Background Although majority of patients in UK want to die at home, about 50% die in Hospital. Many Hospices and clinical commissioners consider achievement of preferred place of death as a quality marker for the palliative care service. Studies show formal recording of preferred place of death, improves the chance of achieving it.
Aim This audit was planned to check the documentation levels of aspects of preferred place of care, preferred place of death, Resuscitation. We also included the documentation of carer’s preferences as well.
Methods At our Hospices, electronic case note system (infoflex) is used to record preferred place of care (PPoC), Resuscitation status (DNAR) and preferred place of death (PPoD). We checked the above aspects on 15 inpatients (IPU) and 15 Home care team patients (HCT) and 15 day therapy patients (DTU). Those patients seen at least 3 times by the professionals only included as some occasions might not be appropriate to discuss these on the first review.
Results The majority of patients from DTU and HCT had their first preference for place of care recorded on the system (14/15 of HCT, 12/15 DTU). Only 10/15 IPU patients had this recorded. Hardly any patients had their second choice of place of care recorded on the system. (2/45). The majority of HCT and DTU patients had their first choice place of death recorded on Infoflex (13/15 and 11/15), however only 60% of IPU patients did (9/15) making 33/45 in total. Only around 7 out of 45 patients had their second preference place of death recorded. Preferred place of death was achieved by 60% of IPU patients, 80% of HCT patients and 70% of DTU patients who had died according to the information. DNAR status was completed in 42/45. ACP discussion was not recorded in the majority of patients seen by IPU and HCT.
Conclusion The audit showed areas of good practice and also some need for improving of recording of these important indices. This was presented to the teams and further audits planned.
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