Abstract
INTRODUCTION
The National End of Life Care (EOLC) Strategy highlighted the need for individualised, accessible, multi-disciplinary care plans for people nearing the end of life. Proformas provide a systematic approach to recording end of life discussions. Our Trust uses an electronic patient record (Cerner), which includes an “End of life care agreement” for people in the last days of life.
An initial staff survey on a Medicine for the Elderly (MFE) ward highlighted a lack of familiarity with required documentation. The aim of this project was to improve end of life care documentation.
METHODS
A Driver Diagram was used to examine the principles underlying excellent EOLC and aided development of change ideas. The Model for Improvement allowed identification of measurable aims. Cerner records of 20 patients were reviewed fortnightly, including patients who had died since the previous intervention.
RESULTS
Three PDSA cycles were completed. The first PDSA cycle involved training for nursing colleagues. Step-by-step teaching on accessing and using Cerner end of life care documentation demonstrated a 15% increase in completed care plans. The second cycle (placing posters around the ward) - detailing how to access and document care plans resulted in a further 5% increase. The third cycle involved education sessions for ward doctors, with a further 25% improvement.
CONCLUSIONS
Comprehensive documentation is key to ensuring good end of life care, as it enables continuity of care and improves MDT communication. Active interventions including face-to-face teaching were more effective than passive (posters) in improving documentation.
Our findings demonstrated consistent improvement in completion of our EOLC agreement. We aim to extend our training interventions to other MFE wards and to integrate documentation training into junior doctor induction. We also plan to use similar methodologies to improve our existing end of life care agreement.