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Patients with a life threatening
illness who have complex physical, psychosocial and/or spiritual needs
requiring specialist intervention.
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Relatives or carers of the above
patient who have related complex needs themselves and require additional
specialist support, preferably with the knowledge of the patient.
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The person being referred is in
agreement with the referral.
- The GP is aware of the referral of the patient.
Professionals who require specialist information, support
and advice may access Dorothy House independently.
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The Medical Team are available
to give advice about any palliative care problems.
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Patients referred for medical consultation
can be seen at Dorothy House, at home, nursing home or hospital. Also,
patients can be seen as out-patients at the RUH, Chippenham and Paulton
Hospitals.
Some problems cannot be managed at home and patients
may be admitted to the In-patient Unit for a short stay. Possible reasons
for admission are:
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Specialist assessment and treatment
of complex symptoms
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Psychological support
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Planned or acute respite
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Readjustment/adaptation to the
effects of disease progression, particularly following transfer from
an acute hospital setting
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Terminal care, where death is expected
within a week
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See patients in their own homes,
community hospitals and residential/nursing homes.
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Work alongside GPs and District
Nurses who remain the patient's primary carers.
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Provide continuing liaison with
hospital based professionals, as appropriate.
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Offer advice, information and support
to professionals whether or not there is direct contact with the patient.
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Provide on-going visits to patients
with specialist palliative care needs.
Patients can be offered weekly Daycare (mid-morning
to mid-afternoon):
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To relieve isolation brought on
by illness and its associated problems.
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When the carer requires respite
because they are in constant attendance.
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For emotional and spiritual support
including confidence building and empowerment.
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Where it is possible to transport
the patient by volunteer-driven vehicles or disabled taxi.
There is also a support group to provide
information, practical advice and support for patients who do not require
full Multi-professional Team input.
Physiotherapy provides help with rehabilitation/adaptation
and symptom control. This includes problems with:
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Breathlessness - non-pharmacological
interventions
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Anxiety - relaxation techniques
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Pain - including TENS, TSE
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Mobility and functional activities
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Patient handling
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Patients can be seen at Dorothy
House, at home, nursing home or hospital.
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Patients with lymphoedema related
to cancer or its treatment.
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Patients should be referred as
soon as possible after diagnosis of lymphoedema.
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Both the RUH and Dorothy House
accept referrals for complex lymphoedema.
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Offer advice, information and support
to professionals whether or not there is direct contact with the patient.
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Palliative care patients are seen
initially by a CNS then referred to the local service if their lymphoedema
is mild to moderate.
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If patients have mild-moderate
lymphoedema, a Key Worker will see them at a local clinic. Patients
with more complex needs will come to Dorothy House for clinic appointments.
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Domiciliary visits are made when
necessary.
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Available within the Dorothy House
catchment area.
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For patients who have expressed
a wish to remain at home to die (supported by family/carers).
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1 or 2 nights respite per week
if expected prognosis less than 3 months.
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If there is complex need, additional
nursing care within the last 4 weeks.
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Up to 24 hour care for patients
at a stage in their terminal illness where death is expected within
14 days.
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Flexibility to meet short term
emergency cover if unable to be met by another agency.
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The Social Worker is available
to assess with patients and their carers any practical and emotional
needs on the In-patient Assessment Unit, in Day Care and, where appropriate,
in the community.
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When appropriate, the Social Worker
will refer to, and link closely with, statutory and voluntary services.
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The Chaplain is available to explore
spiritual needs with patients and families, particularly if they come
into the Assessment Unit or to Day Care.
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The Chaplain will link closely
with local clergy as appropriate.
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The Children's and Young People's
Social Worker supports children and young people up to the age of
18 years old, offering direct support to individuals and families,
as well as guidance and advice to other professionals.
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Referrals can be made by members
of the Multi-professional Team at Dorothy House, professionals in
the community or self-referrals from families known to the hospice.
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Creative and diversional therapy
is provided for patients in Day Care and the In-patient Assessment
Unit.
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Complementary therapies, ie reflexology
and aromatherapy, are available for all our patients. Referrals are
made through our Complementary Therapy Co-ordinator. When appropriate,
carers can be offered complementary therapy.
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The Bereavement Service seeks to
offer emotional and psychological support to help the bereaved adjust
to life without the deceased.
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If Dorothy House has been involved
with a patient, bereaved relatives and carers can access a range of
services as and when those services are both appropriate and available.
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Referrals can come from professionals,
family and friends, or from the bereaved client themselves.
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Bereavement support offered through
the service will be contracted with the client(s), and where possible,
a planned ending to the work negotiated.
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The initial objectives at time
of referral have been achieved.
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There is no longer a need for specialist
intervention.
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The person originally referred
has declined any further specialist input.
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The GP is aware of the discharge.
Re-referral is always welcomed as circumstances
change.
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