9 The opinions of hospice staff and patients towards routine weighing upon admission to an inpatient hospice setting

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IntroductionThe role of inpatient hospice care is gradually changing from overwhelmingly providing care at the end of life, to focusing more on symptom management which facilitates discharge home. However, some hospice clinical practices have not adapted to reflect that change, as seen by infrequent bodyweight assessment at admission. This leads to an inability to conform to best practice in medication management and nutritional assessment.Aims and methodsTo facilitate altering our clinical guidelines to achieve best clinical standards of care we needed to understand the rationale for the reluctance among hospice staff to weigh patients and understand if those fears are justified by consulting with patients. Two paper-based surveys were designed and completed with staff and patients at our hospice. Outcome measures were descriptive information about staff and patient opinions that were grouped into themes for quantitative analysis.ResultsResults among patients mirrored previous research and showed that the majority of patients 37/38 (97.3%) surveyed did not find being weighed distressing, and in fact, 36/38 (94.7%) would prefer to know their bodyweight if measured. We found that staff members, however, were broadly opposed to routine weighing on admission (50.63%).ConclusionRationale for opposition included fear of causing upset and a belief that it is inappropriate for the holistic environment of the hospice. Weight loss can be distressing and preventing unnecessary procedures is important. However, to ensure optimal clinical care we have recommended that weighing patients should be the default position unless reasons for exclusion exist.References. Watson M, Coulter S, McLoughlin C, Kelt S, Wilkinson P, McPherson A, Wilson, R, Eatock M. Attitudes towards weight and weight assessment in oncology patients: survey of hospice staff and patients with advanced cancer. Palliative Medicine2010;24(6):623–629.. National institute for health and clinical excellence (NICE). Nutrition support in adults 2006, [CG32]. London: NICE.. Charani E, Gharbi M, Hickson M, Othman S, Alfituri A, Frost G, Holmes A. Lack of weight recording in patients being administered narrow therapeutic index antibiotics: a prospective cross-sectional study. BMJ Open2015;5(4);e006092–e006092.. Khan A, Flavin K, Tsang J. Weight a minute - iatrogenic paracetamol toxicity is preventable by utilisation of well-designed drug charts. BMJ Quality Improvement Reports2014;3(1):u203956.w1721.

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