St Columba’s Hospice at Home 

Our Hospice at Home support is made up of 3 community-based teams that work in close collaboration. You do not necessarily have to identify which specific team you wish to refer to as triaging and allocation to the appropriate services is carried out by our Access team based on the patient’s needs.

Please phone to discuss with the hospice Access team if you have any questions about referrals.

Community Palliative Care Team (North East/North West Edinburgh)

The St Columba’s Community Palliative Care Teams support people with life limiting illness in their own residence and support their wider health/social care team network. This is a specialist advisory service which provides advice and holistic support; it does not provide clinical nursing care or medicines administration.

The team includes a consultant in palliative medicine, clinical nurse specialists, staff nurses, an occupational therapist, a physiotherapist, and doctors who provide support through home visits and virtual support.

They are available Monday to Friday 8-4pm, with duty CNS Weekend/ Public Holidays 8-4pm cover.

 The teams can support people with:

• Complex physical and psychosocial needs
• Future Care Planning
• Coordination of End of Life Care

Please note:

Patients living in East Lothian are supported by the East Lothian Macmillan Community Palliative Care Team. Tel: 01620 642710   Email: loth.elpallcareteam@nhs.scot

Virtual Ward

This team provides a higher level of medical and nursing care than our Community Palliative Care Team with daily specialist visits 7 days a week between 9am-8:30pm.

• Community based service launched March 2023
• Can support up to 5 patients at any time with complex palliative care needs in their own home, care home or nursing home.
• Face to face assessment and management supported, if needed, by remote consultations.
• Supports hospital and hospice inpatient discharge to community
• Daily assessment by medical and registered nursing staff for up to 2 weeks
• Administration of subcutaneous anticipatory medications and continuous infusions via syringe driver
• Practical nursing care e.g. urinary catheterisation, wound dressings.
• Work collaboratively with District Nursing and Marie Curie Urgent care at home teams.
• Direct contact number for patients/families/primary care between 9am-8:30pm 7 days a week.

Care at Home

This is our hands on personal care team who help people and their families who require physical care and dignity care in the last weeks of life. Care is delivered by experiences clinical support workers across North Edinburgh and East Lothian.

The Care at Home service offers practical support to:

• prevent admission to, or facilitate discharge from, inpatient care
• manage crisis
• support at times of rapid change including end of life care
• offer respite support for families and carers
• promote independence through enabling, empowering, and educating patients and families to be where they want to be, and live as they choose, for as long as they can.

The service is delivered over 7 days from 8am-8pm, with up to 3 daily visits for periods of up to 8 weeks. It may also be able to support in bridging a care package gap – a social care application must be in place with the social work matching team and in process (link available in Resources TAB)

Please note that the service does not currently undertake meal provision or medication.

St Columba’s Hospice Community support – Frequently asked questions

“Can your team administer Intravenous Medications and Fluids?”

At present none of our community services can administer IV fluids or medications (including bisphosphonates). Virtual Ward staff can prepare and administer subcutaneous medications as injection or continuous 24hour infusion via a syringe driver.

“Can hospice clinicians not prescribe medications?”

At present there are still no options available to independent hospice physicians or nurse prescribers to write scripts in Lothian other than via private prescriptions, which patients would need to pay for. This is not a decision taken by St Columba’s hospice care and we recognise the difficulties the current system can present for GPs including:

 -Requests for urgent scripts during busy clinics.

-Requests for complex medications and doses that may be unfamiliar.

-The potential for error through written or verbal communication of requests.

We are incredibly grateful for the work done by our GP colleagues to provide prescriptions under the current system. Until there is a change in health board policy on this matter, we will continue to do our best to communicate the need for prescriptions in a timely, accurate and concise manner.

“Can you prescribe Oxygen in the community?”

Our Hospice consultants can prescribe oxygen via Dolby Vivisol Scotland.

If oxygen is needed urgently or next working day, then please phone the hospice Access team to discuss this. Otherwise, oxygen delivery may take up to 1 week as standard.

For a prescription we require the following information in an e-mail or discussed via the phone:

1. Patient’s Name, CHI, Address and contacts number (and a second contact number if possible)
2. Indication for oxygen
3. Current flow rate of oxygen and predicted maximum flow rate in Litres/min
4. Need for any additional equipment:  Nasal cannula, non-breathable masks, extra-long tubing
5. Need for any ambulatory equipment: Please tell us the flow rate needed and the maximum duration in 24hours the person will require to use this.
6. There can be no smokers in the house and the patient must not be using a vape
7. Urgency: Same day (8 hours), next working day or 4 working days.

“Can you complete MCCD (death certificates) in the community?”

Only our Virtual Ward doctors can complete an online MCCD for community patients

We recognise that the Virtual Ward team may be best placed to complete the MCCD in many circumstances as they have daily contact in the last days-weeks of the patient’s life. If the patient dies under the support of our Virtual ward team, one of the team’s doctors will contact the practice to discuss this and plan for who is completing the form.