ratio
Malignant:Non-malignant
Age range
IWGC form given
IWGC not given/not
documented
Reason not given documented?
120
62:58
90:30
45-91 years
7
(6%)
113
(94%)
26
(23%)
Patients meeting audit criteria?
33
(27.5%)
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.
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.
Results of Re-Audit
Initial Audit
120
Re-Audit
136
62:58
90:30
62:74
112:24
Age range
45-91
44-93
IWGC form given
7
(6%)
57
(42%)
IWGC not given/not
documented
Reason not given
documented?
113
(94%)
79
(58%)
26
(23%)
40
(51%)
Patients meeting audit
criteria?
33
(27.5%)
97
(71%)
Total number patients
audited
Male:Female ratio
Malignant:Non-malignant
Reasons Why Forms are not Given
25
20
15
10
5
0
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.
Thankyou.