Day in the Life: Palliative Care Paramedic Rosanna Ashford
THE Welsh Ambulance Service appointed palliative care paramedics last year in a UK ambulance service first.
The new recruits are part of a multi-disciplinary team which provides support for people with incurable life-limiting illnesses, both in the community and in a hospital and hospice setting.
They aim to provide the best quality of life for patients by managing pain and other symptoms, giving holistic care and support to the patient and those closest to them.
Among the new recruits is Rosanna Ashford, who has been working as part of Swansea Bay University Health Board’s Specialist Palliative Care Team (SCPT) since November.
Rosanna began her career as an emergency care assistant at East Midlands Ambulance Service before qualifying as an emergency medical technician and a paramedic.
She later relocated to Wales, where she joined the Welsh Ambulance Service.
Rosanna writes: “When the role of palliative care paramedic was advertised, I jumped at the chance to be involved.
“Historically, the focus of the paramedic role has been to preserve life, but there has been a shift in the last decade.
“I’ve always had a passion for end-of-life care, and to support patients and their families during such an emotional and difficult time is a privilege.”
Day in the Life
08:00
I arrive at Ty Olwen hospice to start my day. I turn on the work mobile and laptop ready for the visit requests to come in for the day. Whilst awaiting my first call, I use the time to finish off some documentation from a visit I attended the day before. I review any blood test results I’ve requested, discuss with colleagues and contact patients if any action is required. I also make some follow-up phone calls to patients I’ve seen over previous days to see how they’ve been.
10:00
I walk up to the main hospital and visit a patient on a ward who is due to be discharged later today for end-of-life care at home. I introduce myself and explain a bit about the community team, answering any questions or concerns from the patient and their family. I also arrange for a paramedic follow-up at the home the following day.
11:30
We receive a call from a district nurse about a patient with advanced cancer. The district nursing team visited several times in the night to administer medications as the patient had been experiencing worsening pain. On arrival, I learn that the patient is diabetic, and upon assessment, it becomes clear that hypoglycaemia has been causing reduced level of consciousness. After discussion with the patient and a doctor in the SPCT, we make a treatment plan to commence a syringe driver containing a continual supply of medications for pain management. In turn, we hope this will improve symptoms, enabling the patient to eat and reduce the risk of low blood sugar episodes. I liaise with the GP, collect the prescription and call the district nurses about the administration of the syringe driver. We’ll monitor the patient over the coming days, making changes as appropriate.
13:30
Lunch time.
14:00
My colleague receives a call on the advice line from a relative of a patient who is concerned that they are becoming increasingly confused and disorientated. I’m asked to review and assess the patient to determine if disease progression is the cause, or if there’s a potentially reversible cause. I find the patient sat in an armchair unable to speak. Prior to this morning’s events, the patient could communicate and was fully mobile. Clinical observations are all within normal range but due to the patient’s illness, I’m concerned that they’re displaying symptoms of hypercalcemia, which is when calcium levels in the blood increase. It can be fatal if left untreated. With the agreement of family, the patient is referred directly to hospital for urgent investigations which later reveal that it was hypercalcemia. The patient received intravenous fluids and medications and was able to return home.
16:00
I visit a patient with a brain tumour who has become more unwell over the last week, with worsening headaches and increased periods of sleeping. Unfortunately, it appears that the deterioration is due to disease progression and they’ve been to unwell for treatments like chemotherapy. The family have a lot of sadness, anxiety and fear, so I offer support, guidance and reassurance over a cup of tea. I then introduce the difficult topic of advance care planning, discussing what the patient and the family’s wishes are when the patient deteriorates further. It’s a difficult discussion but a very important one in order to help them plan for the future and avoid a possible crisis situation. This is something that can take time and frequent visits, so I arrange for the patient’s clinical nurse specialist to continue this on their next visit. Back at the office, I discuss the patient’s symptoms with the team and make adjustments to their medication to help ease the headaches. I also liaise with the patient’s oncologist to update them on the deterioration. I refer the patient to the occupational therapy team, who will organise a hospital-style bed for the home and any aids needed to assist them as they become more unwell. It’s so important that we work closely with other members of the team.
17:30
I complete documentation entries for each of today’s visits onto the shared database. I then add each patient along with my assessment and plan into the next community multi-disciplinary team meeting which enables the whole team to review each case, and arrange any further follow up as required.
18:30
Phew, it’s been a busy day! Time to head home, rest up and return tomorrow.
Rosanna said: “Every patient’s care needs a multi-disciplinary approach, and we’re working hard to strengthen relationships with partners, including district nurses, GPs, acute clinical teams and third sector support, such as Marie Curie.
“District nurses in particular are a really close ally of ours, and they work tirelessly 24/7 providing amazing care and support to patients with a range of care needs.
“We’re proud and grateful to be part of Swansea Bay’s Specialist Palliative Care Team, where the mentorship and learning opportunities have been brilliant.
“The palliative care paramedic is a new role but it’s fast evolving, and I look forward to what the future brings.”
Idris Baker, Swansea Bay Palliative Medicine Consultant, who helped trained the paramedics, added: “Day after day we’re seeing the difference the palliative care paramedics are making to the care we can provide.
“Their assessment skills, their responsiveness, their growing confidence in liaising with the wider team and signposting to the right sources of advice and support, are being put to good use.
“And above all their commitment to supporting people and getting to the heart of what matters for them.
“Getting paramedics into the palliative care team in this way hasn’t been done before so it’s great to see how they’re enjoying being so useful.”
Editor’s Notes
For more information, please call Head of Communications Lois Hough on 07866887559 or email Lois.Hough@wales.nhs.uk