Alison Docherty Macmillan Advanced Practitioner Occupational Therapist Specialist Palliative Care Team Y Bwthyn Newydd, Princess of Wales Hospital

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Preferred place of care…… Yours or mine Preferred place of care…… Yours or mine? THE ROLE OF THE OCCUPATIONAL THERAPIST IN FACILITATING PATIENT CHOICE It has been well research and documented within Palliative Care literature that out of patients who express a preference for their place of care, only a small percentage actually achieve this. There are clearly many factors that influence this outcome, some of which cannot be changed. However with a little creative thinking there are many that can.

46 yr old female with metastatic breast cancer Married with one 6 year old son Problem- unable to supine to sit in bed independently due to spinal metastasises Choice – to want to sleep with her husband in their queen size bed on the 3rd floor of her home

Discharged from DGH orthopaedic ward following assessment by a ward based OT with………….. Reason – What if she hurts herself in the Queen size bed it’s not safe and we don’t adapt this size bed

Creative thinking Rapport building Listening and understanding Investigation regarding queen size bed Actually 2 single beds bolted together with separate mattresses OT screwed hard board over slatted base of bed Fitted electric backrest to patients “half” of the bed Removal of the hospital bed

59 year old lady with lung cancer Choice – to go home to be with her family Challenge – O2 requirements needing x2 condensers and cylinders Cylinders not lasting – unable to store quantity and concerns regarding safety

Creative thinking Contacted local fire station for advice. Fire service carried out assessment of the home and provided advice Decision in interest of safety that fire station would store cylinders and family would have 24 hour access to the cylinders stored there. Fire officer attended hospital to provide feedback

65 year old lady with pancreatic cancer Choice – to die in her camper van over looking the sea Challenge…….everything!!

Creative thinking Team approach Contacted coroner GP temporary registration District nursing agreement to visit at camper van Police informed – increased passing patrols Council permission – waiver of parking charges Funeral director involved

Risks………. There will always be risks, no matter what we do……. Life is a risk

Driving force……… Preferred place of care…… yours or mine? Is this influenced by an attempt to eliminate all risks? Or Should it be about risk reduction/management and having awareness and knowledge about the risk……

Final thought…… If ever I am in need of Palliative Care…… I will make sure my bed is high enough…. I will make sure that I use a pressure mattress….. However I will not need a hospital bed with bars to keep me in…. As I will be in the arms of my husband and he won’t let me fall