Now heading off lovely @docofagesSophie's house. So you can un-mute me now. Hope I haven't driven people bananas with #POS2015

— Becky Baines (@Becbaines) February 5, 2015

A successful workshop closed by Prof Claudia Bausewein, Munich, thanks to all involved-look forward to tomorrow's research day #POS2015 #hpm

— CSI Palliative Care (@CSI_KCL) February 5, 2015

#POS2015 @CSI_KCL and @DrFlissMurtagh really want to have more of these days. How to improve them?

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 IPOS helps to remind us to cover all the domains in clinical validity. Very much advising pragmatic use.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Great question: happy for us really focus on clinical concerns first, narrative etc then fill in detail. Sensible clinical use.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Summing up and questions by Claudia Bausewein.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Re: using for service evaluation. Try to pick an area where the service/team are directly influencing the outcomes.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Another suggestion: look at 3 most bothersome symptoms for each pt. Track over time.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Some early stage audits in planning phase. eg. Start with pain. Maybe just use one score and develop?

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Benchmarks are likely to be different in different populations.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Tips for IPOS audit/QI: start simple, small. Clinical ownership. Proper training. Template: http://t.co/hafztpSPNX

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Looked for standard of 22% in one month. Achieved standard of 21%. But demonstrated needed for shorted form.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 What standard did they set? Looked at data for cog impairment for admitted pts: 40-50%. So unlikely to be able to complete POS

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 KCH audit 2011. Do staff routinely complete POS data? Used bereavement and discharge lists to look at electronic pt record

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Examples of audits: Stevens et al, 2005, Supp Care Cancer: POS improved symptoms

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 QI: "systematic critical analysis" of quality of clinical care inc procedures, use of resources and patient outcomes

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 How should we look at measuring quality? Break down to: input/structure, process, output (all involve counting stuff and things)

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Next up: using IPOS in audit.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Need feedback loop to improve whole system.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Used clinical champions to teach and train in the use of POS. Staff shortages and attrition were a problem.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Discussion now about the natural progression of symptoms. Natural cycles in symptom severity.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Via OACC, can be out in touch with teams using different IT systems. Crosscare, EMIS being used already to collect data.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 May be a system developed where pts can fill in information on app or website and can then be added to individual databases

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Likely to be a system available where data can be analysed by OACC for a fee.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 OACC looking at how to support pilot sites. Shared project with @hospiceuk. Can pay for different levels of support.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Manual vs technological data extraction. Different challenges.

— Becky Baines (@Becbaines) February 5, 2015

Our group is split into sessions- using POS in diff cultures, ensuring work in practice, data aggregation & audit ideas #POS2015 #hpm

— CSI Palliative Care (@CSI_KCL) February 5, 2015

#POS2015 Says anonymised data sharing between sites generated "healthy competition".

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Teams themselves looked at data and identified areas where "doing well". Made changes to improve data collection eg. IT

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Initial feedback from first few months of data - missing data a problem.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Data needs careful interpretation on service and pt level.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Need to really demonstrate to clinical staff that it improves pt care.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Next session: Using POS in practice.

— Becky Baines (@Becbaines) February 5, 2015

#pos2015 In IP settings 60-65% of pts cannot give their own POS. Do staff ones often, but pt POS if possible before they deteriorate

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Often bigger discrepancies between staff and pts on information giving than pain/sob etc

— Becky Baines (@Becbaines) February 5, 2015

#pos2015 #hpm Skilled staff better than not skilled. As close to family members. Look at individual patient and assess.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 A from @DrFlissMurtagh: Staff POS is validated for use by staff. Agreement not perfect, but reasonable levels. Dr vs nurse no diff.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Q: Was comparison made between staff reported measures vs pt reported measures?

— Becky Baines (@Becbaines) February 5, 2015

#pos2015 if sending POS to people it's useful to explain why doing this and to leave some free text for them to explain #palliative

— Irene Higginson (@ij_higginson) February 5, 2015

#POS2015 A: some use of postal POS in research with Myeloma pts. But free text page to allow patients to expand.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 A: Some use of iPad with form on before OPD clinic appointment. No use of sending it out in post so far. Will it arrive in time?

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 suggestion of sending POS questions to patients before coming to the #palliative care service to discover their issues #hpm

— Irene Higginson (@ij_higginson) February 5, 2015

#POS2015 Q: any use of sending out the IPOS forms prior to first community visit?

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Suggestion that POS scores could be done on Mondays and Thursdays to make it easier to remember than admission and day 3,6,9

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 POS combined with PPS (similar to Karnofsky) has provided really good evidence.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Worked better when there was clinical buy in and teams saw that POS made a different to patients.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 POS valuable in Calgary for clinical assessment, team communication, outcome evaluation, assessment of changing care needs #hpm

— Irene Higginson (@ij_higginson) February 5, 2015

#pos2015 Lessons learned: Hospices needed to feel that the POS tool worked for them. Shows positive impact of Hospice program overall

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Erin Forsyth combined POS data shows how #hospice provided clinically good care, and patients symptoms were controlled #palliative

— Irene Higginson (@ij_higginson) February 5, 2015

#POS2015 Initially there was missing data. Some Hospices were better at collecting data than others. More engaged.

— Becky Baines (@Becbaines) February 5, 2015

#pos2015 Allows benchmarking of the 7 hospices.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Each Hospice provides quarterly report on first 4 POS scores for every pt admitted. Data is collected and entered in database

— Becky Baines (@Becbaines) February 5, 2015

Great to hear presentation from Erin Forsyth, from #Hospice in Calgary, Canada and how POS is helping improve care #POS2015 #hpm

— Irene Higginson (@ij_higginson) February 5, 2015

#pos2015 Some Hospices used hand written POS, others fancy graphing that showed data over 3 weeks.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 How was POS useful? Allows team to adapt care plan. Target appropriate member of team to provide support.

— Becky Baines (@Becbaines) February 5, 2015

#pos2015 Really helpful when used as a tool to stimulate discussion. Used pt and family member simultaneous scores to start conversations

— Becky Baines (@Becbaines) February 5, 2015

How is POS family of measures used in international services? Erin Forsyth from Alberta Health Services Canada discusses #POS2015 #hpm

— CSI Palliative Care (@CSI_KCL) February 5, 2015

#POS2015 POS scores are done on admission, day 3, day 6 and day 9. Kept in notes.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Calgary chose to use 5 out of the 11 main POS questions. Took approach that it HAD to work for the team.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Resistance from team: "just more paperwork". Lots of work to get team involved.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Calgary decided that POS did what they needed. Targeted patient's own issues, measured change over time. Decided not to go for ESAS

— Becky Baines (@Becbaines) February 5, 2015

@CSI_KCL @DrFlissMurtagh train your staff, use the i.e. IPOS at least twice during spell and feedback your data to your staff #pos2015 #hpm

— Susanne de Wolf (@SusannedeWolf) February 5, 2015

#POS2015 In 2005, Calgary considered need for standard outcome meassure. Looked at possibilities to support patients AND families.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Interesting to hear that patients who are still appropriate for CPR and other life-prolonging treatments would not be admitted #hpm

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 1.2 million population. 108 beds, 7 Hospices. >1200 admissions per year.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Next up: Erin Forsyth from Calgary Hospice Program in Canada.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Use information and data in clinical care and to show how well services are working. Demonstrate to staff so they see benefits

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Showing staff information in graphical form or tabular form seems to help as it is any easy way of seeing change over time.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Crosscare allows graphing of both individual symptoms plus total IPOS scores. Shown at MDT each week.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Community team in Bradford using IPOS on SystmOne. Other teams using Crosscare.

— Becky Baines (@Becbaines) February 5, 2015

How can you use the POS family of measures in daily practice? @DrFlissMurtagh @SusannedeWolf #POS2015 #hpm #palliative care

— CSI Palliative Care (@CSI_KCL) February 5, 2015

#POS2015 Slot in regular reviews of how IPOS is working in practice. Could present data at regular business meetings, for instance.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Helpful for clinical champions to network across teams. Joint assessments as a key way of learning.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Identify clinical champions. Allow extra time for them study. Allow extra time for champions to teach and train.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Storage of data, data entry (clinical vs admin), who will monitor quality of data? Staff member employed to monitor quality.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Next up: QI lead at OACC. How to use the data when it is collected?

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Helpful to sit next to patients so that they can read the 0-4 scores, otherwise it gets repetitive. Laminated large print versions

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Could the pre-amble include: "I'll go this step by step and we'll go into things in more detail and make a plan at the end"

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 For some role players, it felt like they were missing opportunities to really listen to the patient.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 feedback from role play sessions - does need to ask questions lead to missing of cues?

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Kings use PCS, St Wilfred's at Eastbourne use Crosscare. Specially designed windows for data entry.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 More discussion about technology? How can data be put into common databases automatically?

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Need to think about how you will extract data from the info. How can data be meaningfully extracted?

— Becky Baines (@Becbaines) February 5, 2015

.@Becbaines Not sure how I feel about this. Would something be lost in the more direct questioning at beg rather open questions? #POS2015

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Suggestion is to use POS to start and then follow up with deeper questioning about individual symptoms.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 practical session on developing POS competencies underway with @hensonbuffie #hpm #palliative care

— CSI Palliative Care (@CSI_KCL) February 5, 2015

#POS2015 Need to explain what will happen to data, where it will be stored etc.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 1st step is choosing pt vs staff questionnaire. Use pt questionnaire by preference, if people are well enough.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Jury still out on whether outcome measures improve patient care. 3 syst reviews published. Evidence for +ve effect on communication

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Now developing POS competencies in practice. Christina Ramsenthaler...may be some role play.

— Becky Baines (@Becbaines) February 5, 2015