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Associated stressful life events both within and outside the hospital environment may contribute to the high-risk environment. The cohort studied here was hospitalized for a significant psychiatric problem, a factor which puts them in the high-risk category. When the severe psychiatric diagnosis is combined with a significant stressful life event, the risk of suicide is increased significantly. Language: en

The National Service Framework for Renal Services Part 2 identifies quality requirements for end-of-life care for individuals with kidney failure, recognizing the potential to forge closer relationships between renal and specialist palliative care providers. This article describes a pilot project set up by two Clinical Nurse Specialists, one working in hospice specialist palliative care and the other in renal palliative care within an acute trust. The purpose of the pilot was to work in collaboration to run a streamlined nurse-led clinic that would meet the palliative care needs of chronic kidney disease (CKD) Stage 5 patients and their carers. To achieve this the clinic would have to provide optimal symptom management, empower patients to make their own choices, and support them with advance care planning underpinned by the End of Life Care Strategy. The partnership also aimed to promote service improvement and practice development using transference of knowledge, skills, and expertise. Initial informal feedback, including a very small patient survey, suggests that the clinic was well received by patients, carers, and other health professionals. The clinic is ongoing and deserves more formal evaluation to encourage future service development.

Background Advance Care Planning (ACP) is a voluntary process of discussion about future care between an individual and their care providers and is recommended as best practice in end of life care. Hospice in the Weald (HitW) routinely documents patients9 ACP in the patient record. This audit was carried out to ascertain what impact this information had on the patients9 end of life care. Aims To identify how many deceased patients had ACP conversations clearly documented in their record To explore the content of the information in the notes in a 10% random sample To look at place of death for these patients and compare with those who didn9t have ACP notes Method A retrospective audit was performed looking at patients who died between 1/8/2012–29/2/2013. A 10% random sample was identified, of whom half had ACP clearly documented. The notes were read and salient information recorded. Results 439 patients died during the 7 month period of whom 51% had an identifiable ACP conversation recorded in their notes. 44 notes were looked at and there was a marked difference between the place of death for those with documented ACP and those without (Home 37% vs 22% and Hospital 4% vs 19%). There were many instances where although ACP conversations were taking place they were not recorded in one location and not updated and therefore were not easily accessible to all staff. Conclusions This audit confirms that well documented ACP conversations do impact on place of death but that even within a specialised setting, it can be difficult to identify significant ACP discussions and for all staff to be easily aware of them. This has implications for recording and sharing this information between organisations which is recommended best practice. Changes to our recording processes are now in place in an attempt to improve this for the future.