Background: As Doctors with an interest in end of life care, we wanted to explore practice at a District General Hospital. We observed that many patients lack capacity at the end of life and there is often a missed opportunity for Advanced Care Plans (ACP).
General Medical Council guidance recommends that Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders should be made in a timely fashion, by a senior Doctor and discussed with the patient or family as appropriate.
The Liverpool Care Pathway (LCP) is used to support dying patients (31% in the National Care of the Dying Audit) to ensure that the best quality of care is provided.
We aimed to identify what proportion of patients lacked capacity and how many had ACP. We recorded the circumstances surrounding DNACPR decisions and the proportion of patients supported with the LCP.
Sampling methods: We reviewed 212 available notes for patients that died in the first quarter of 2011. Data was collected using a proforma.
Results: 28% of patients had capacity to make decisions. 37% of patients lacked capacity and we could not comment on 35%. 1% had an ACP.
60% of DNACPR orders were made on admission. 61% were made by a consultant. The decision was discussed with the patient or family in 82% and no one in 18%.
51% of patients died on the LCP. This was started during working hours in 78%. It was unknown why 34% were not on the LCP.
Conclusions: Many patients lacked capacity and only two patients had ACP, highlighting an area for development.
Although it can be improved, we identified that there are areas of exemplary practice regarding DNACPR orders that must be maintained.
Our survey shows that LCP usage is above the national average for dying patients.