Abstract
Introduction
Improvement project in response to several bereavement meetings with families reporting concerns with communication and care received during their loved ones’ end of life care (EOLC).
Methods
Retrospective review of 79 inpatients documentation who died between August 2021-March 2022 in comparison against the Royal College of Physicians National Care of the dying audit to identify targets for intervention. Survey of 22 members of ward staff between (January-March 23) including medical, nursing, and allied health professionals to understand confidence, clinical knowledge and available resources to care for EOL patients and families.
Results
Retrospective audit showed 13.9% of families expressed concerns about EOLC received. Discussions held of the potential for progression into EOLC were 82.4% of cases and that of approaching the terminal phase of life 83.5% which is similar to the national findings of 83% and 79% respectively. There was an absence in offering holistic support to families and patients like food vouchers, parking permits, and referral to chaplaincy team at only 27.8% cases. This theme was seen in the staff survey, with 16.5% of staff suggesting offering parking permits and 15.2% suggesting food vouchers. The survey also highlighted the relative lack of confidence of allied health professionals 5.9/10 vs the remaining team average of 8.1/10 when providing EOLC.
Conclusions
The audit and survey identified gaps in patient care and communication for our ward staff. To improve quality of care, teaching sessions in collaboration with palliative care team are set to start for ward staff. To improve communication, end-of-life board was set up as visual aid for staff, patients and family as well as a proforma to standardise death verification documentation across the trust. These are first cycle interventions to help improve patients and families holistic.
Comments
Communication to care homes too
Running a care home at the time our nurses were unable to communicate with hospital consultants to speed up discharge for our residents to die in their home with us . now at a hospice I notice that our consultants are able to speak to hospital consultants . in DEC 2021 at the care home we used PALS to provoke action and our resident who had been deemed days to live at the hospital recovered in the home and lived a meaningful further 6 months at the care home even making a speech and then died peacefully there with staff who knew her ...she had no living family