Background Around half of all deaths in England occur in hospitals, even though many like to die in their own place of care. It is recognised that Health care professionals are required to respect patients wish to achieve preferred place of death. We aimed to document the baseline quality of discharge documentation of those patients discharged ‘home to die’ for end of Life Care.
Objectives To check relevant pathways used effectively and patients who were discharged home for end of life care given appropriate medications, healthcare professionals are communicated to coordinate the support the patient/carer likely to need.
Methodology Retrospective case notes review of 30 patients who were discharged home for end of Life Care at Home. Patients were identified using referrals to Crisis Support Team (Hospice). The following items were checked: Home to Die check list, discharge decision (from medical notes entry), GP/District nurse informed, palliative care form completion, crisis medications prescribed, documentation of patient discharged home to die (for end of life care) in EDN, DNACPR for completed and communicated to GP, DNACPR sent with the patient.
Results 27/30 had poor completion of Home to Die check list.29/30 had poor completion of palliative care handover form.18/30 discharged within 48 h of decision to discharge.9/30 patients had GP informed, 20/30 had District Nurses informed.14/30 had evidence of medications review,29/30 had crisis medications prescribed. Only 5/30 patients had clear documentation of ‘Discharged Home to Die’ in their discharge letter,23/30 had DNACPR form completed and communicated to relevant professionals.10/30 patients had their DNACPR forms inappropriately left in their notes.
Conclusion We found overall need for improvement in documentation and communication to community health care professionals (GPs, District nurses and Palliative care team). We plan to update the discharge the check list, EDN and educate the teams to improve the situation.
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