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

2. Warning
Stay awake at all times during this presentation as you may fall from your chair and this could result in severe injury or even death
Do not chew your pen at any time as you may break it, swallow it or someone may want to borrow it.
Do not slouch in you chair as the risk of increased osteoarthritis is your spine is considerable.
When taking notes during this presentation please make sure that your wrists are fully supported as the presenter cannot be held responsible for you developing repetitive strain injury in your wrist.
If you feel the need to applaud this presentation please be careful not to injure the person sat either side of you or clap too hard as this could result in vibration white finger.
The presenter does not accept any liability of the misuse of any information in this presentation

3. 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.

6. 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

7. 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

8. 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

10. 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

11. 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

13. 65 year old lady with pancreatic cancer
Choice – to die in her camper van over looking the sea
Challenge…….everything!!

14. 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

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

16. 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……

17. 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