Communication with patients and their families/carers is key to excellent palliative care and both the GMC and NICE state that families/carers should be routinely offered information about their relative within the confines of confidentiality. An audit was conducted at Hospice in the Weald to review the involvement that families/carers had in key decision making for patients on the ward. It reviewed whether all important clinical decisions made whilst the patient was on the ward had been discussed with families/carersMethods
A retrospective case note audit was carried out for all the patients on the ward during one month (September 2015). Information was drawn from the Electronic Care Record (ECR) and paper notes including DNACPR forms. 6 key clinical decisions were identified as instances when a discussion with families/carers would be appropriate. Discussions had to be clearly documented for it to be considered eligible that discussion had taken place.Results
5/6 (83%) DNACPR decisions made in the Hospice ward were discussed with families/carers, 30/36 (88%) families/carers had discussions about ceilings of treatment, 31/32 (97%) families/carers were involved in discussions regarding medical interventions, 27/27 families/carers (100%) were told that their relative had deteriorated and 23/23 (100%) of families/carers had an opportunity to discuss their relatives’ end of life needs.Conclusions
These results show that the vast majority of important clinical decisions are communicated with the families and carers of the patients involved however there is room for improvement especially around DNACPR and ceilings of treatment discussions. Often these discussions had been had previously with other healthcare professionals and so were not revisited. This highlights a need for robust shared clinical records and the increased use of EPaCCS to ensure full communication between services.