P-104 Recognising dying in adults: identifying patients in the last 12 months of life

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Recognising dying presents a challenge for healthcare workers, prognostic uncertainty can be a barrier to advanced care planning. NICE quality standard 13 Quality statement 1 states; People approaching the end of life are identified in a timely way. The GMC defines approaching end of life as when a person is likely to die within the next 12 months.


I conducted a retrospective audit of 27 patients who died in hospital over a 2 week period in 2016. Data was collected for 3 separate time intervals; 12 months- 6 months before death, 6 months to 7 days before death and the last 7 days of life.


At 12 months to 6 months before their death, most patients (19/27) met the criteria for Gold standard framework, however no patients had formal advanced care planning documented, 3/27 had DNA-CPR in place. At 6 months to 7 days before death all patients met criteria for GSF, more than could be identified as advanced or unstable disease, 3/27 had ACP documented. Most patients had hospital admissions during this time (23/27), more than one third of patients were referred to the Palliative Care Team. During the last 7 days of life 19/27 patients were recognised as dying, and had their wishes documented, all patients had DNA-CPR in place and 18/27 were referred to the Palliative Care Team.


From this audit there were significant opportunities for healthcare workers to identify patients in the last 12 months of life, if this can be recognised sooner advanced care planning could be offered earlier to patients. These results suggest a need to make use of tools such as the Gold Standard Framework to better recognise patients who may be approaching end of life in order to help plan their preferred care.

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