Recent national documents, such as One Chance to Get it Right and Ambitions for Palliative and End of Life Care, have highlighted the importance of high quality end of life care. In particular they have promoted the use of individualised care planning for the dying adult. Ashford and St Peters NHS Trust is a busy district general hospital in Surrey and has over 1000 deaths per year. To ensure that high quality care was delivered to all by all healthcare professionals an individualised care plan was devised. A baseline audit was undertaken before this was rolled out across the trust.Methods
An audit tool was created based on the 5 priorities of care and NICE guidance for care of the dying adult. This was to assess the documentation of care given to the dying adult and their family. A retrospective notes review of the first 100 deaths in quarter 1 was undertaken.Results
Recognition of dying on the wards ranged from 50%–100% and was initially documented by the medical team in 60%. Most patients were recognised as dying in the last 48 hours. Almost 80% of patients were unable to participate in decision making about their care, although family was involved in over 95%. Over 55% were prescribed anticipatory medication and over 20% had evidence of a holistic assessment. Less than 5% of notes reviewed showed evidence of adequate individualised care planning in the last days of life.Conclusion
This audit has highlighted that health professionals were recognising dying. Late recognition leads to patients not being involved in their care planning and achieving their ?priorities of care. Documentation and care is reliant on individual health care professionals approach rather than an informed, standardised practice. Individualised care planning can support healthcare professionals in delivering and evidencing this care.